Background: To assess the outcome after meningioma surgery and protontherapy (PT). Methods: We processed the French Système National des Données de Santé database to retrieve appropriate cases of meningiomas operated and irradiated between 2008 and 2017. Survival methods were implemented. Results: One hundred ninety-three patients who received PT after meningioma surgery over a 10-year period were identified. Of the 193 patients, 75.6% were female. Median age at surgery was 50 years (interquartile range [IQR] 41-62). The median number of PT fractions was 31 (IQR 30-39) given over a median duration of 52 days (IQR 44-69). Fourteen patients (7.3%) also received photon radiotherapy and six patients (3.1%) stereotactic radiosurgery. Median follow-up was 4.4 years (IQR 3.86-4.71). Five-year progression-free survival (PFS) rate was 69% (95% confidence interval [CI] 62.1–76.6). For benign, atypical, and malignant meningioma, 5-year PFS rates were 71.5% (95% CI 64.4-79.4), 55.6% (95% CI 32.5-95), and 35.6% (95% CI 12.8-98.9), respectively (p<0.01). In the adjusted regression, tumour location (hazard ratio [HR]=0.1, 95% CI 0.05-0.22, p<0.001), aggressive meningioma (HR=2.26, 95% CI 1.1-4.66, p=0.027), and the need of cerebrospinal fluid (CSF) insertion for hydrocephalus (HR=3.51, 95% CI 1.32-9.31, p=0.012) remained significantly associated to the PFS. All grades considered, 5-year overall survival (OS) rates was 89.7% (95% CI 84.6-95.1). For benign, atypical, and malignant meningioma, 5-year OS rates were 93% (95% CI 88.7-97.4), 76.4% (95% CI 51.4-100), and 44.4% (95% CI 16.7-100), respectively (p<0.01). In the multivariable regression, an older age above 70 years (HR=5.95, 95% CI 2.09-16.89, p<0.001) associated to a high level of comorbidities (HR=5.31, 95% CI 1.43-19.78, p=0.013) and a malignant meningioma (HR=5.68, 95% CI 1.54-20.94, p=0.009) remained significantly associated to a reduced OS. Conclusion Five-year PFS and OS after meningioma surgery and PT is favourable but impaired for older patients with high level of morbidities, tumour of the convexity, malignant histopathology and for those requiring CSF shunting. Further inclusion and prolonged follow-up is required to assess other predictors such as sex, tumour volume, or given dose.

Methods: The current study processed the Système National des Données de Santé (SNDS), the French national administrative medical database, to retrieve appropriate cases. Results: This study identified 2,844 patients (79.1% females) between 2008 and 2017. The median age at surgery was 66 years (interquartile range [IQR], 56–75 years). Moreover, 95.9% of SMs were removed through posterior or posterolateral approaches, and 6.9% were epidural and 0.7% needed an associated spine stabilization. Benign meningioma represented 92.9%, with 5% and 2.1% atypical and malignant, respectively. The median follow-up was 3.3 years (IQR, 3.1–3.5 years). Of the patients, 0.25% and 1.2% expired within a month and a year of surgery, respectively. At data collection, 225 patients (7.9%) expired. The 5-year overall survival (OS) probability was 90.1% (95% CI, 88.6%–91.7%). However, absolute excess risk of mortality after SM surgery was null, and the related standardized mortality ratio was 1 (95% CI, 0.9–1.2; p =0.565). In the adjusted regression, age at surgery (hazard ratio [HR], 1.06; 95% CI, 1.04–1.07; p <0.001), level of comorbidities (HR, 1.44; 95% CI, 1.34–1.54; p <0.001), neurofibromatosis type 2 (NF2; HR, 3.65; 95% CI, 1.28–10.39; p =0.0152), epidural SM (HR, 1.73; 95% CI, 1.09–2.75; p =0.0206), and malignant meningioma (HR, 2.64; 95% CI, 1.51–4.61; p <0.001) remained significantly associated to a reduced OS. Conclusions The SNDS is of great value in assessing SM incidence, associated mortality, and its predictors. OS after meningioma surgery is favorable but may be impaired for NF2 or older patients with a high level of comorbidities, epidural tumor, and malignant histopathology. SM surgery is not associated with an increased absolute excess mortality risk despite being performed on even more senior patients compared with intracranial meningioma.