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Atypical and Malignant Meningiomas: Patterns of Care in Use of Adjuvant Radiation
E74
International Journal of Radiation Oncology Biology Physics
2173
did and did not receive RT. Kaplan-Meier analysis was used to compare overall survival between these two groups and compared via the log-rank test. Univariable and multivariable logistic regression was used to assess for predictors of RT use. Univariable and multivariable Cox regression analysis were used to identify potential prognostic factors for survival. Results: A total of 3,271 patients were included, with a median follow-up of 30.3 months. There were 2,985 (91.3%) with Grade II disease of which 741 (24.8%) received RT to a median dose of 5400cGy. There were 286 (8.7%) with Grade III disease, of which 170 (59.4%) received RT to a median dose of 6,000cGy. On multivariable logistic regression, the strongest predictor for the receipt of RT was grade 3 disease (OR 4.30, 95% CI 3.28-5.64, p<0.001), followed by increasing tumor size (OR 1.44-1.55), while the presence of a gross total resection (OR 0.69, 95% CI 0.58-0.81, p<0.001) and increasing Charlson/Deyo score (OR 0.61-0.70) were associated with decreased likelihood of RT. There were no significant survival differences based on RT. The 3year overall survival was 89.1% for surgery alone compared to 88.4% for RT (pZ0.86). On multivariable Cox regression, female gender (HR 0.60, 95% CI 0.47-0.75, p<0.001) and treatment at an academic center (HR 0.74, 95% CI 0.59-0.93, pZ0.01) were associated with improved survival. Receipt of RT (HR 0.94, 95% CI 0.73-1.22, pZ0.64) was not associated with an improvement in overall survival. Conclusion: Most patients (>70%) in this large hospital-based study of patients with Grade II or III meningioma did not receive RT. There was no survival benefit noted for those who did receive RT. Author Disclosure: E.L. Garay: None. A.J. Lederman: None. V. Osborn: None. D. Schwartz: None. D. Schreiber: Independent Contractor; Brooklyn VA Medical Center.
Utilization Patterns for Stereotactic Radiosurgery in the Management of Meningioma: A National Cancer Database Report C. Gamboa and O. Algan; University of Oklahoma Health Sciences Center, Oklahoma City, OK Purpose/Objective(s): The purpose of our study was to evaluate the utilization of stereotactic radiosurgery (SRS) by race in the management of benign and malignant meningioma. Materials/Methods: The NCDB is a joint project of the American Cancer Society and the Commission on Cancer of the American College of Surgeons, and is a nationwide, comprehensive clinical surveillance resource oncology data set that captures 70% of all newly-diagnosed malignancies in the United States annually. Data for patients meeting the ICD-O-3 criteria for meningioma and undergoing radiation therapy were extracted from the Participant Use File (PUF) 2013 data file encompassing the years 2004 to 2013. Trends of use by race and independent factors related to SRS use were studied. Race categories included White (Wh), Black (Bl), American Indian (AI), Asian (As), and Hawaiian/Polynesian (HP). Statistical analyses were performed on IBM SPSS Statistics version 23.0. Association between SRS use and independent factors was assessed using a general linear model for univariate analysis (UVA), and a linear regression model for multivariate analysis (MVA). Results: A total of 179,498 patients diagnosed with meningioma were identified in the PUF 2013 file. Of these, 17,353 patients underwent RT (56.2% SRS and 43.8% non-SRS). Demographics for this group of patients were: Median age 60, female 70.6%, Wh 83.1%, Bl 13.1%, AI 0.3%, As 3.3%, and HP 0.2%. For patients undergoing SRS, 25.6% of patients were over 70, 95.1% had benign tumors, 70% had tumors <4cm, 80% of patients underwent SRS as monotherapy, and 19.8% of patients underwent combined modality therapy. For the entire population, SRS use increased from 58.8% in 2004 to 62.2% in 2005, and then steadily decreased (48.3% in 2013; p< 0.001). When evaluated by race, Wh patients tended to have the highest rate of SRS use (59.6% in 2004, 64.5% peak in 2005, and 48.2% in 2013), and Bl patients had the lowest rate (53.9% in 2004, 57.7% peak in 2007, and 48.5% in 2013). As patients tended to have the second highest SRS utilization, and detailed analyses for AI and HP patients were limited secondary to small patient numbers. Of the 17 variables evaluated, 10 variables were significant on both UVA and MVA: Year of diagnosis, patient age, insurance status, histology, behavior, tumor size, grade, margin status, facility type and location, and Crowfly distance. Conclusion: SRS utilization in the treatment of meningioma peaked in 2005, and has slowly decreased. Numerous factors were associated with SRS use including demographic, tumor characteristics, and the use of surgery. Race was significant on UVA, with Bl patients being less likely to undergo SRS treatments, but not on MVA. Further research is needed to better understand the causes underlying these observed trends. Author Disclosure: C. Gamboa: None. O. Algan: None.
