The 5-factor Modified Frailty Index as a Prognostic Factor for Stereotactic Radiosurgery in Meningioma Management

Purpose Meningiomas are the most frequent primary intracranial malignancy. While surgical resection can confer long term tumor control, stereotactic radiosurgery (SRS) is often used for small, asymptomatic tumors in the adjuvant setting. Frailty has been associated with increased rates of peri-operative morbidity but has yet to be defined in the setting of SRS for meningiomas. We therefore sought to examine the relationship between frailty and clinical/radiographic outcomes of patients with meningiomas who have undergone SRS. Methods A single-center, retrospective cohort study classified patients by their 5-factor modified frailty index (mFI-5) score into pre-frail (0–1) and frail (2–5) at the time of SRS treatment. Evaluations of overall survival (OS) and progression free survival (PFS) were performed using Kaplan-Meier analysis. Cox proportional hazards regression analysis was used to further define factors associated with OS/PFS. Results 94 patients met inclusion criteria and underwent SRS for meningioma treatment from 2019–2023. Analyses compared prefrail (0–1) and frail (2–5) individuals. Kaplan-Meier analysis demonstrated an association between frailty and OS (24-month survival: 73.8%) in the frail group versus the pre-frail group (24-month survival: 90.6%, p = 0.053 HR = 3.68). There was a significant relationship between frailty and PFS (12-month PFS: 68.8%) in the frail group versus the pre-frail group (12-month PFS: 92.9%, p < 0.05 HR = 2.95). Univariable regression analysis demonstrated that frailty, prior surgical excision, and cumulative tumor volume predicted PFS. Conclusion Frailty, as assessed by the mFI-5, did not independently predict OS but did predict PFS in individuals with meningioma undergoing SRS.