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@ARTICLE{Mirian:309806,
      author       = {C. Mirian and L. R. Jensen and A. G. Hoffmann and T. A.
                      Juratli and A. D. Maier and P. Lindner and A. Broechner and
                      S. H. Torp and H. A. Shih and R. A. Morshed and J. S. Young
                      and S. T. Magill and W. Stummer and D. C. Spille and B.
                      Brokinkel and M. Proescholdt and Y. Kuroi and K. Gousias and
                      M. Simon and R. Prat-Acin and S. Goutagny and J. Wach and E.
                      Güresir and J. Yamamoto and Y. Z. Kim and J. H. Lee and D.
                      W. Kim and M. Koshy and D. M. Cannon and D. C. Shrieve and
                      C.-O. Suh and J. H. Chang and M. Kamenova and S. Straumann
                      and J. Soleman and I. Y. Eyüpoglu and T. Catalan and A. Lui
                      and P. V. Theodosopoulos and M. W. McDermott and P. Góes
                      and F. Wang and L. Souhami and M.-C. Guiot and T. Csonka and
                      T. Endo and T. Gupta and A. J. Patel and T. J. Klisch and J.
                      W. Kim and F. Maiuri and V. Barresi and M. D. Tabernero and
                      S. Skyrman and M. Krause$^*$ and I. Law and B. W. Kristensen
                      and T. N. Munch and T. Meling and K. Fugleholm and P.
                      Blanche and T. Mathiesen},
      title        = {{F}ractionated radiotherapy adjuvant to surgery of {WHO}-2
                      meningioma with and without gross total resection: a
                      multicenter, retrospective cohort study of 1,452 patients.},
      journal      = {Journal of neuro-oncology},
      volume       = {176},
      number       = {3},
      issn         = {0167-594X},
      address      = {Dordrecht [u.a.]},
      publisher    = {Springer Science + Business Media B.V},
      reportid     = {DKFZ-2026-00319},
      pages        = {201},
      year         = {2026},
      note         = {#DKTKZFB26# / #NCTZFB26#},
      abstract     = {Purpose:The role of adjuvant fractionated radiotherapy
                      (aFRT) after gross total resection (GTR) of WHO-2
                      meningiomas remains unclear. We aimed to estimate the effect
                      of aFRT on recurrence risk and survival following GTR and
                      subtotal resection (STR).Methods:We analyzed 1452 patients
                      with WHO-2 from our international, multicenter database
                      (followed between 1989 and 2019). Outcomes were recurrence
                      (10-year follow-up) and death (5-year follow-up). Risk
                      estimates were obtained using competing risks and survival
                      analysis. Average treatment effects were estimated by
                      G-computation, adjusted for potential confounding by age,
                      sex, Simpson grade, Ki-67 proliferation index, location,
                      country group (universal healthcare or not), and year of
                      treatment initiation. The robustness of findings was
                      examined through sensitivity analyses.Results:Overall, 276
                      of 1452 patients $(19.0\%)$ received aFRT. Among GTR
                      patients, unadjusted analysis showed comparable recurrence
                      proportions between irradiated and non-irradiated patients
                      $(25.5\%$ vs. $22.8\%$ within 5 years). Adjusted analyses
                      provided no evidence that aFRT reduced the risk of
                      recurrence (largest difference: $−2.7\%,$ $95\%$ CI −5.6
                      to 0.2); although, the CIs include the possibility of small
                      beneficial effects. In STR patients, aFRT was associated
                      with reduced recurrence risk in both unadjusted and adjusted
                      analyses. Unexpectedly, a higher mortality was observed
                      among irradiated GTR patients, largely driven by older
                      patients with low Ki-67 PI receiving aFRT. Sensitivity
                      analyses showed similar results for patients with STR but
                      discrepancy in estimates for those with
                      GTR.Conclusion:Adjuvant FRT showed a consistent reduction in
                      recurrence risk after STR while inconsistent recurrence risk
                      estimates were observed for patients with GTR. The findings
                      reflect efficacy of aFRT using real-world data without
                      standardized guidelines.},
      keywords     = {Atypical meningioma (Other) / Meningioma (Other) /
                      Progression (Other) / Radiotherapy (Other) / Recurrence
                      (Other) / Resection (Other)},
      cin          = {DD01 / DD04 / DD02},
      ddc          = {610},
      cid          = {I:(DE-He78)DD01-20160331 / I:(DE-He78)DD04-20160331 /
                      I:(DE-He78)DD02-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41661453},
      doi          = {10.1007/s11060-025-05349-7},
      url          = {https://inrepo02.dkfz.de/record/309806},
}