2174 Atypical and Malignant Meningiomas: Patterns of Care in Use of Adjuvant Radiation E.L. Garay,1,2 A.J. Lederman,1,2 V. Osborn,1,2 D. Schwartz,1,2 and D. Schreiber1,2; 1SUNY Downstate Medical Center, Brooklyn, NY, 2 Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY Purpose/Objective(s): The National Comprehensive Cancer Network recommends adjuvant radiation therapy (RT) for Grade III meningioma, however, its role in Grade II disease remains unclear. In this study the National Cancer Data Base (NCDB) was used to assess the patterns of care and survival of patients with grade II and III meningiomas. Materials/Methods: The NCDB was queried for patients with WHO Grade II or III meningiomas who had undergone subtotal or gross total resection between 2010 e 2012. All cases must have had documentation regarding receipt of RT and those who survived 6 months were excluded. Demographic, clinical, and treatment details were compared between those who
2175 Stereotactic Radiosurgery for ‡10 Brain Metastases M.A. Garcia, C. Xu, J.L. Nakamura, P.L. Menzel, S.E. Fogh, P.V. Theodosopoulos, M.W. McDermott, P.K. Sneed, and S.E. Braunstein; University of California, San Francisco, San Francisco, CA Purpose/Objective(s): Growing data support stereotactic radiosurgery (SRS) alone, without WBRT, for multiple brain metastases (BM). Prospective evidence shows similar SRS-treatment outcomes for 5-10 BM compared to 24 BM. Here we compare freedom from intracranial progression (FFIP) and overall survival (OS) after SRS for 10 vs 2-9 BM treated with SRS. Materials/Methods: We reviewed patients treated with fixed-frame SRS for new or recurrent BM at our institution from 2010-2013. Patients who had an SRS-planning MRI with gadolinium enhancement were included in the analysis. Those who had immediate WBRT after SRS were excluded from analysis (nZ5). Post-SRS FFIP and OS were estimated by KaplanMeier method and compared by log-rank tests. Cox proportional hazard multivariate analysis was performed. Results: 320 patients met inclusion criteria. Median age was 60, and 17% of patients had prior WBRT. Median KPS was 80 (range 40-100). A total of 38 patients (of whom 41% had prior WBRT) had 10 BM treated in a single SRS session (median number of BM in this group was 15, IQR 11-18). At median imaging follow up of 9.8 months, median FFIP was 8.1 months for patients with <10 BM treated compared to 4.5 months for 10 BM treated (pZ0.007). Excluding patients with a single brain metastasis (nZ89), median FFIP for patients with 2-9 BM (nZ193) and 10 BM was 7.4 and 4.5 months, respectively (pZ0.05). With stratification, median FFIP for patients with 2-4 (nZ127), 5-9 (nZ66), and 10 BM were 8.4, 5.6, and 4.5 months (pZ0.03). Among the entire cohort, prior WBRT was not associated with FFIP. However, progressive extracranial disease (vs no/stable extracranial disease) was associated with worse FFIP (p<0.001). On multivariate analysis, with inclusion of extracranial disease status, there was no significant difference in FFIP between patients with 2-9 vs 10 BM (adjusted HR 1.4, 95%CI 0.89-2.2, pZ0.15). Specifically among patients with no/stable extracranial disease, median FFIP for 2-9 and 10 BM treated was 8.9 and 8.0 months, respectively (pZ0.19). On multivariate analysis, there was no significant difference in FFIP between 2-4, 5-9, and 10 BM
International Journal of Radiation Oncology Biology Physics
2173
did and did not receive RT. Kaplan-Meier analysis was used to compare overall survival between these two groups and compared via the log-rank test. Univariable and multivariable logistic regression was used to assess for predictors of RT use. Univariable and multivariable Cox regression analysis were used to identify potential prognostic factors for survival. Results: A total of 3,271 patients were included, with a median follow-up of 30.3 months. There were 2,985 (91.3%) with Grade II disease of which 741 (24.8%) received RT to a median dose of 5400cGy. There were 286 (8.7%) with Grade III disease, of which 170 (59.4%) received RT to a median dose of 6,000cGy. On multivariable logistic regression, the strongest predictor for the receipt of RT was