Radiotherapy after complete resection of atypical meningioma halved recurrence

Design

International, multicentre, open-label, phase 3 randomised trial (ROAM/EORTC-1308)

Population

157 patients aged ≥16 after complete resection of WHO grade 2 atypical meningioma

Primary outcome

Disease-free survival (MRI recurrence or death)

Effect

5-year DFS 79.9% vs 64.3%, HR 0.51 (95% CI 0.27–0.97)

ROAM/EORTC-1308 was an open-label phase 3 trial at 58 centres in 11 countries. It randomised 157 patients (median age 57) who had undergone surgeon-assessed complete resection of a newly diagnosed WHO grade 2 atypical meningioma to adjuvant intensity-modulated radiotherapy (60 Gy in 30 fractions) or active MRI observation.

At a median 64 months, recurrence occurred in 14% with radiotherapy and 30% with observation. Five-year disease-free survival was 79.9% versus 64.3% (HR 0.51, 95% CI 0.27–0.97; absolute difference 15.6 points, 95% CI 0.6–30.5). Grade 2–3 radiation-related serious adverse events occurred in 8%, with no treatment-related deaths.

This is the first randomised answer to a long-standing question, and it favours radiotherapy. But the trial is small, the confidence interval only just excludes no effect, and the harms of brain radiotherapy — cognitive and endocrine — may appear years after the follow-up window. The authors themselves frame it as a choice for the patient: fewer recurrences now against possible late effects later.

• Patients with a completely resected atypical meningioma should be offered a radiotherapy discussion, not default observation.
• Frame it as a trade-off: about one fewer recurrence for every six treated, against possible late radiation effects.
• About one in twelve had a serious radiation-related adverse event.
• Continue MRI surveillance whichever route is chosen.
• The result applies to grade 2 tumours after complete resection only.

Why it matters

It turns a surgeon-by-surgeon judgement into an evidence-based conversation with a patient.

Don't overread it

With 157 patients and an interval nearly touching no effect, the size of the benefit is uncertain, and late cognitive harms were not measured beyond five years.

The statistics, in plain English

An HR of 0.51 means about half the rate of recurrence or death, but the confidence interval (0.27–0.97) is wide — the true effect could be anything from a large benefit to a very small one. The absolute gain of 15.6 points could be as little as 0.6.

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