The jury is out and RT wins-for now

Comparison of Survival After Treatment of Presumed Intracranial Meningioma by Radiotherapy or Surgery in 285 Dogs

Geiger, R.; Mankin, J.; Volk, H.A.; de Decker, S.; van Asselt, N.; Randhawa, K.; Ehling, T.; Maitz, C.A.; Naramor, A.; Coates, J.R.; Stalin, C.; Johnstone, L.; Morris, J.; Plessas, I.N.; Forward, A.; Garosi, L.; Scarpante, E.; Cherubini, G.; Harcourt-Brown, T.; Carrera-Justiz, S.; Gutti, J.R.; Takada, M.; White, J.; Nagata, K.; Kent, M.; Barber, R.; Ito, D.; Nakayama, T.; Oshima, A.; Sekigucki, N.; Smith-Oskrochi, L.; Jeffery, N.

Background:
Meningioma is the most common intracranial tumor in dogs, but the comparative effectiveness of radiotherapy versus surgery remains uncertain. While both treatments are used in clinical practice, previous studies have lacked direct comparisons of survival outcomes. This study aimed to evaluate and compare survival times in dogs with presumed intracranial meningioma treated with either radiotherapy or surgical excision.

Methods:
A multicenter retrospective study included 285 dogs diagnosed with intracranial meningioma based on MRI findings and treated with either surgery (n=117) or radiotherapy (n=168) at 11 veterinary institutions. Survival outcomes were analyzed using Cox proportional hazards models and counterfactual modeling to account for treatment allocation bias. Key prognostic factors, including tumor location and size, were assessed to determine their impact on survival.

Results:
Dogs treated with radiotherapy had a significantly longer median survival (696 days, IQR: 368–999) compared to those undergoing surgery (297 days, IQR: 99–768). The unadjusted hazard ratio for death in surgically treated dogs was 1.802 (95% CI: 1.357–2.394) compared to those receiving radiotherapy. Counterfactual modeling estimated a 29% reduction in survival time for surgery (mean survival: 480 days) versus radiotherapy (mean survival: 673 days). Tumor location and size were not significantly associated with survival.

Limitations:
The study's retrospective design introduces potential biases related to treatment allocation and case selection. While statistical methods were used to adjust for confounders, unmeasured variables may still influence outcomes. Additionally, variations in surgical techniques and radiotherapy protocols across institutions were not standardized.

Conclusions:
Radiotherapy was associated with significantly longer survival than surgery in dogs with presumed intracranial meningioma. These findings suggest that radiotherapy should be the preferred treatment when available. Further prospective studies are needed to confirm these results and refine treatment recommendations.

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