Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients

Christian Mirian; Lasse Rehné Jensen; Adam Gorm Hoffmann; Tareq A. Juratli; Andrea Daniela Maier; Pernilla Lindner; Anders Broechner; Sverre H. Torp; Helen A. Shih; Ramin A. Morshed; Jacob S. Young; Stephen T. Magill; Walter Stummer; Dorothee Cäcilia Spille; Benjamin Brokinkel; Martin Proescholdt; Yasuhiro Kuroi; Konstantinos Gousias; Matthias Simon; Ricardo Prat-Acin; Stéphane Goutagny; Johannes Wach; Erdem Güresir; Junkoh Yamamoto; Young Zoon Kim; Joo Ho Lee; Daniel W. Kim; Matthew Koshy; Donald M. Cannon; Dennis C. Shrieve; Chang Ok Suh; Jong Hee Chang; Maria Kamenova; Sven Straumann; Jehuda Soleman; Ilker Y. Eyüpoglu; Tony Catalan; Austin Lui; Philip V. Theodosopoulos; Michael W. McDermott; Pedro Góes; Fang Wang; Luis Souhami; Marie Christine Guiot; Tamás Csonka; Toshiki Endo; Tejpal Gupta; Akash J. Patel; Tiemo J. Klisch; Jun Won Kim; Francesco Maiuri; Valeria Barresi; María Dolores Tabernero; Simon Skyrman; Mechthild Krause; Ian Law; Bjarne Winther Kristensen; Tina Nørgaard Munch; Torstein Meling; Kåre Fugleholm; Paul Blanche; Tiit Mathiesen

doi:10.1007/s11060-025-05349-7

Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients

Christian Mirian^*, Lasse Rehné Jensen, Adam Gorm Hoffmann, Tareq A. Juratli, Andrea Daniela Maier, Pernilla Lindner, Anders Broechner, Sverre H. Torp, Helen A. Shih, Ramin A. Morshed, Jacob S. Young, Stephen T. Magill, Walter Stummer, Dorothee Cäcilia Spille, Benjamin Brokinkel, Martin Proescholdt, Yasuhiro Kuroi, Konstantinos Gousias, Matthias Simon, Ricardo Prat-AcinStéphane Goutagny, Johannes Wach, Erdem Güresir, Junkoh Yamamoto, Young Zoon Kim, Joo Ho Lee, Daniel W. Kim, Matthew Koshy, Donald M. Cannon, Dennis C. Shrieve, Chang Ok Suh, Jong Hee Chang, Maria Kamenova, Sven Straumann, Jehuda Soleman, Ilker Y. Eyüpoglu, Tony Catalan, Austin Lui, Philip V. Theodosopoulos, Michael W. McDermott, Pedro Góes, Fang Wang, Luis Souhami, Marie Christine Guiot, Tamás Csonka, Toshiki Endo, Tejpal Gupta, Akash J. Patel, Tiemo J. Klisch, Jun Won Kim, Francesco Maiuri, Valeria Barresi, María Dolores Tabernero, Simon Skyrman, Mechthild Krause, Ian Law, Bjarne Winther Kristensen, Tina Nørgaard Munch, Torstein Meling, Kåre Fugleholm, Paul Blanche, Tiit Mathiesen

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

Purpose
The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR).

Methods
We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), and year of treatment initiation. The robustness of findings was examined through sensitivity analyses.

Results
Overall, 276 of 1452 patients (19.0%) received aFRT. Among GTR patients, unadjusted analysis showed comparable recurrence proportions between irradiated and non-irradiated patients (25.5% vs. 22.8% within 5 years). Adjusted analyses provided no evidence that aFRT reduced the risk of recurrence (largest difference: −2.7%, 95% CI −5.6 to 0.2); although, the CIs include the possibility of small beneficial effects. In STR patients, aFRT was associated with reduced recurrence risk in both unadjusted and adjusted analyses. Unexpectedly, a higher mortality was observed among irradiated GTR patients, largely driven by older patients with low Ki-67 PI receiving aFRT. Sensitivity analyses showed similar results for patients with STR but discrepancy in estimates for those with GTR.

Conclusion
Adjuvant FRT showed a consistent reduction in recurrence risk after STR while inconsistent recurrence risk estimates were observed for patients with GTR. The findings reflect efficacy of aFRT using real-world data without standardized guidelines.

Originalsprog	Engelsk
Artikelnummer	201
Tidsskrift	Journal of Neuro-Oncology
Vol/bind	176
Udgave nummer	3
Antal sider	13
ISSN	0167-594X
DOI	https://doi.org/10.1007/s11060-025-05349-7
Status	Udgivet - 2026

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Publisher Copyright:
© The Author(s) 2026.