grade 3 disease (OR 4.30, 95% CI 3.28-5.64, p<0.001), followed by increasing tumor size (OR 1.44-1.55), while the presence of a gross total resection (OR 0.69, 95% CI 0.58-0.81, p<0.001) and increasing Charlson/Deyo score (OR 0.61-0.70) were associated with decreased likelihood of RT. There were no significant survival differences based on RT. The 3year overall survival was 89.1% for surgery alone compared to 88.4% for RT (pZ0.86). On multivariable Cox regression, female gender (HR 0.60, 95% CI 0.47-0.75, p<0.001) and treatment at an academic center (HR 0.74, 95% CI 0.59-0.93, pZ0.01) were associated with improved survival. Receipt of RT (HR 0.94, 95% CI 0.73-1.22, pZ0.64) was not associated with an improvement in overall survival. Conclusion: Most patients (>70%) in this large hospital-based study of patients with Grade II or III meningioma did not receive RT. There was no survival benefit noted for those who did receive RT. Author Disclosure: E.L. Garay: None. A.J. Lederman: None. V. Osborn: None. D. Schwartz: None. D. Schreiber: Independent Contractor; Brooklyn VA Medical Center.
Utilization Patterns for Stereotactic Radiosurgery in the Management of Meningioma: A National Cancer Database Report C. Gamboa and O. Algan; University of Oklahoma Health Sciences Center, Oklahoma City, OK Purpose/Objective(s): The purpose of our study was to evaluate the utilization of stereotactic radiosurgery (SRS) by race in the management of benign and malignant meningioma. Materials/Methods: The NCDB is a joint project of the American Cancer Society and the Commission on Cancer of the American College of Surgeons, and is a nationwide, comprehensive clinical surveillance resource oncology data set that captures 70% of all newly-diagnosed malignancies in the United States annually. Data for patients meeting the ICD-O-3 criteria for meningioma and undergoing radiation therapy were extracted from the Participant Use File (PUF) 2013 data file encompassing the years 2004 to 2013. Trends of use by race and independent factors related to SRS use were studied. Race categories included White (Wh), Black (Bl), American Indian (AI), Asian (As), and Hawaiian/Polynesian (HP). Statistical analyses were performed on IBM SPSS Statistics version 23.0. Association between SRS use and independent factors was assessed using a general linear model for univariate analysis (UVA), and a linear regression model for multivariate analysis (MVA). Results: A total of 179,498 patients diagnosed with meningioma were identified in the PUF 2013 file. Of these, 17,353 patients underwent RT (56.2% SRS and 43.8% non-SRS). Demographics for this group of patients were: Median age 60, female 70.6%, Wh 83.1%, Bl 13.1%, AI 0.3%, As 3.3%, and HP 0.2%. For patients undergoing SRS, 25.6% of patients were over 70, 95.1% had benign tumors, 70% had tumors <4cm, 80% of patients underwent SRS as monotherapy, and 19.8% of patients underwent combined modality therapy. For the entire population, SRS use increased from 58.8% in 2004 to 62.2% in 2005, and then steadily decreased (48.3% in 2013; p< 0.001). When evaluated by race, Wh patients tended to have the highest rate of SRS use (59.6% in 2004, 64.5% peak in 2005, and 48.2% in 2013), and Bl patients had the lowest rate (53.9% in 2004, 57.7% peak in 2007, and 48.5% in 2013). As patients tended to have the second highest SRS utilization, and detailed analyses for AI and HP patients were limited secondary to small patient numbers. Of the 17 variables evaluated, 10 variables were significant on both UVA and MVA: Year of diagnosis, patient age, insurance status, histology, behavior, tumor size, grade, margin status, facility type and location, and Crowfly distance. Conclusion: SRS utilization in the treatment of meningioma peaked in 2005, and has slowly decreased. Numerous factors were associated with SRS use including demographic, tumor characteristics, and the use of surgery. Race was significant on UVA, with Bl patients being less likely to undergo SRS treatments, but not on MVA. Further research is needed to better understand the causes underlying these observed trends. Author Disclosure: C. Gamboa: None. O. Algan: None.
