Adjuvant radiotherapy after surgery reduces recurrence in atypical meningioma
- In a phase 3 trial, adjuvant radiotherapy after complete surgical resection of WHO grade 2 atypical meningioma improved 5-year disease-free survival to 79.9% compared with 64.3% for observation.
- The hazard ratio for recurrence or death was 0.51 (95% CI 0.27-0.97; p=0.0396).
- Between April 28, 2016, and May 21, 2021, 157 patients were randomly assigned to radiotherapy (n=78) or observation (n=79).
- At a median follow-up of 64 months, meningioma recurrence occurred in 11 (14%) of 78 participants in the radiotherapy group and 24 (30%) of 79 in the observation group.
The publication
In a phase 3 trial, adjuvant radiotherapy after complete surgical resection of WHO grade 2 atypical meningioma improved 5-year disease-free survival to 79.9% compared with 64.3% for observation. The hazard ratio for recurrence or death was 0.51 (95% CI 0.27-0.97; p=0.0396).
Who the findings apply to
Patients were aged 16 years or older with newly diagnosed atypical meningioma who had undergone a surgeon-assessed complete surgical resection.
The trial was conducted at 58 hospitals and academic centres in 11 countries with appropriate multidisciplinary expertise, neurosurgery, and radiotherapy facilities.
Why this matters
WHO grade 2 atypical meningioma carries a high risk of recurrence even after complete surgical resection, and the role of adjuvant radiotherapy has remained uncertain. The trial results suggest that radiotherapy reduces meningioma recurrence, supporting its consideration when preventing recurrence is valued higher than the potential delayed adverse effects of radiotherapy.
What the study found
Between April 28, 2016, and May 21, 2021, 157 patients were randomly assigned to radiotherapy (n=78) or observation (n=79).
At a median follow-up of 64 months, meningioma recurrence occurred in 11 (14%) of 78 participants in the radiotherapy group and 24 (30%) of 79 in the observation group.
5-year disease-free survival was 79.9% (95% CI 67.6-87.9) in the radiotherapy group and 64.3% (51.9-74.2) in the observation group, with an absolute difference of 15.6 percentage points (95% CI 0.6-30.5).
Disease-free survival was improved in the radiotherapy group compared with the observation group (hazard ratio 0.51 [95% CI 0.27-0.97]; p=0.0396).
Participants assigned to the radiotherapy group received fractionated external-beam intensity-modulated radiotherapy at a total dose of 60 Gy in 30 fractions over 6 weeks.
What the result does not establish
Grade 2 or 3 radiation-related serious adverse events occurred in five (8%) of 66 participants in the radiotherapy group, with no treatment-related deaths.
The authors note that decisions should be based on individual discussion with the patient, weighing the prevention of recurrence against the potential delayed adverse effects of radiotherapy.
Authors’ conclusion
“Our findings suggest that adjuvant radiotherapy should be considered in patients with atypical meningioma after complete surgical resection of atypical meningioma when the prevention of recurrence is valued higher than the potential delayed adverse effects of radiotherapy. This practice will benefit patients by reducing meningioma recurrence. Decisions should be based on individual discussion with the patient.”
Study and sources
Radiotherapy versus observation following surgical resection of WHO grade 2 atypical meningioma (ROAM/EORTC-1308): an international, multicentre, open-label, phase 3, randomised controlled trial
Randomised trial · Phase 3 · Lancet · 2026-09-25
Sources and limitations
- PubMed record PMID 42790456 (PubMed / NLM · 2026-09-27)
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