- Wang, Justin;
- Patil, Vikas;
- Landry, Alexander;
- Gui, Chloe;
- Ajisebutu, Andrew;
- Liu, Jeff;
- Saarela, Olli;
- Pugh, Stephanie;
- Won, Minhee;
- Patel, Zeel;
- Yakubov, Rebeca;
- Kaloti, Ramneet;
- Wilson, Christopher;
- Cohen-Gadol, Aaron;
- Zaazoue, Mohamed;
- Tabatabai, Ghazaleh;
- Tatagiba, Marcos;
- Behling, Felix;
- Almiron Bonnin, Damian;
- Holland, Eric;
- Kruser, Tim;
- Barnholtz-Sloan, Jill;
- Sloan, Andrew;
- Horbinski, Craig;
- Chotai, Silky;
- Chambless, Lola;
- Gao, Andrew;
- Rebchuk, Alexander;
- Makarenko, Serge;
- Yip, Stephen;
- Sahm, Felix;
- Maas, Sybren;
- Tsang, Derek;
- Rogers, C;
- Aldape, Kenneth;
- Nassiri, Farshad;
- Zadeh, Gelareh
Treatment 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.