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Citationsformater

Mirian, C., Jensen, L. R., Hoffmann, A. G., Juratli, T. A., Maier, A. D., Lindner, P., Broechner, A., Torp, S. H., Shih, H. A., Morshed, R. A., Young, J. S., Magill, S. T., Stummer, W., Spille, D. C., Brokinkel, B., Proescholdt, M., Kuroi, Y., Gousias, K., Simon, M., ... Mathiesen, T. (2026). Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients. Journal of Neuro-Oncology, 176(3), Artikel 201. https://doi.org/10.1007/s11060-025-05349-7

Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients. / Mirian, Christian; Jensen, Lasse Rehné; Hoffmann, Adam Gorm et al.
I: Journal of Neuro-Oncology, Bind 176, Nr. 3, 201, 2026.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Mirian, C, Jensen, LR, Hoffmann, AG, Juratli, TA, Maier, AD, Lindner, P, Broechner, A, Torp, SH, Shih, HA, Morshed, RA, Young, JS, Magill, ST, Stummer, W, Spille, DC, Brokinkel, B, Proescholdt, M, Kuroi, Y, Gousias, K, Simon, M, Prat-Acin, R, Goutagny, S, Wach, J, Güresir, E, Yamamoto, J, Kim, YZ, Lee, JH, Kim, DW, Koshy, M, Cannon, DM, Shrieve, DC, Suh, CO, Chang, JH, Kamenova, M, Straumann, S, Soleman, J, Eyüpoglu, IY, Catalan, T, Lui, A, Theodosopoulos, PV, McDermott, MW, Góes, P, Wang, F, Souhami, L, Guiot, MC, Csonka, T, Endo, T, Gupta, T, Patel, AJ, Klisch, TJ, Kim, JW, Maiuri, F, Barresi, V, Tabernero, MD, Skyrman, S, Krause, M, Law, I , Kristensen, BW , Munch, TN, Meling, T, Fugleholm, K , Blanche, P & Mathiesen, T 2026, 'Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients', Journal of Neuro-Oncology, bind 176, nr. 3, 201. https://doi.org/10.1007/s11060-025-05349-7

@article{9aad13c31e904293a1062762c426ae0d,

title = "Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection: a multicenter, retrospective cohort study of 1,452 patients",

abstract = "Purpose: The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR). Methods: We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), and year of treatment initiation. The robustness of findings was examined through sensitivity analyses. Results: Overall, 276 of 1452 patients (19.0%) received aFRT. Among GTR patients, unadjusted analysis showed comparable recurrence proportions between irradiated and non-irradiated patients (25.5% vs. 22.8% within 5 years). Adjusted analyses provided no evidence that aFRT reduced the risk of recurrence (largest difference: −2.7%, 95% CI −5.6 to 0.2); although, the CIs include the possibility of small beneficial effects. In STR patients, aFRT was associated with reduced recurrence risk in both unadjusted and adjusted analyses. Unexpectedly, a higher mortality was observed among irradiated GTR patients, largely driven by older patients with low Ki-67 PI receiving aFRT. Sensitivity analyses showed similar results for patients with STR but discrepancy in estimates for those with GTR. Conclusion: Adjuvant FRT showed a consistent reduction in recurrence risk after STR while inconsistent recurrence risk estimates were observed for patients with GTR. The findings reflect efficacy of aFRT using real-world data without standardized guidelines.",

keywords = "Atypical meningioma, Meningioma, Progression, Radiotherapy, Recurrence, Resection",

author = "Christian Mirian and Jensen, {Lasse Rehn{\'e}} and Hoffmann, {Adam Gorm} and Juratli, {Tareq A.} and Maier, {Andrea Daniela} and Pernilla Lindner and Anders Broechner and Torp, {Sverre H.} and Shih, {Helen A.} and Morshed, {Ramin A.} and Young, {Jacob S.} and Magill, {Stephen T.} and Walter Stummer and Spille, {Dorothee C{\"a}cilia} and Benjamin Brokinkel and Martin Proescholdt and Yasuhiro Kuroi and Konstantinos Gousias and Matthias Simon and Ricardo Prat-Acin and St{\'e}phane Goutagny and Johannes Wach and Erdem G{\"u}resir and Junkoh Yamamoto and Kim, {Young Zoon} and Lee, {Joo Ho} and Kim, {Daniel W.} and Matthew Koshy and Cannon, {Donald M.} and Shrieve, {Dennis C.} and Suh, {Chang Ok} and Chang, {Jong Hee} and Maria Kamenova and Sven Straumann and Jehuda Soleman and Ey{\"u}poglu, {Ilker Y.} and Tony Catalan and Austin Lui and Theodosopoulos, {Philip V.} and McDermott, {Michael W.} and Pedro G{\'o}es and Fang Wang and Luis Souhami and Guiot, {Marie Christine} and Tam{\'a}s Csonka and Toshiki Endo and Tejpal Gupta and Patel, {Akash J.} and Klisch, {Tiemo J.} and Kim, {Jun Won} and Francesco Maiuri and Valeria Barresi and Tabernero, {Mar{\'i}a Dolores} and Simon Skyrman and Mechthild Krause and Ian Law and Kristensen, {Bjarne Winther} and Munch, {Tina N{\o}rgaard} and Torstein Meling and K{\aa}re Fugleholm and Paul Blanche and Tiit Mathiesen",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

year = "2026",

doi = "10.1007/s11060-025-05349-7",

language = "English",

volume = "176",

journal = "Journal of Neuro-Oncology",

issn = "0167-594X",

publisher = "Springer",

number = "3",

}

TY - JOUR

T1 - Fractionated radiotherapy adjuvant to surgery of WHO-2 meningioma with and without gross total resection

T2 - a multicenter, retrospective cohort study of 1,452 patients

AU - Mirian, Christian

AU - Jensen, Lasse Rehné

AU - Hoffmann, Adam Gorm

AU - Juratli, Tareq A.

