Patient Selection for Adjuvant Radiotherapy in WHO Grade 2 Intracranial Meningiomas
Bibliographic record
Abstract
Introduction: Meningiomas are the most common intracranial tumor, of which 5 to 20% are classified as WHO grade 2. Compared with lower grade meningiomas, these tumors recur more frequently and have worse overall survival. There is conflicting evidence whether adjuvant radiotherapy improves overall survival and local recurrence following surgical resection of grade 2 meningiomas. In this study, our objective was to explore patient-level factors in patients receiving surgery with adjuvant radiotherapy compared with surgery alone for grade 2 meningiomas at a tertiary care university hospital. Methods: We performed a retrospective study of all patients diagnosed with a WHO Grade 2 intracranial meningioma at our institution between July 2007 and 2020. All patients underwent initial operative resection and, at the discretion of the treating neurosurgeon and local cancer agency, select patients underwent adjuvant radiotherapy. Between group differences in demographics, clinical presentation, extent of resection, and tumor location were explored. Results: A total of 191 patients were included in the study, of which 19 (9.9%) received adjuvant radiotherapy after surgical resection. Mean age was 57.5 ± 14.8 years, 123 patients (64.4%) were female, and mean Karnofsky Performance Scale (KPS) on presentation was 71 ± 18. There were no differences in age, sex, or KPS between groups. Tumor location significantly varied between groups, p = 0.02. Patients receiving adjuvant radiotherapy had a higher proportion of tumors located on the sphenoid ridge (47.4 vs. 12.8%), and a lower proportion located at convexity (15.8 vs. 35.5%) and falcine/parasagittal (15.8 vs. 26.7%) locations. Subtotal resection (Simpson grade 4–5) was associated with a significantly higher likelihood of receiving adjuvant radiotherapy (OR: 6.2 [95% CIs: 2.3, 16.8], p < 0.001). There were no differences in overall survival ( p = 0.905) or progression-free survival ( p = 0.983) between groups. Conclusion: At a tertiary care academic hospital, factors increasing the likelihood of undergoing adjuvant radiotherapy following surgical resection of a WHO grade 2 intracranial meningioma include subtotal resection, and deeper, more challenging to access tumor locations. To determine if adjuvant radiotherapy confers a survival or local recurrence advantage in grade 2 meningiomas, future prospective trials must control for these potentially confounding factors. Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".