A retrospective analysis of survival and prognostic factors after stereotactic radiosurgery for aggressive meningiomas

Radiation Oncology (Impact Factor: 2.55). 01/2014; 9(1):38. DOI: 10.1186/1748-717X-9-38
Source: PubMed


While most meningiomas are benign, aggressive meningiomas are associated with high levels of recurrence and mortality. A single institution's Gamma Knife radiosurgical experience with atypical and malignant meningiomas is presented, stratified by the most recent WHO classification.
Thirty-one patients with atypical and 4 patients with malignant meningiomas treated with Gamma Knife radiosurgery between July 2000 and July 2011 were retrospectively reviewed. All patients underwent prior surgical resection. Overall survival was the primary endpoint and rate of disease recurrence in the brain was a secondary endpoint. Patients who had previous radiotherapy or prior surgical resection were included. Kaplan-Meier and Cox proportional hazards models were used to estimate survival and identify factors predictive of recurrence and survival.
Post-Gamma Knife recurrence was identified in 11 patients (31.4%) with a median overall survival of 36 months and progression-free survival of 25.8 months. Nine patients (25.7%) had died. Three-year overall survival (OS) and progression-free survival (PFS) rates were 78.0% and 65.0%, respectively. WHO grade II 3-year OS and PFS were 83.4% and 70.1%, while WHO grade III 3-year OS and PFS were 33.3% and 0%. Recurrence rate was significantly higher in patients with a prior history of benign meningioma, nuclear atypia, high mitotic rate, spontaneous necrosis, and WHO grade III diagnosis on univariate analysis; only WHO grade III diagnosis was significant on multivariate analysis. Overall survival was adversely affected in patients with WHO grade III diagnosis, prior history of benign meningioma, prior fractionated radiotherapy, larger tumor volume, and higher isocenter number on univariate analysis; WHO grade III diagnosis and larger treated tumor volume were significant on multivariate analysis.
Atypical and anaplastic meningiomas remain difficult tumors to treat. WHO grade III diagnosis and treated tumor volume were significantly predictive of recurrence and survival on multivariate analysis in aggressive meningioma patients treated with radiosurgery. Larger tumor size predicts poor survival, while nuclear atypia, necrosis, and increased mitotic rate are risk factors for recurrence. Clinical and pathologic predictors may help identify patients that are at higher risk for recurrence.

Download full-text


Available from: Joseph Simpson, Apr 06, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atypical meningiomas (AM) frequently recur following gross total resection (GTR). We conducted a meta-analysis to evaluate the benefit of adjuvant therapy after GTR of AMs. A PubMed/MEDLINE search identified studies detailing AMs treated by GTR alone or GTR and adjuvant RT, published between 1984-2012. Original data from 14 retrospective studies were combined and analyzed. Odds ratio (OR) and chi-square testing were used when appropriate. Selected data sets were used to generate each variable, where available. 757 patients (M to F ratio 9:10) with AMs were included, 72.52%(n=549) of atypical meningiomas were treated by GTR alone and 27.47%(n=208) underwent adjuvant RT after GTR to a median dose of 54 Gy. The crude recurrence rate was twice as high without adjuvant RT(33.7% vs. 15%, P = 0.005). The 1-year local control (LC) rate was 90% for GTR and 97% for GTR + RT(OR=3.36, P=0.11). The median 5-year LC rate was 62% for GTR and 73% for GTR + RT respectively, (OR=1.71, P=0.06). The 5-yr overall survival for each group was 90% (OR=0.97, P=0.95). 85% of recurrences that were salvaged, 33% by RT and 67% required surgery. Radiation-related toxicity was <10%, at a median follow-up of 42 months. Postoperative RT for AMs may decrease risk for disease relapse and improve local control, although most tumors are salvageable with surgery or radiation. While the data suggests little or no impact of postoperative RT on survival, further investigation regarding the long term efficacy and toxicity of radiation is warranted. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · World Neurosurgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The management of WHO Grade II "atypical" meningiomas (AMs) and Grade III "malignant" meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.
    Full-text · Article · Mar 2015 · Neurosurgical FOCUS
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Object: World Health Organization Grade 2 meningiomas are aggressive tumors associated with a high recurrence rate leading to repeated surgical procedures, which can seriously worsen a patient's neurological status. Although radiosurgery is an increasingly popular technique, its role in the management of Grade 2 meningiomas has yet to be defined. In this study the authors aimed to evaluate radiosurgery in achieving control of proven tumor progression occurring after resection of Grade 2 meningioma. Methods: This retrospective study included consecutive patients who, between 2000 and 2012, had undergone radiosurgery for radiologically proven progression of a previously surgically treated Grade 2 meningioma. Results: Twenty-seven patients were eligible for analysis. There were 9 men and 18 women with a mean age of 59 years. The mean radiation dose was 15.2 Gy (range 12-21 Gy), and the mean target volume was 5.4 cm(3) (range 0.194-14.2 cm(3)). Thirty-four radiosurgical procedures were performed in the 27 patients. The mean progression-free survival after radiosurgery was 32.4 months among those with progression in a target irradiated volume and 26.4 months among those with progression in any intracranial meninges. With a mean follow-up of 56.4 months (range 12-108 months), the 12-, 24-, and 36-month actuarial local control rates for all patients were 75%, 52%, and 40%, respectively, and the regional control rates were 75%, 48%, and 33%. A single case of transient hemiparesis completely resolved without sequelae. Conclusions: Radiosurgery appears to be a safe and effective treatment for the local control of delayed progression after resection of a Grade 2 meningioma. Higher radiation doses similar to those applied for malignant tumors should be recommended when possible.
    Preview · Article · Mar 2015 · Journal of Neurosurgery
Show more