Wang, Justin Z.Patil, VikasLandry, Alexander P.Gui, ChloeAjisebutu, AndrewLiu, JeffSaarela, OlliPugh, Stephanie L.Won, MinheePatel, ZeelYakubov, RebecaKaloti, RamneetWilson, ChristopherCohen-Gadol, AaronZaazoue, Mohamed A.Tabatabai, GhazalehTatagiba, MarcosBehling, FelixAlmiron Bonnin, Damian A.Holland, Eric C.Kruser, Tim J.Barnholtz-Sloan, Jill S.Sloan, Andrew E.Horbinski, CraigChotai, SilkyChambless, Lola B.Gao, AndrewRebchuk, Alexander D.Makarenko, SergeYip, StephenSahm, FelixMaas, Sybren L. N.Tsang, Derek S.International Consortium on Meningiomas (ICOM)Rogers, C. LelandAldape, KennethNassiri, FarshadZadeh, Gelareh2024-12-112024-12-112024Wang JZ, Patil V, Landry AP, et al. Molecular classification to refine surgical and radiotherapeutic decision-making in meningioma. Nat Med. 2024;30(11):3173-3183. doi:10.1038/s41591-024-03167-4https://hdl.handle.net/1805/44946Treatment of the tumor and dural margin with surgery and sometimes radiation are cornerstones of therapy for meningioma. Molecular classifications have provided insights into the biology of disease; however, response to treatment remains heterogeneous. In this study, we used retrospective data on 2,824 meningiomas, including molecular data on 1,686 tumors and 100 prospective meningiomas, from the RTOG-0539 phase 2 trial to define molecular biomarkers of treatment response. Using propensity score matching, we found that gross tumor resection was associated with longer progression-free survival (PFS) across all molecular groups and longer overall survival in proliferative meningiomas. Dural margin treatment (Simpson grade 1/2) prolonged PFS compared to no treatment (Simpson grade 3). Molecular group classification predicted response to radiotherapy, including in the RTOG-0539 cohort. We subsequently developed a molecular model to predict response to radiotherapy that discriminates outcome better than standard-of-care classification. This study highlights the potential for molecular profiling to refine surgical and radiotherapy decision-making.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalMeningeal neoplasmsMeningiomaTumor biomarkersProgression-free survivalArticle