Radiotherapy after surgery ‘reduces risk of recurrence of certain brain cancers’

Giving certain brain tumour patients radiotherapy after surgery can halve the risk of their cancer returning, a new study suggests.

Atypical meningioma is a type of brain tumour that grows back nearly 50% of the time within five years of surgery.

But a new study led by experts from The Walton Centre NHS Foundation Trust the University of Liverpool suggests this risk can be reduced with radiotherapy after surgery.

One patient has described how he would have “definitely” requested radiotherapy after surgery had the findings been published sooner.

Andy Tudor, a defence systems engineer, from Denmead near Waterlooville in Hampshire, was 52 when he was diagnosed with an atypical meningioma in 2017.

Andy Tudor said he would have “definitely” requested radiotherapy after surgery had the findings been published sooner (handout/PA)

The father-of-three had surgery a month later but the tumour recurred in January 2022, and he was then offered Gamma Knife (stereotactic) radiotherapy in March 2022.

He has since been given the all-clear and is now a volunteer with The Brain Tumour Charity.

Mr Tudor said: “My meningioma was classed as atypical Grade 2 and although apparently completely removed by surgery, I wasn’t offered radiotherapy afterwards.

“I had a recurrence which was discovered on my fifth annual scan.

“It was successfully treated by stereotactic radiotherapy with no further long-term side-effects.

If I’d known about this research at the time I’d have definitely requested radiotherapy after my surgery.”

The new study, published in The Lancet and presented to the European Association of Neuro-Oncology, is the first to compare giving patients radiotherapy after completely removing the tumour during surgery with active monitoring to see whether cancer returns.

Between 2016 and 2021, 157 patients were enrolled in the trial.

About half – 79 patients – were monitored as usual and 78 people were given six weeks of daily radiotherapy sessions.

They were then tracked for about five years.

During this timeframe the tumour had returned in 30% of people who were being actively monitored and 14% of people who had radiotherapy, researchers found.

Five-year disease free survival was 80% among those who had radiotherapy and 64% among those who were given observation.

There was no difference between the two groups in quality of life or memory and thinking skills, but nearly half of those who had radiotherapy had some short-term side-effects including scalp redness, hair loss, tiredness and headache.

Chief investigator and first author of the study, Professor Michael Jenkinson, from The Walton Centre NHS Foundation Trust the University of Liverpool, said: “The trial tackles a question that has been debated for many years: whether patients with atypical meningioma should receive radiotherapy after surgery.

“I’m proud that our team has been able to generate robust evidence that can help patients and clinicians make better-informed decisions.”

Dr Simon Newman, chief scientific officer at The Brain Tumour Charity, said: “Meningiomas are the most common brain tumour in adults and account for 27% of all brain tumour diagnoses.

“Between a quarter and a third of all meningiomas are grade 2 ‘atypical’ tumours and more likely to recur within five years. For those patients, the landmark Roam trial provides vital evidence to help weigh up their treatment options.

“The trial showed that five years after complete surgical removal of their tumour, the risk of recurrence was halved in patients who received radiotherapy compared with surgery alone – 14% versus 30%.

“While radiotherapy was associated with some mild short-term side-effects, there was no difference in quality of life, memory or thinking skills between the groups.

“Longer-term follow-up will be important to confirm these findings, and we look forward to hearing more about them.”

Dr Karen Noble, director of research and policy at Brain Tumour Research, said: “Meningioma is the most common form of primary brain tumour in the UK, and while the majority of cases are slow growing, there are more aggressive forms that can return after surgery that are really difficult to treat.

“This study is the first to provide evidence which could shape treatment options for those patients, showing that radiotherapy after surgery can reduce the risk of tumour recurrence with limited side effects. We need to see more investment in research into brain tumours so that clinical studies such as these can improve outcomes for patients.”