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Adding radiation therapy after brain tumor surgery pays off. A phase 3 trial found that adjuvant radiotherapy following complete resection of WHO grade 2 atypical meningioma cut the risk of recurrence nearly in half compared to observation alone — with a 5-year disease-free survival of 79.9% vs 64.3%. Serious side effects were rare, with no treatment-related deaths reported.
A landmark phase 3 randomized trial published in The Lancet has found that adjuvant radiotherapy after complete surgical removal of WHO grade 2 atypical meningiomas significantly reduces the chance of the tumor coming back. Conducted across 58 hospitals in 11 countries, the trial followed 157 patients for a median of 64 months — and the results were clear: radiation works.
Patients who received external-beam intensity-modulated radiotherapy (60 Gy in 30 fractions over 6 weeks) saw their recurrence rate drop to 14%, compared to 30% in those who were simply monitored. Importantly, the benefit held up even after accounting for molecular tumor characteristics like DNA methylation class, suggesting radiation's protective effect is broad and not limited to specific tumor subtypes.
Why it matters: Atypical meningiomas carry a meaningful risk of recurrence even after what surgeons consider a complete resection. This trial gives clinicians strong evidence to support offering adjuvant radiotherapy as a standard next step — cutting recurrence risk in half with minimal toxicity and no measurable impact on quality of life or cognitive function.
