Vol.:(0123456789) 1 3 Journal of Neuro-Oncology https://doi.org/10.1007/s11060-020-03604-7 CLINICAL STUDY Adjuvant radiation for WHO grade II and III intracranial meningiomas: insights on survival and practice patterns from a National Cancer Registry Desmond A. Brown 1  · Anshit Goyal 1,2  · Panagiotis Kerezoudis 1  · Mohammed Ali Alvi 1,2  · Benjamin T. Himes 1  · Mohamad Bydon 1,2  · Jamie J. Van Gompel 1  · Kaisorn L. Chaichana 3  · Alfredo Quiñones‑Hinojosa 3  · Terry C. Burns 1  · Elizabeth Yan 4  · Ian F. Parney 1 Received: 25 May 2020 / Accepted: 23 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Introduction WHO grades II (atypical) and III (malignant) meningiomas are associated with signifcant morbidity and mor- tality. The role of adjuvant radiotherapy (RT) in management remains controversial. The goal of this study was to evaluate the impact of adjuvant RT on 5-year survival in patients with atypical and malignant meningiomas. We secondarily aimed to assess contemporary practice patterns and the impact of sociodemographic factors on outcome. Methods We queried the National Cancer Database for patients ≥ 18 years of age with cranial atypical or malignant men- ingiomas from 2010 through 2015 who underwent surgical resection with or without adjuvant radiotherapy. Subjects with unknown WHO grade or radiation status and those not receiving any surgical procedure were excluded from analysis. Results The study includes 7486 patients, 6788 with atypical and 698 with malignant meningiomas. Overall 5-year survival was 76.9% (95% CI 75.5–78.3%) and 43.3% (95% CI 38.8–48.2%) among patients with WHO grades II and III meningiomas, respectively. Adjuvant RT correlated with improved survival in a multivariable model in patients with grade II tumors (HR 0.78; p = 0.029) regardless of the extent of resection. Age (HR 2.33; p < 0.001), male sex (HR 1.27; p < 0.001), Black race (HR 1.27; p = 0.011) and Charlson-Deyo Score ≥ 2 (1.35; p = 0.001) correlated with poorer survival whereas private insurance (HR 0.71; p < 0.001) correlated with improved survival. Adjuvant RT was also associated with improved 5-year survival among those with grade III tumors on univariate analysis (log-rank p = 0.006) but was underpowered for multivariable modeling. Utilization of adjuvant radiotherapy was only 28.4% and correlated with private insurance status. Academic institutions (25.3%) and comprehensive community cancer programs (21.4%) had lower radiotherapy utilization rates compared with integrated network cancer programs (30.5%) and community cancer programs (29.7%). Conclusions Adjuvant RT may correlate with improved overall survival in patients with grades II and III intracranial men- ingiomas regardless of the extent of resection. There is poor utilization of adjuvant RT for patients with grades II and III meningiomas likely due to a paucity of quality data on the subject. These fndings will be strengthened with prospective data evaluating the role of adjuvant RT. Keywords Atypical meningioma · Malignant meningioma · Adjuvant radiation · Extent of resection · National Cancer Database Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11060-020-03604-7) contains supplementary material, which is available to authorized users. * Anshit Goyal goyal.anshit@mayo.edu * Ian F. Parney parney.ian@mayo.edu 1 Department of Neurological Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA 2 Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA 3 Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA 4 Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA