A 10-year trial finds radiotherapy cuts atypical meningioma recurrence after surgery
ROAM/EORTC-1308, an independent phase 3 trial, randomised 157 patients after complete brain-tumour removal; adjuvant radiotherapy improved five-year disease-free survival, but the benefit's confidence interval was wide.
| Group | Value (%) |
|---|---|
| Radiotherapy | 79.9 |
| Observation | 64.3 |
Giving radiotherapy after surgery to remove an atypical meningioma — a slow-growing but recurrence-prone brain tumour — reduced the chance the tumour came back, according to ROAM/EORTC-1308, an international phase 3 trial that took a decade to read out [s1]. The result answers a question neurosurgeons and oncologists have argued over for years, though the trial was small and the size of the benefit remains uncertain [s1].
Atypical meningioma is classified as WHO grade 2: more aggressive than the common benign grade 1 tumour but not cancerous in the way a glioblastoma is. Even after a surgeon removes all visible tumour, a substantial share recur, and whether to follow surgery with radiotherapy — which carries its own long-term risks to the brain — or simply watch and scan has had no randomised answer [s1]. In the absence of trial evidence, practice has varied between centres and countries, with some irradiating every patient and others reserving radiotherapy for the recurrences that do appear. ROAM was built to replace that guesswork with a direct comparison [s1].
What the trial did
ROAM/EORTC-1308 was run at 58 hospitals and academic centres across 11 countries and was funded by public and academic bodies — the UK's National Institute for Health and Care Research, the European Organisation for Research and Treatment of Cancer, and research councils in Australia — not by industry [s1]. Patients aged 16 or older who had undergone a surgeon-assessed complete resection of a newly diagnosed atypical meningioma were randomly assigned 1:1 to adjuvant radiotherapy or to observation [s1][s2]. The radiotherapy group received 60 Gy delivered in 30 fractions over six weeks, and everyone was followed for a minimum of four years [s1]. The primary endpoint was disease-free survival — the time from surgery to an MRI-confirmed recurrence or death from any cause [s1].
Recruitment ran from 28 April 2016 to 21 May 2021. Of 990 patients assessed, 157 were randomised: 78 to radiotherapy and 79 to observation [s1]. The median age was 57.4 years, and 84 (54%) of participants were female [s1]. That is a modest sample for a phase 3 trial, a reflection of how uncommon the tumour is and how long such trials take to fill.
What it found
At a median follow-up of 64 months, the tumour recurred in 11 (14%) of 78 patients given radiotherapy and in 24 (30%) of 79 who were observed [s1]. Five-year disease-free survival was 79.9% (95% confidence interval 67.6–87.9) with radiotherapy and 64.3% (51.9–74.2) with observation — an absolute difference of 15.6 percentage points, though its confidence interval ran from just 0.6 up to 30.5 points [s1]. The hazard ratio for disease-free survival was 0.51 (95% confidence interval 0.27–0.97; p=0.0396), a result that is statistically significant but only just [s1].
On safety, grade 2 or 3 radiation-related serious adverse events occurred in five (8%) of 66 patients who received radiotherapy, and there were no treatment-related deaths [s1]. That rate of serious short-term harm is low, but the follow-up so far is too short to capture the slow-developing cognitive and vascular effects that brain irradiation can cause years later — the very risks that make the decision to irradiate finely balanced [s1].
How to read it
The headline is real: in the first randomised test of the question, adjuvant radiotherapy roughly halved the recurrence hazard and lifted five-year disease-free survival [s1]. But the trial's limits should temper how firmly that is stated. With only 157 patients and 35 recurrence-or-death events in total, the confidence intervals are wide — the lower bound of the absolute benefit is barely above zero, and the hazard-ratio interval nearly touches 1.0 [s1]. The endpoint is recurrence and disease-free survival, not overall survival, which the trial was not powered to measure; a tumour that recurs can often be treated again [s1].
It is also worth noting what the trial did not do: it did not compare early radiotherapy against radiotherapy given later, at the point of recurrence. Because a recurrent atypical meningioma can often be re-operated or irradiated, the real-world question for some patients is not whether radiotherapy helps but whether to have it now or keep it in reserve — a comparison ROAM was not designed to make [s1].
The clinical read the authors offer is a conditional one: adjuvant radiotherapy should be considered when preventing recurrence is valued more highly than the potential late effects of irradiating the brain, a trade-off best settled in discussion with each patient [s1].
What to watch
Longer follow-up will show whether the disease-free-survival gap translates into a difference in overall survival or quality of life, and whether the late neurological effects of radiotherapy erode the early advantage [s1]. This article describes research and is not medical advice.
Sources
- Radiotherapy versus observation after resection of atypical meningioma (ROAM/EORTC-1308) — The Lancet, 25 September 2026
- ROAM trial registration, ISRCTN71502099 — ISRCTN registry
Sources
- Radiotherapy versus observation following surgical resection of WHO grade 2 atypical meningioma (ROAM/EORTC-1308): an international, multicentre, open-label, phase 3, randomised controlled trial — The Lancet , September 25, 2026
- Radiotherapy versus Observation following surgical resection of Atypical Meningioma (ROAM), ISRCTN71502099 — ISRCTN registry
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