Leon Schmidt, Dragan Jankovic, Santhosh Thavarajasingam, Reem Fakak, Michael Kosterhon, Alice Dauth, Marc Brockmann, Clemens Sommer, Florian Ringel, Darius Kalasauskas
Radiation-induced meningioma status was associated with shorter progression-free survival following propensity score matching and multivariable adjustment. Complete resection was associated with improved PFS, supporting maximal safe resection when clinically feasible. However, residual measured and unmeasured confounding cannot be excluded, and the present findings should not be interpreted as evidence of intrinsically more aggressive tumor biology.
BACKGROUND: Intracranial meningiomas may be induced after radiation exposure, for example following radiotherapy for CNS malignancies. However, data on their clinical characteristics and risk factors for recurrence remain limited. This study aimed to evaluate clinical features and independent predictors of progression-free survival in radiation-induced meningiomas compared to sporadic tumors.
METHODS: All cases of radiation-induced (RI) intracranial meningiomas that underwent tumor resection at our institution between 2007 and 2023 were identified. Patients were matched to non-radiation-induced controls by propensity score using age, WHO grade, and Simpson grade as covariates (1:5 ratio). Demographics, tumor characteristics, and outcomes were compared. Survival was analyzed using Kaplan-Meier curves and Cox regression.
RESULTS: A total of 39 RI meningioma cases were matched to 195 non-exposed controls. After matching, there were no significant differences in age, WHO grade, or Simpson grade between groups, confirming adequate baseline balance. Prior cranial surgery was more frequent in the RI group (38.5% vs. 4.1%; p < 0.001), and adjuvant radiotherapy was more commonly administered (33.3% vs. 11.3%; p < 0.001). Relapse rate was significantly higher in RI tumors (28% vs. 17%; p = 0.001). In multivariate Cox regression, RI tumor status (HR 2.1; 95% CI 1.02-434; p = 0.04) and complete resection (HR 0.29; 95% CI 0.15-0.54; p < 0.001) were independent predictors of progression-free survival.
CONCLUSION: Radiation-induced meningioma status was associated with shorter progression-free survival following propensity score matching and multivariable adjustment. Complete resection was associated with improved PFS, supporting maximal safe resection when clinically feasible. However, residual measured and unmeasured confounding cannot be excluded, and the present findings should not be interpreted as evidence of intrinsically more aggressive tumor biology.