AU - Maier, Andrea Daniela

AU - Lindner, Pernilla

AU - Broechner, Anders

AU - Torp, Sverre H.

AU - Shih, Helen A.

AU - Morshed, Ramin A.

AU - Young, Jacob S.

AU - Magill, Stephen T.

AU - Stummer, Walter

AU - Spille, Dorothee Cäcilia

AU - Brokinkel, Benjamin

AU - Proescholdt, Martin

AU - Kuroi, Yasuhiro

AU - Gousias, Konstantinos

AU - Simon, Matthias

AU - Prat-Acin, Ricardo

AU - Goutagny, Stéphane

AU - Wach, Johannes

AU - Güresir, Erdem

AU - Yamamoto, Junkoh

AU - Kim, Young Zoon

AU - Lee, Joo Ho

AU - Kim, Daniel W.

AU - Koshy, Matthew

AU - Cannon, Donald M.

AU - Shrieve, Dennis C.

AU - Suh, Chang Ok

AU - Chang, Jong Hee

AU - Kamenova, Maria

AU - Straumann, Sven

AU - Soleman, Jehuda

AU - Eyüpoglu, Ilker Y.

AU - Catalan, Tony

AU - Lui, Austin

AU - Theodosopoulos, Philip V.

AU - McDermott, Michael W.

AU - Góes, Pedro

AU - Wang, Fang

AU - Souhami, Luis

AU - Guiot, Marie Christine

AU - Csonka, Tamás

AU - Endo, Toshiki

AU - Gupta, Tejpal

AU - Patel, Akash J.

AU - Klisch, Tiemo J.

AU - Kim, Jun Won

AU - Maiuri, Francesco

AU - Barresi, Valeria

AU - Tabernero, María Dolores

AU - Skyrman, Simon

AU - Krause, Mechthild

AU - Law, Ian

AU - Kristensen, Bjarne Winther

AU - Munch, Tina Nørgaard

AU - Meling, Torstein

AU - Fugleholm, Kåre

AU - Blanche, Paul

AU - Mathiesen, Tiit

PY - 2026

Y1 - 2026

N2 - Purpose: The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR). Methods: We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), and year of treatment initiation. The robustness of findings was examined through sensitivity analyses. Results: Overall, 276 of 1452 patients (19.0%) received aFRT. Among GTR patients, unadjusted analysis showed comparable recurrence proportions between irradiated and non-irradiated patients (25.5% vs. 22.8% within 5 years). Adjusted analyses provided no evidence that aFRT reduced the risk of recurrence (largest difference: −2.7%, 95% CI −5.6 to 0.2); although, the CIs include the possibility of small beneficial effects. In STR patients, aFRT was associated with reduced recurrence risk in both unadjusted and adjusted analyses. Unexpectedly, a higher mortality was observed among irradiated GTR patients, largely driven by older patients with low Ki-67 PI receiving aFRT. Sensitivity analyses showed similar results for patients with STR but discrepancy in estimates for those with GTR. Conclusion: Adjuvant FRT showed a consistent reduction in recurrence risk after STR while inconsistent recurrence risk estimates were observed for patients with GTR. The findings reflect efficacy of aFRT using real-world data without standardized guidelines.

AB - Purpose: The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR). Methods: We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), and year of treatment initiation. The robustness of findings was examined through sensitivity analyses. Results: Overall, 276 of 1452 patients (19.0%) received aFRT. Among GTR patients, unadjusted analysis showed comparable recurrence proportions between irradiated and non-irradiated patients (25.5% vs. 22.8% within 5 years). Adjusted analyses provided no evidence that aFRT reduced the risk of recurrence (largest difference: −2.7%, 95% CI −5.6 to 0.2); although, the CIs include the possibility of small beneficial effects. In STR patients, aFRT was associated with reduced recurrence risk in both unadjusted and adjusted analyses. Unexpectedly, a higher mortality was observed among irradiated GTR patients, largely driven by older patients with low Ki-67 PI receiving aFRT. Sensitivity analyses showed similar results for patients with STR but discrepancy in estimates for those with GTR. Conclusion: Adjuvant FRT showed a consistent reduction in recurrence risk after STR while inconsistent recurrence risk estimates were observed for patients with GTR. The findings reflect efficacy of aFRT using real-world data without standardized guidelines.

KW - Atypical meningioma

KW - Meningioma

KW - Progression

KW - Radiotherapy

KW - Recurrence

KW - Resection

U2 - 10.1007/s11060-025-05349-7

DO - 10.1007/s11060-025-05349-7

M3 - Journal article

C2 - 41661453

AN - SCOPUS:105029682269

SN - 0167-594X

VL - 176

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

IS - 3

M1 - 201

ER -