Analysis of Prognostic Factors for Local Recurrence in Atypical Meningiomas

Shakir, S.I.; Souhami, Luís; Petrecca, Kevin; Mansure, José João; Khushdeep, S.; Panet-Raymond, Valérie; Shenouda, George; Odaini, A. Al; Abdulkarim, Bassam; Guiot, Marie‐Christine

doi:10.1016/j.ijrobp.2016.06.787

Cited by 2 publications

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“…Studies have shown questionable or no benefit, 8,12,14,15,20,25,29,37 a trend toward benefit, 1,11,13,17 or significant benefit 2,5,29,30,34 with adjuvant RT. Multiple studies have independently reported 100% 1,14,34 or near-100% 2,5,21 local control after GTR and adjuvant RT, albeit with small sample sizes of 8-22 patients. These encouraging data appear to be validated by the initial 3-year results from RTOG 0539, 32 a Phase II nonrandomized trial that showed 3-year progression-free survival of 96% in 52 intermediate-risk meningiomas that received adjuvant RT, including 36 atypical meningiomas treated with GTR and 16 recurrent WHO grade I meningiomas.…”

Section: Adjuvant Rt After Gtr Of Atypical Meningiomamentioning

confidence: 99%

“…11,26,29 Multiple studies have independently reported high rates of local control in patients receiving adjuvant RT following GTR of meningioma. 1,2,5,14,21,34 Nevertheless, there is significant variability in treatment of atypical meningioma because limited data exist to identify patients who are most likely to benefit from adjuvant RT. 35 The purpose of this study was to investigate the impact of adjuvant RT on local recurrence and overall survival (OS) in patients undergoing primary resection of atypical meningioma, and to identify predictive factors to guide patient selection for adjuvant RT.…”

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Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy

Chen

Magill

et al. 2018

Journal of Neurosurgery

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OBJECTIVEThe goal of this study was to investigate the impact of adjuvant radiotherapy (RT) on local recurrence and overall survival in patients undergoing primary resection of atypical meningioma, and to identify predictive factors to inform patient selection for adjuvant RT.METHODSOne hundred eighty-two patients who underwent primary resection of atypical meningioma at a single institution between 1993 and 2014 were retrospectively identified. Patient, meningioma, and treatment data were extracted from the medical record and compared using the Kaplan-Meier method, log-rank tests, multivariate analysis (MVA) Cox proportional hazards models with relative risk (RR), and recursive partitioning analysis.RESULTSThe median patient age and imaging follow-up were 57 years (interquartile range [IQR] 45–67 years) and 4.4 years (IQR 1.8–7.5 years), respectively. Gross-total resection (GTR) was achieved in 114 cases (63%), and 42 patients (23%) received adjuvant RT. On MVA, prognostic factors for death from any cause included GTR (RR 0.4, 95% CI 0.1–0.9, p = 0.02) and MIB1 labeling index (LI) ≤ 7% (RR 0.4, 95% CI 0.1–0.9, p = 0.04). Prognostic factors on MVA for local progression included GTR (RR 0.2, 95% CI 0.1–0.5, p = 0.002), adjuvant RT (RR 0.2, 95% CI 0.1–0.4, p < 0.001), MIB1 LI ≤ 7% (RR 0.2, 95% CI 0.1–0.5, p < 0.001), and a remote history of prior cranial RT (RR 5.7, 95% CI 1.3–18.8, p = 0.03). After GTR, adjuvant RT (0 of 10 meningiomas recurred, p = 0.01) and MIB1 LI ≤ 7% (RR 0.1, 95% CI 0.003–0.3, p < 0.001) were predictive for local progression on MVA. After GTR, 2.2% of meningiomas with MIB1 LI ≤ 7% recurred (1 of 45), compared with 38% with MIB1 LI > 7% (13 of 34; p < 0.001). Recursive partitioning analysis confirmed the existence of a cohort of patients at high risk of local progression after GTR without adjuvant RT, with MIB1 LI > 7%, and evidence of brain or bone invasion. After subtotal resection, adjuvant RT (RR 0.2, 95% CI 0.04–0.7, p = 0.009) and ≤ 5 mitoses per 10 hpf (RR 0.1, 95% CI 0.03–0.4, p = 0.002) were predictive on MVA for local progression.CONCLUSIONSAdjuvant RT improves local control of atypical meningioma irrespective of extent of resection. Although independent validation is required, the authors’ results suggest that MIB1 LI, the number of mitoses per 10 hpf, and brain or bone invasion may be useful guides to the selection of patients who are most likely to benefit from adjuvant RT after resection of atypical meningioma.

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Section: Adjuvant Rt After Gtr Of Atypical Meningiomamentioning

confidence: 99%

mentioning

confidence: 99%

Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy

Chen

Magill

et al. 2018

Journal of Neurosurgery

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Salvage therapy outcomes for atypical meningioma

et al. 2018

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Atypical menginomas demonstrate increased clinical aggressiveness characterized by recurrence and diminished survival. The optimal management of atypical meningioma in the recurrent setting is especially not well defined. To characterize outcomes following salvage treatment of recurrent atypical meningioma and to identify risk factors for further recurrence. Retrospective chart review was performed on 65 patients who underwent salvage treatment of atypical meningioma at a single institution. Data were analyzed using the Kaplan-Meier method and Cox proportional hazards modeling. Sixty-five patients with recurrent atypical meningioma and median imaging follow-up of 4.0 years (range 1.9-6.6 years) underwent 62 surgeries and 114 radiation treatments (RT) for salvage therapy. Salvage modality was surgery (21%), surgery/RT (25%), or RT alone (54%), associated with 2 year local freedom from recurrence (LFFR) of 36, 59, and 73%, respectively (P = 0.01). Twenty percent of patients experienced CTCAE grade ≥ 3 toxicity with salvage therapy. Thirty-nine percent of patients experienced ≥ 3 recurrences. The median disease-free survival intervals after first and second salvage treatments were 2.9 and 1.3 years, respectively. On univariate Cox analysis, prior subtotal resection, prior RT, tumor diameter > 2.5 cm, and multifocal local recurrence were associated with recurrence after salvage therapy. On multivariate logistic regression, only multifocal local recurrence was associated with further recurrence. Recurrent atypical meningioma is clinically and pathologically more aggressive than primary atypical meningioma, and the likelihood of durable local control with salvage therapy is lower. Future efforts should identify patients at risk of recurrence, and aggressive upfront treatment should be employed.

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Analysis of Prognostic Factors for Local Recurrence in Atypical Meningiomas

Cited by 2 publications

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Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy

Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy

Salvage therapy outcomes for atypical meningioma

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