Rate and predictors of surgical resection following radiotherapy for meningiomas: A Surveillance, Epidemiology, and End Results (SEER) database analysis

Purpose Surgical resection for meningiomas, while curative, can be associated with potential morbidity. Radiotherapy (RT) provides comparable control in certain circumstances, however failure is often defined as radiologic progression. We evaluated salvage surgery following definitive radiotherapy for meningiomas as a primary measure of treatment failure. Methods A retrospective analysis was performed using the SEER database for all meninigioma patients treated with definitive radiation from 2000 to 2022. RT failure was defined as need for subsequent surgical resection. Demographic variables were collected and compared between groups using univariate and multivariate analyses. Survival data was collected and evaluated via Kaplan-Meyer curve. Results There were 6,776 patients included in the final analysis with 121 (1.78%) requiring microsurgical resection after RT. On univariate analysis, tumors > 30 mm and non-benign tumor behavior were associated with failure (p < 0.001). On multivariate analysis, tumor size (OR 2.359, 95% CI 1.563–3.561, p < 0.001) and non-benign behavior (OR 5.831, 95% CI 2.788–12.196, p < 0.001) remained predictors of treatment failure. The time from diagnosis to initial treatment was shorter for patients who later required surgical resection (99.75 vs 63.45 days, p < 0.001). There were no differences in survival between groups. Conclusion RT is an effective treatment for meningiomas, with only 1.78% of patients requiring salvage treatment. Factors associated with RT failure include larger tumor size and non-benign tumor behavior. Future prospective studies are needed to fully assess utilizing salvage surgery, as opposed to radiologic progression, as a primary measure of failure following RT.