Design: Phase 3, randomised, open-label, multicentre
Population: 157 adults after complete resection of atypical meningioma
Primary outcome: Disease-free survival
Effect: 5-year DFS 79.9% vs 64.3%; HR 0.51 (95% CI 0.27–0.97)

The ROAM/EORTC-1308 trial, in The Lancet (25 September), randomised 157 patients after complete resection of a newly diagnosed WHO grade 2 (atypical) meningioma to 60 Gy of radiotherapy or MRI observation, at 58 centres in 11 countries.

At a median of 64 months, recurrence occurred in 14% after radiotherapy and 30% under observation. Five-year disease-free survival was 79.9% against 64.3%, a hazard ratio of 0.51. Grade 2 or 3 radiation-related serious adverse events affected 8%, with no treatment-related deaths.

This settles a long-standing question in favour of offering radiotherapy, but the trial was small and the confidence interval wide. The authors frame it as a shared decision, weighing recurrence against delayed effects of brain radiation.

Recurrence fell from 30% to 14% with adjuvant radiotherapy at about five years
Discuss radiotherapy after complete resection of atypical meningioma, as a shared decision
Delayed effects of brain irradiation are part of the conversation
Most clinicians meet these patients in follow-up; know that observation is no longer the clear default

Why it matters

It replaces years of practice variation with randomised evidence.

The statistics, in plain English

A hazard ratio of 0.51 (95% CI 0.27 to 0.97) means recurrence was about halved, but the upper end close to 1 shows how few patients there were. The absolute five-year difference of 15.6 points has a CI from 0.6 to 30.5.