Radiotherapy Improves DFS After Atypical Meningioma Resection

Adjuvant radiotherapy improved disease-free survival (DFS) compared with observation in patients with newly diagnosed WHO grade 2 atypical meningioma who had undergone complete surgical resection, according to results of the phase 3 ROAM/EORTC-1308 trial published in The Lancet.

The investigators noted that atypical meningioma carries a high risk of recurrence even after complete resection and that the role of adjuvant radiotherapy has remained uncertain. They described the study as, to their knowledge, the first randomized trial comparing adjuvant fractionated radiotherapy with observation in this population.

The international, multicenter, open-label trial (ISRCTN71502099) randomly assigned 157 patients aged 16 years or older at 58 sites in 11 countries to radiotherapy (n=78) or observation (n=79) after surgeon-assessed complete resection. Radiotherapy consisted of intensity-modulated radiotherapy at 60 Gy in 30 fractions over 6 weeks. DFS was defined as time from surgery to MRI-confirmed recurrence or death from any cause. At a median follow-up of 64 months, recurrence occurred in 14% of the radiotherapy group and 30% of the observation group. Five-year DFS was 79.9% vs 64.3%, respectively (absolute difference, 15.6 percentage points; 95% CI, 0.6-30.5; hazard ratio, 0.51; P=.0396).

Grade 2 or 3 radiation-related serious adverse events occurred in 5 (8%) of 66 patients who received radiotherapy, with no treatment-related deaths. The investigators reported no difference in 5-year overall survival and no clear differences in neurocognitive function, which was assessed in 75 participants from the UK and Ireland. Twelve patients assigned to radiotherapy did not receive it, which the authors said may have biased the estimated effect toward the null.

The authors noted that the trial did not reach its prespecified target of 46 events, that enrollment relied on local neuropathology without central review, and that neurocognitive and quality-of-life findings should be interpreted cautiously because of missing data. They concluded that adjuvant radiotherapy should be considered when preventing recurrence is valued more than potential delayed adverse effects, with decisions based on individual discussion with the patient.

Source: Jenkinson MD, Rosala-Hallas A, Sahm F, et al. Radiotherapy versus observation following surgical resection of WHO grade 2 atypical meningioma (ROAM/EORTC-1308): an international, multicentre, open-label, phase 3, randomised controlled trial. Lancet. Published online September 25, 2026. doi:10.1016/S0140-6736(26)01804-0