Utility of mFI-5 Scores in Patients Undergoing Stereotactic Radiosurgery for Meningiomas

Introduction: Meningiomas are the most common diagnosed primary intracranial tumor. While surgical excision can confer long term tumor control, stereotactic radiosurgery (SRS) is increasingly employed for patients who are not ideal surgical candidates or in patients with small recurrent disease. Frailty has been associated with increased rates of peri-operative morbidity, but its relationship in the setting of SRS has not been studied. We therefore sought to examine the relationship between frailty scores and clinical/radiographic outcomes of patients with meningiomas who have undergone SRS.

Methods: A single-center, retrospective cohort study was conducted and patients were classified by their 5-factor modified frailty index (mFI-5) score into pre-frail (mFI-5: 0-1), frail (mFI-5: 2), and severely-frail (mFI-5: 3+) at the time of SRS treatment. Evaluations of overall survival (OS) and progression free survival (PFS) were performed using Kaplan-Meier analysis. Cox proportional hazards regression analysis was then used to further elucidate factors contributing to OS/PFS.

Results: A total of 94 patients met inclusion criteria and underwent SRS for treatment of meningioma from 2019-2023. Analyses compared prefrail (0-1) and frail (2-3+) individuals. Kaplan-Meier analysis demonstrated earlier mortality in the frail group (36-month survival: 70%) versus the pre-frail group (36-month survival: 90.6%), although survival did not significantly differ between groups (P = 0.20). Progression-free survival was demonstrated to be similar between groups (P = 0.90). Univariate Cox proportional hazards regression analyzed age, sex, mFI5, prior surgical excision, hypertension, diabetes, COPD, CHF, and KPS. None of these factors individually predicted overall survival. In contrast, prior surgical excision significantly predicted progression-free survival (HR = 8.1, P = 0.047). In a multivariable analysis adjusted for prior surgical incision, mFI5 did not predict progression/death.

Conclusion : Frailty, as assessed by the mFI-5, did not independently predict overall survival or progression-free survival in individuals with meningioma undergoing SRS. SRS is well tolerated in the frail population.