2174 Atypical and Malignant Meningiomas: Patterns of Care in Use of Adjuvant Radiation E.L. Garay,1,2 A.J. Lederman,1,2 V. Osborn,1,2 D. Schwartz,1,2 and D. Schreiber1,2; 1SUNY Downstate Medical Center, Brooklyn, NY, 2 Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY Purpose/Objective(s): The National Comprehensive Cancer Network recommends adjuvant radiation therapy (RT) for Grade III meningioma, however, its role in Grade II disease remains unclear. In this study the National Cancer Data Base (NCDB) was used to assess the patterns of care and survival of patients with grade II and III meningiomas. Materials/Methods: The NCDB was queried for patients with WHO Grade II or III meningiomas who had undergone subtotal or gross total resection between 2010 e 2012. All cases must have had documentation regarding receipt of RT and those who survived 6 months were excluded. Demographic, clinical, and treatment details were compared between those who
2175 Stereotactic Radiosurgery for ‡10 Brain Metastases M.A. Garcia, C. Xu, J.L. Nakamura, P.L. Menzel, S.E. Fogh, P.V. Theodosopoulos, M.W. McDermott, P.K. Sneed, and S.E. Braunstein; University of California, San Francisco, San Francisco, CA Purpose/Objective(s): Growing data support stereotactic radiosurgery (SRS) alone, without WBRT, for multiple brain metastases (BM). Prospective evidence shows similar SRS-treatment outcomes for 5-10 BM compared to 24 BM. Here we compare freedom from intracranial progression (FFIP) and overall survival (OS) after SRS for 10 vs 2-9 BM treated with SRS. Materials/Methods: We reviewed patients treated with fixed-frame SRS for new or recurrent BM at our institution from 2010-2013. Patients who had an SRS-planning MRI with gadolinium enhancement were included in the analysis. Those who had immediate WBRT after SRS were excluded from analysis (nZ5). Post-SRS FFIP and OS were estimated by KaplanMeier method and compared by log-rank tests. Cox proportional hazard multivariate analysis was performed. Results: 320 patients met inclusion criteria. Median age was 60, and 17% of patients had prior WBRT. Median KPS was 80 (range 40-100). A total of 38 patients (of whom 41% had prior WBRT) had 10 BM treated in a single SRS session (median number of BM in this group was 15, IQR 11-18). At median imaging follow up of 9.8 months, median FFIP was 8.1 months for patients with <10 BM treated compared to 4.5 months for 10 BM treated (pZ0.007). Excluding patients with a single brain metastasis (nZ89), median FFIP for patients with 2-9 BM (nZ193) and 10 BM was 7.4 and 4.5 months, respectively (pZ0.05). With stratification, median FFIP for patients with 2-4 (nZ127), 5-9 (nZ66), and 10 BM were 8.4, 5.6, and 4.5 months (pZ0.03). Among the entire cohort, prior WBRT was not associated with FFIP. However, progressive extracranial disease (vs no/stable extracranial disease) was associated with worse FFIP (p<0.001). On multivariate analysis, with inclusion of extracranial disease status, there was no significant difference in FFIP between patients with 2-9 vs 10 BM (adjusted HR 1.4, 95%CI 0.89-2.2, pZ0.15). Specifically among patients with no/stable extracranial disease, median FFIP for 2-9 and 10 BM treated was 8.9 and 8.0 months, respectively (pZ0.19). On multivariate analysis, there was no significant difference in FFIP between 2-4, 5-9, and 10 BM