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.
Michael D Jenkinson, Anna Rosala-Hallas, Felix Sahm et al.
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In 30 seconds
ROAM/EORTC-1308 was an international, multicentre, open-label, phase 3 randomised trial comparing adjuvant radiotherapy with observation after complete resection of newly diagnosed WHO grade 2 atypical meningioma. It enrolled 157 patients aged 16 years or older, with median follow-up of 64 months. Five-year disease-free survival was 79·9% (95% CI 67·6-87·9) with radiotherapy and 64·3% (51·9-74·2) with observation; the hazard ratio was 0·51 (95% CI 0·27-0·97; p=0·0396). Grade 2 or 3 radiation-related serious adverse events occurred in five participants, with no treatment-related deaths.
Key findings
- Recurrence occurred in 11 (14%) of 78 radiotherapy participants and 24 (30%) of 79 observation participants.
- Five-year disease-free survival was 79·9% (95% CI 67·6-87·9) with radiotherapy versus 64·3% (51·9-74·2) with observation.
- Radiotherapy improved disease-free survival relative to observation (hazard ratio 0·51 [95% CI 0·27-0·97]; p=0·0396).
- Grade 2 or 3 radiation-related serious adverse events occurred in five (8%) of 66 treated participants; there were no treatment-related deaths.
Why it matters
After complete resection of atypical meningioma, recurrence remains a concern and the role of adjuvant radiotherapy has been uncertain. This randomised comparison found better disease-free survival and fewer observed recurrences with radiotherapy, while also documenting serious radiation-related adverse events. These results help frame the trade-off between recurrence prevention and potential treatment harms.
What to keep in mind
The trial enrolled 157 participants, and follow-up was a median of 64 months; the abstract notes that delayed adverse effects remain a consideration.