Early adjuvant radiotherapy in the treatment of atypical meningioma

Jenkinson, Michael D.; Waqar, Mueez; Farah, Jibril Osman; Farrell, Michael; Barbagallo, Giuseppe; McManus, Robin; Looby, Seamus; Hussey, Deirdre; Fitzpatrick, David; Certo, Francesco; Javadpour, Mohsen

doi:10.1016/j.jocn.2015.09.021

Cited by 68 publications

(34 citation statements)

References 38 publications

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“…Further, there may be large inter-institutional discrepancies in the use of radiation therapy for AAM patients. Early adjuvant radiation for AAM has been analyzed in a multicenter study and was not found to be beneficial to atypical meningioma patients [11,28] This lack of effect on survival or PFS was independent of extent of resection, however, there was selection bias present in this study. Other studies have shown benefit of radiation therapy in PFS but not in OS [19,29,30].…”

Section: Discussionmentioning

confidence: 72%

Atypical and anaplastic meningioma: outcomes in a population based study

et al. 2017

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Atypical and anaplastic meningiomas (AAM) are aggressive tumors. This study is aimed at examining associations between patient and tumor-related factors and tumor-related death in patients with AAM. We conducted a population-based cohort study utilizing prospectively collected data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with diagnosis of AAM from 1973 to 2012 in the SEER database were included. Patients lacking clinical information were excluded. Multivariate analysis between patient and lesion characteristics, and AAM-related death was performed to adjust for confounding factors. We identified and included 522 patients in our study. Mean age at diagnosis was 60.8 ± 15.7 years. The majority of patients were White(73%), 15.5% Black, and 9.8% Asian. Average tumor size was 48.2 ± 20.3 mm. The tumor was locally confined in 57.1%, whereas it had intracranial extension in 29.3%, and extracranial extension in 8.8% of patients. The vast majority (94.8%) of tumors were supratentorial. Gross total resection (GTR) was documented in 65.5% of patients. Age at diagnosis (p = 0.001), tumor size (p = 0.003), surgery result (GTR vs. subtotal resection, p = 0.027), and radiation therapy (p = 0.2) were found to be significantly different between the comparison groups. In a multivariate proportional competing risk regression analysis age (HR 1.03, CI [1.01,1.04], p < 0.001), infratentorial location (HR 2.81, CI [1.20, 6.56], p = 0.017), tumor size (HR 1.01, CI [1.00,1.02], p = 0.032),and radiation treatment (HR 1.52, CI [1.11, 2.09], p = 0.01) were significantly associated with tumor-related death. The association of age at diagnosis, tumor size, location, and radiotherapy with overall survival in patients with AAM is demonstrated. The results provide a context for individualized treatment plans in patients with AAM. Additional studies focusing on issues such as the use of radiation and chemotherapy will clarify the best modality to achieve disease control.

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Section: Discussionmentioning

confidence: 72%

Atypical and anaplastic meningioma: outcomes in a population based study

et al. 2017

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“…Even though the completeness of resection was not consistently significant in multivariate analysis, residual tumor is a well-established risk factor for meningioma recurrence [ 4 , 17 , 18 ]. Because of conflicting results from retrospective studies, the effect of postoperative radiation remains controversial [ 4 , 17 , 19 , 20 , 21 , 22 ], while no prospective data is available yet.…”

Section: Discussionmentioning

confidence: 99%

Identification of High-Risk Atypical Meningiomas According to Semantic and Radiomic Features

Kalasauskas

Kronfeld

Renovanz

et al. 2020

Cancers

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Up to 60% of atypical meningiomas (World Health Organization (WHO) grade II) reoccur within 5 years after resection. However, no clear radiological criteria exist to identify tumors with higher risk of relapse. In this study, we aimed to assess the association of certain radiomic and semantic features of atypical meningiomas in MRI with tumor recurrence. We identified patients operated on primary atypical meningiomas in our department from 2007 to 2017. An analysis of 13 quantitatively defined radiomic and 11 qualitatively defined semantic criteria was performed based on preoperative MRI scans. Imaging characteristics were assessed along with clinical and survival data. The analysis included 76 patients (59% women, mean age 59 years). Complete tumor resection was achieved in 65 (86%) cases, and tumor relapse occurred in 17 (22%) cases. Mean follow-up time was 41.6 (range 3–168) months. Cystic component was significantly associated with tumor recurrence (odds ratio (OR) 21.7, 95% confidence interval (CI) 3.8–124.5) and shorter progression-free survival (33.2 vs. 80.7 months, p < 0.001), whereas radiomic characteristics had no predictive value in univariate analysis. However, multivariate analysis demonstrated significant predictive value of high cluster prominence (hazard ratio (HR) 5.89 (1.03–33.73) and cystic component (HR 20.21 (2.46–166.02)) for tumor recurrence. The combination of radiomic and semantic features might be an effective tool for identifying patients with high-risk atypical meningiomas. The presence of a cystic component in these tumors is associated with a high risk of tumor recurrence.

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“…Managing these patients requires evaluating the role of adjuvant therapy in both patients receiving GTR and STR. A growing body of literature suggests that early adjuvant radiotherapy improves local control [7–9]; however, the effect on OS is more disputed with some recent studies finding no benefit [7,27]. Some of the inconsistencies reported in the literature could be a result of the variability in the administration of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Early or late radiotherapy following gross or subtotal resection for atypical meningiomas: Clinical outcomes and local control

Dohm

McTyre

Chan

et al. 2017

Journal of Clinical Neuroscience

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We report a single institution series of surgery followed by either early adjuvant or late radiotherapy for atypical meningiomas (AM). AM patients, by WHO 2007 definition, underwent subtotal resection (STR) or gross total resection (GTR). Sixty-three of a total 115 patients then received fractionated or stereotactic radiation treatment, early adjuvant radiotherapy (≤4 months after surgery) or late radiotherapy (at the time of recurrence). Kaplan Meier method was used for survival analysis with competing risk analysis used to assess local failure. Overall survival (OS) at 1, 2, and 5 years for all patients was 87%, 85%, 66%, respectively. Progression free survival (PFS) at 1, 2, and 5 years for all patients was 65%, 30%, and 18%, respectively. OS at 1, 2, and 5 years was 75%, 72%, 55% for surgery alone, and 97%, 95%, 75% for surgery + radiotherapy (log-rank p-value = 0.0026). PFS at 1, 2, and 5 years for patients undergoing surgery without early adjuvant radiotherapy was 64%, 49%, and 27% versus 81%, 73%, and 59% for surgery + early adjuvant radiotherapy (log-rank p-value = 0.0026). The cumulative incidence of local failure at 1, 2, and 5 years for patients undergoing surgery without early External Beam Radiation Therapy (EBRT) was 18.7%, 35.0%, and 52.9%, respectively, versus 4.2%, 13.3%, and 20.0% for surgery and early EBRT (p-value = 0.02). Adjuvant radiotherapy improves OS in patients with AM. Early adjuvant radiotherapy improves PFS, likely due to the improvement in local control seen with early adjuvant EBRT.

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Early adjuvant radiotherapy in the treatment of atypical meningioma

Cited by 68 publications

References 38 publications

Atypical and anaplastic meningioma: outcomes in a population based study

Atypical and anaplastic meningioma: outcomes in a population based study

Identification of High-Risk Atypical Meningiomas According to Semantic and Radiomic Features

Early or late radiotherapy following gross or subtotal resection for atypical meningiomas: Clinical outcomes and local control

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