The role of radiation therapy following subtotal resection (STR) of atypical meningiomas remains unclear. Sun and colleagues therefore retrospectively evaluated predictors of radiographic progression in 59 patients with STR of atypical meningiomas treated with varied postoperative strategies. Patients treated with conventional radiation or radiosurgery after STR experienced improved local control (p=0.02) and increased progression free survival (p=0.007) compared to patients without any type of radiation treatment, with 10 year PFS of 45% in the former group vs. 26% in the latter. However, in subgroup analyses, atypical meningiomas that harbored evidence of spontaneous necrosis did not demonstrate a response to radiation treatment. This study therefore provides evidence that histopathologic features may help to stratify patients with STR that may benefit from post-operative radiation treatment, although it will be important to validate these findings in a larger dataset.
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