Long-term outcomes of active surveillance after DOTATATE PET/MRI-confirmed gross total resection in WHO grade 2 meningioma.
| Publication Type | Academic Article |
| Authors | Ivanidze J, Vu K, Tosi U, Chris Chang S, Rosen K, Otis H, Chernek P, Watson A, Haghdel A, Corzo V, Kim S, Pisapia D, Magge R, Pan P, Pannullo S, Roytman M, Lin E, Nehmeh S, Karakatsanis N, RoyChoudhury A, Osborne J, Brandmaier A, Beal K, Zonenshayn M, Ramakrishna R, Stieg P, Liechty B, Knisely J, Schwartz T |
| Journal | Neurooncol Adv |
| Volume | 7 |
| Issue | 1 |
| Pagination | vdaf210 |
| Date Published | 09/18/2025 |
| ISSN | 2632-2498 |
| Abstract | BACKGROUND: Somatostatin receptor 2 (SSTR2), a highly sensitive and specific meningioma biomarker, can be imaged with [68Ga]-DOTATATE PET, improving diagnosis and treatment. The role of postoperative radiotherapy (RT) for WHO grade 2 (WHO-2) meningiomas following gross total resection (GTR) remains controversial. We hypothesized that confirmation of GTR by DOTATATE PET/MRI followed by active surveillance would yield superior progression-free survival (PFS) compared to MRI-based GTR assessment alone. METHODS: Patients with WHO-2 meningioma enrolled in a prospective registry were included if postoperative PET/MRI showed GTR and if they were managed with surveillance alone. All patients underwent serial MRI and/or PET/MRI follow-up. Kaplan-Meier analysis was used to determine PFS. A retrospective institutional comparator cohort of patients with WHO-2 meningiomas and MRI-determined GTR managed with surveillance alone was also evaluated. RESULTS: Twenty-eight prospective subjects (61% women, mean age 61 years) met inclusion criteria. Meningiomas were located along the convexity (50%), falx (21%), and skull base (29%). Mean mitotic count was 5.1 per 10 high-power fields; mean follow-up was 28 months (range 5-64). In the PET/MRI cohort, PFS was 90.0% at 5 years. In comparison, the MRI-only cohort (n = 33) demonstrated a 5-year PFS of 67.0% (log-rank P = .04), despite similar clinicopathologic features. CONCLUSIONS: DOTATATE PET/MRI-confirmed GTR followed by active surveillance yielded significantly higher PFS compared to MRI-based GTR assessment in patients with WHO-2 meningioma. DOTATATE PET/MRI increases diagnostic certainty, enabling more accurate postoperative risk stratification and potentially avoiding unnecessary RT, supporting its integration into postoperative decision-making for WHO-2 meningioma. |
| DOI | 10.1093/noajnl/vdaf210 |
| PubMed ID | 41497451 |
| PubMed Central ID | PMC12768507 |