RATIONALE: Sometimes a tumor may not need treatment until it progresses. In this case, observation may be sufficient. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor, such as 3-dimensional conformal radiation therapy and intensity-modulated radiation therapy, may kill more tumor cells and cause less damage to normal tissue. It is not yet known whether observation is more effective than radiation therapy in treating patients with meningioma.
PURPOSE: This phase II trial is studying observation to see how well it works compared with radiation therapy in treating patients with grade I, grade II, or grade III meningioma.
Phase II Trial of Observation for Low-Risk Meningiomas and of Radiotherapy for Intermediate- and High-Risk Meningiomas
To estimate the rates of progression-free survival at 3 years in patients with low-risk meningioma undergoing observation and in patients with intermediate- or high-risk meningioma undergoing radiotherapy.
To study the concordance, or lack thereof, between central and parent institution histopathologic diagnosis, grading, and subtyping.
To estimate the rates of overall survival at 3 years in these patients.
To estimate the incidence rates of acute and late adverse events ≥ grade 2 in patients with intermediate- or high-risk meningioma undergoing radiotherapy.
To evaluate MRI imaging predictors by central neuroradiology review at diagnosis, at any failure, and at 3 years.
To evaluate adherence to protocol-specific target and normal tissue radiotherapy parameters.
OUTLINE: This is a multicenter study. Patients are assigned to 1 of 3 groups according to risk.
Group 1 (low-risk disease): Patients undergo observation.
Group 2 (intermediate-risk disease): Patients undergo 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy (IMRT) once daily 5 days a week for 6 weeks.
Group 3 (high-risk disease): Patients undergo IMRT once daily 5 days a week for 6 weeks.
After completion of study treatment, patients are followed up every 3-6 months for 3 years and then annually for 10 years.
Brain and Central Nervous System Tumorsadult grade I meningiomaadult grade II meningiomaadult grade III meningiomaadult anaplastic meningiomaadult papillary meningiomarecurrent adult brain tumor
For people ages 18–120
Histologically confirmed meningioma, meeting 1 of the following criteria:
Low-risk disease, as defined by the following:
Newly diagnosed, WHO grade I disease that was gross totally resected(Simpson's grade I, II, or III resection with no residual nodular enhancement on postoperative imaging) or subtotally resected (residual nodular enhancement or Simpson grade IV or V resection)
Intermediate-risk disease, as defined by the following:
Newly diagnosed, WHO grade II disease that was gross totally resected OR recurrent WHO grade I disease irrespective of the resection extent
High-risk disease, as defined by 1 of the following:
Newly diagnosed or recurrent WHO grade III disease of any resection extent
Recurrent WHO grade II disease of any resection extent
Newly diagnosed, WHO grade II disease that was subtotally resected
Patients with newly diagnosed disease must have had a histologic diagnosis within the past 6 months AND have undergone pre- and post-operative MRIs within the past 3 months
Patients with recurrent/progressive intermediate- or high-risk disease who have not undergone recent surgery must have documentation of recurrence or progression by MRI within the past 3 months
No extracranial or multiple meningioma and/or hemangiopericytoma
Zubrod performance status 0-1
Negative pregnancy test (for patients enrolled in groups 2 or 3)
Fertile patients must use effective contraception (for patients enrolled in groups 2 or 3)
Able to receive gadolinium
No other invasive malignancy within the past 3 years except for nonmelanoma skin cancer or carcinoma in situ of the breast, oral cavity, or cervix
No severe, active comorbidity including, but not limited to, any of the following: