A comparison of World Health Organization tumor grades at recurrence in patients with non-skull base and skull base meningiomas Clinical article

Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 10/2009; 112(5):925-33. DOI: 10.3171/2009.9.JNS09617
Source: PubMed


Despite a favorable outcome for most patients with WHO Grade I meningiomas, a subset of these patients will have recurrent or progressive disease that advances to a higher grade and requires increasingly aggressive therapy. The goal of this study was to identify clinical characteristics associated with the recurrence of benign meningiomas and their acceleration to atypical and malignant histological types.
Records of 216 patients with WHO Grade I, II, or III meningioma that were initially treated between 1965 and 2001 were retrospectively reviewed. Median follow-up was 7.2 years.
Patients with non-skull base cranial meningiomas (82 of 105 [78%]) were more likely to have undergone a gross-total resection than patients with skull base meningiomas (32 of 78 [41%]; p < 0.001). Consequently, patients with Grade I non-skull base cranial meningiomas had better 5-year recurrence-free survival (69%) than patients with Grade I skull base meningiomas (56%) or Grade II or III tumors at any site (50%; p = 0.005). Unexpectedly, patients with non-skull base tumors who experienced a recurrence (8 of 22 [36%]) were more likely than patients with skull base tumors (1 of 19 [5%]) to have a higher grade tumor at recurrence (p = 0.024). Furthermore, the median MIB-1 labeling index of Grade I non-skull base cranial meningiomas (2.60%) was significantly higher than that of Grade I skull base tumors (1.35%; p = 0.016).
Cranial meningiomas that occur outside of the skull base are more likely to have a higher MIB-1 labeling index and recur with a higher grade than those within the skull base, suggesting that non-skull base cranial tumors may have a more aggressive biology than skull base tumors.

10 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Meningiomas are common benign tumors of the central nervous system. Patients with meningiomas achieve postoperative optimal functional recovery, but there is a probability of tumor recurrence months or years after surgical resection. This study aims to evaluate the prevalence of recurrent meningioma and the correlation between tumor recurrence and certain factors. Materials and Methods: We performed a retrospective descriptive-analytical study of patients with meningiomas who underwent surgical treatment in hospitals affiliated with Shiraz University of Medical Sciences during a 20-year period (1988 to 2008). Factors including sex, age, bone changes, peritumoral edema, histological subtypes, tumor size, shape, location and resection degree, and recurrence time were evaluated in each patient. Results: The recurrence rate of intracranial meningioma in a total of 644 patients included in the study was 10%. Statistical analysis of data showed a correlation between edema, bone changes, tumor size and shape, and histological subtypes. No relationship was found between age, sex and tumor location. This study has shown a statistical correlation between radiotherapy and a reduced probability of tumor recurrence or growth after surgical resection. Conclusion: Although the majority of meningiomas are benign, they can have malignant presentations. Recurrence occurs after a shorter period of time in patients with malignant and atypical meningiomas than in patients with benign meningiomas. Edema, bone changes, large size, special tumor shape and malignant histological subtypes are important prognostic factors that predict the probability of tumor recurrence or growth. Findings show a statistical correlation between the degree of tumor resection and its recurrence. This study recommends a more complete tumor resection along with adjuvant therapy and closer follow-up to decrease the risk of tumor recurrence.
    Preview · Article · Apr 2007 · Tehran University Medical Journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Spontaneous intratumoral hemorrhage associated with a meningioma is an extremely rare event and has a very high rate of morbidity and mortality. We report a patient with a history of subtotal resection of a petroclival meningioma followed by gamma knife radiosurgery who presented with sudden neurological deterioration following intratumoral hemorrhage after 4 asymptomatic years. The patient underwent early resection of this atypical meningioma and evacuation of hematoma via a retrosigmoid transpetrosal approach and had rapid neurological improvement.
    Full-text · Article · Nov 2010 · Skull Base
  • [Show abstract] [Hide abstract]
    ABSTRACT: Definitive data allowing clinicians to predict which meningioma patients will fail to respond to conservative management are lacking. To address this need, the authors systematically reviewed the published literature regarding the natural history of small, untreated meningiomas. The authors performed a systematic review of the existing literature on untreated meningiomas that were followed with serial MR imaging. They summarize the published linear rates of tumor growth, and the risk factors for development of new or worsened symptoms during follow-up by using a stratified chi-square test. The search methods identified 22 published studies reporting on 675 patients with untreated meningiomas followed by serial MR imaging. Linear growth rates varied significantly: no growth was the most common rate, although reports of more aggressive tumors noted growth rates of up to a 93% linear increase in size per year. The authors found that few patients with initial tumor diameters < 2 cm went on to develop new or worsened symptoms over a median follow-up period of 4.6 years. Patients with initial tumor diameters of 2-2.5 cm demonstrated a marked difference in the rate of symptom progression if their tumors grew > 10% per year, compared with those tumors growing ≤ 10% per year (42% vs 0%; p < 0.001, chi-square test). Patients with tumors between > 2.5 and 3 cm in initial size went on to develop new or worsened symptoms 17% of the time. This systematic review of the literature regarding the clinical behavior of untreated meningiomas suggests that most meningiomas ≤ 2.5 cm in diameter do not proceed to cause symptoms in the approximately 5-year period following their discovery. Those that do cause symptoms can usually be predicted with close radiographic follow-up. Based on these findings, the authors suggest the importance of observation in the early course of treatment for small asymptomatic meningiomas, especially those with an initial diameter < 2 cm.
    No preview · Article · Nov 2010 · Journal of Neurosurgery
Show more