We greatly appreciate the insightful comments from Dr Corrales García and Dr. Delgado López [1]. We are in full agreement and acknowledge the shortcomings in the manuscript that they have raised concerning this retrospective observational study [2].
The size, location, and recurrent nature of the tumors are presented in the data and accounted for. As a matter of fact, the size is one of the persistent adverse indicators of outcome.
We presented the radiotherapy data by modality and protocol as they are in the record. We analyzed each modality individually (stereotactic fractionated radiation therapy, radiosurgery, and proton beam) and found that all were risk factors for recurrence, and that stereotactic fractionated radiation therapy and radiosurgery were also risk factors for cause-specific death.
The concept of “clinical control” versus “radiological control” is well established in tumor oncology [3]. It is applied in outcome studies of radiated meningiomas [4,5] and specifically in gamma knife radiosurgery outcomes, as Kondziolka et al. stated “clinical tumor control rate (no resection required)” [6]. It is mainly used to indicate that the tumor is still under control despite its growth. Thus, we analyzed and reported both, as is common in similar articles.
We concur with Dr. Corrales García and Dr. Delgado López on the well-known effect of radiation on DNA and tumor progression, which our study shows to be very significant in meningiomas.
We are very cognizant of and cited some of the conspicuous literature that shows superlative outcomes of the modern radiation therapy on WHO grade I meningioma, including three of the references kindly provided by Dr. Corrales García and Dr. Delgado López.
We have the same reservation about the article by Alfredo et al., with a short follow-up of a median of 36 months [7].
Unfortunately, there has not been a prospective double-blinded “level I evidence-based” study on the effect of radiation on WHO grade I. The prospective study cited only addresses the outcome of WHO grade I meningiomas that had not received irradiation [8].
As we indicated, the length of follow-up is the critical factor that explains the contradictions between the results of the relatively short follow-up in comparison to our extended long-term follow-up. We believe that for WHO grade I meningioma studies, a minimum of 10 years needs to pass.
Author Contributions
Conceptualization, O.A.-M.; methodology, A.G.L., and O.A.-M.; software, A.G.L., and O.A.-M.; validation, A.G.L., R.A., and O.A.-M.; formal analysis, A.G.L., R.A., and O.A.-M.; investigation, A.G.L., and O.A.-M.; resources, A.G.L., and O.A.-M.; data curation, A.G.L.; writing—original draft preparation, A.G.L., R.A., and O.A.-M.; writing—review and editing, A.G.L., R.A., and O.A.-M.; visualization, A.G.L., and O.A.-M.; supervision, O.A.-M.; project administration, O.A.-M.; funding acquisition, NA. All authors have read and agreed to the published version of the manuscript.
Conflicts of Interest
The authors declare no conflict of interest.
References
- Corrales-García, E.M.; Delgado-López, P.D. Comment on Giotta Lucifero et al. Impact of Irradiation on Post-Surgical Residuals of WHO Grade I Meningioma. J. Clin. Med. 2025, 14, 5829. J. Clin. Med. 2025, 14, 8790. [Google Scholar] [CrossRef]
- Giotta Lucifero, A.; Almefty, R.; Al-Mefty, O. Impact of Irradiation on Post-Surgical Residuals of WHO Grade I Meningioma. J. Clin. Med. 2025, 14, 5829. [Google Scholar] [CrossRef] [PubMed]
- Huang, R.Y.; Bi, W.L.; Weller, M.; Kaley, T.; Blakeley, J.; Dunn, I.; Galanis, E.; Preusser, M.; McDermott, M.; Rogers, L.; et al. Proposed response assessment and endpoints for meningioma clinical trials: Report from the Response Assessment in Neuro-Oncology Working Group. Neuro Oncol. 2019, 21, 26–36. [Google Scholar] [CrossRef] [PubMed]
- Fu, J.; Zeng, J.; Huang, M.; Liang, S.; He, Y.; Xie, L.; Deng, Y.; Yu, J. Primary versus postoperative gamma knife radiosurgery for intracranial benign meningiomas: A matched cohort retrospective study. BMC Cancer 2022, 22, 206. [Google Scholar] [CrossRef] [PubMed]
- Fu, J.; Wu, L.; Peng, C.; Yang, X.; You, H.; Cao, L.; Deng, Y.; Yu, J. Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience. Front. Oncol. 2020, 10, 598582. [Google Scholar] [CrossRef] [PubMed]
- Kondziolka, D.; Levy, E.I.; Niranjan, A.; Flickinger, J.C.; Lunsford, L.D. Long-term outcomes after meningioma radiosurgery: Physician and patient perspectives. J. Neurosurg. 1999, 91, 44–50. [Google Scholar] [CrossRef] [PubMed]
- Conti, A.; Senger, C.; Acker, G.; Kluge, A.; Pontoriero, A.; Cacciola, A.; Pergolizzi, S.; Germanò, A.; Badakhshi, H.; Kufeld, M.; et al. Normofractionated stereotactic radiotherapy versus CyberKnife-based hypofractionation in skull base meningioma: A German and Italian pooled cohort analysis. Radiat. Oncol. 2019, 14, 201, Erratum in Radiat. Oncol. 2020, 15, 279. https://doi.org/10.1186/s13014-020-01707-z. [Google Scholar] [CrossRef] [PubMed]
- Rogers, C.L.; Pugh, S.L.; Vogelbaum, M.A.; Perry, A.; Ashby, L.S.; Modi, J.M.; Alleman, A.M.; Barani, I.J.; Braunstein, S.; Bovi, J.A.; et al. Low-risk meningioma: Initial outcomes from NRG Oncology/RTOG 0539. Neuro Oncol. 2023, 25, 137–145. [Google Scholar] [CrossRef]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).