Radiotherapy after surgery significantly reduces atypical meningioma recurrence, clinical trial finds
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Atypical meningiomas are tumors that originate in the meninges and are associated with a high risk of recurrence. Until now, it was unclear whether patients benefit from radiotherapy after complete surgical removal of the tumor. An international study in which MedUni Vienna played a key role provides new evidence that radiotherapy can significantly reduce the recurrence rate. The results, recently published in The Lancet, are set to be incorporated into national and international guidelines.
The study, known as ROAM/EORTC-1308, involved 157 patients after the complete removal of an atypical meningioma. Of those, 78 randomly selected patients each received 30 sessions of radiotherapy, while 79 were monitored regularly through imaging. The clinical trial was conducted at 58 hospitals in 11 countries (Austria, Australia, Belgium, Ireland, France, Germany, New Zealand, Italy, Spain, Switzerland and the United Kingdom). The Medical University of Vienna played a leading role in the study through the Division of Oncology at the Department of Medicine I and its head, Matthias Preusser.
The results provide the first robust evidence from a randomized trial that radiotherapy after complete removal of an atypical meningioma significantly reduces the risk of recurrence. After a median follow-up period of around five years, 11 of 78 patients (14%) in the radiotherapy group experienced a meningioma recurrence, compared with 24 of 79 patients (30%) in the observation group. A clear difference was also observed in disease-free survival: After five years, 79.9% of patients in the radiotherapy group were recurrence-free, compared with 64.3% of those under imaging surveillance.
"The ROAM/EORTC-1308 trial has demonstrated a significant reduction in the recurrence rate and thus provides the best available evidence for the use of adjuvant radiotherapy in patients who have undergone complete surgical resection of an atypical meningioma. These findings will be incorporated into national and international guidelines," says Preusser, who led the study with Michael Jenkinson (Liverpool Clinical Trials Centre, UK), Carrol Gamble (Liverpool Clinical Trials Centre, UK) and Damien C. Weber (Paul Scherrer Institute and Inselspital—University Hospital of Bern, Switzerland).
However, the decision for or against radiotherapy must be made jointly with patients, the study authors emphasize. It is important to consider possible side effects and long-term consequences of the treatment, even though serious radiation-related events were rare during the study.
Meningiomas account for around one-third of primary brain tumors in adults—that is, tumors not caused by metastases. Atypical meningiomas are associated with a high risk of recurrence even after complete surgical removal. The benefit of additional radiotherapy after tumor removal had not previously been established by a randomized trial. The ROAM/EORTC-1308 trial now provides the first evidence from a randomized trial on this question. Further studies will seek to clarify, among other things, whether the benefit of radiotherapy persists beyond five years.
Publication details
Michael D Jenkinson 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, The Lancet (2026). DOI: 10.1016/s0140-6736(26)01804-0
Journal information: The Lancet
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OncologyNeurology Provided by Medical University of Vienna Who's behind this story?
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