A management dilemma: adjuvant radiotherapy after gross total resection of atypical meningioma

Weber et al. recently published initial results of a prospective phase II trial of patients with grade II and III meningiomas treated with adjuvant radiotherapy (RT) after subtotal or gross total resection (GTR) (1). This initial publication of EORTC 22042 reports outcomes of the 56 enrolled patients with grade II meningiomas who underwent GTR followed by adjuvant RT, and shows favorable 3-year progression free survival (PFS) with moderate toxicity. Together with RTOG 0539 intermediate risk cohort (2), these two trials provide the only prospective data on outcomes of adjuvant RT for atypical meningiomas. Despite meeting the primary endpoints for both of the aforementioned trials, adjuvant RT remains controversial in the management of gross totally resected grade II meningiomas.