Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma

Zhu, Hongda; Bi, Wenya Linda; Aizer, Ayal A.; Hua, Lingyang; Tian, Mi; Den, Jiaojiao; Tang, Hailiang; Chen, Hong; Wang, Yin; Mao, Ying; Dunn, Ian F.; Xie, Qing; Gong, Yi

doi:10.1002/cam4.1531

Cited by 70 publications

(43 citation statements)

References 26 publications

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“…Hilary et al demonstrated that adjuvant radiotherapy for meningiomas resected with Simpson grade I-III improved local control rates [16]. The prognosis of primary anaplastic meningiomas has been shown to be improved by adjuvant radiotherapy; however, in the subgroup analyses, no significant improvement was observed in either PFS or OS in patients with recurrent meningiomas [17]. In the present study, radiotherapy did not improve PFS and OS for overall patients.…”

Section: Discussioncontrasting

confidence: 54%

“…In the recent decade, the efficacy of adjuvant radiotherapy has been demonstrated for high-grade meningiomas [15][16][17]. Hilary et al demonstrated that adjuvant radiotherapy for meningiomas resected with Simpson grade I-III improved local control rates [16].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies 17] and SBMs [18,19] after initial surgical resection. Various forms of adjuvant radiotherapy, including fractionated radiotherapy and stereotactic radiosurgery, have been found to improve local control [16,17,19]. However, the efficacy of adjuvant radiotherapy for the recurrent stage of SBMs remains unclear [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Various forms of adjuvant radiotherapy, including fractionated radiotherapy and stereotactic radiosurgery, have been found to improve local control [16,17,19]. However, the efficacy of adjuvant radiotherapy for the recurrent stage of SBMs remains unclear [16,17]. Few studies have specifically investigated prognostic factors of recurrent SBMs.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

Kuranari

Tamura

Tsuda

et al. 2019

JCM

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Skull base meningiomas (SBMs) are considered to be less aggressive and have a slower growth rate than non-SBMs. However, SBMs often develop local recurrences after surgical resection. Gross total removal is difficult because SBMs are deep-seated tumors and involve critical neurovascular structures. The treatment strategy for recurrent SBMs remains controversial. The present study aimed to evaluate the long-term clinical course and prognostic factors associated with shorter progression-free survival (PFS) of recurrent SBMs. This retrospective study included 85 recurrent SBMs from 65 patients who underwent surgery from January 2005 to September 2018. Overall survival (OS) and PFS were evaluated, and the associations among shorter PFS and age, sex, tumor size, lesions, World Health Organization (WHO) grading, removal rate, and time since prior surgery were analyzed. The median follow-up period for PFS was 68 months. The 2-, 5-, and 10-year PFS rates were 68.0%, 52.8%, and 22.7%, respectively. WHO grade II or III, multiple lesions, and tumor size were significantly associated with shorter PFS (p < 0.0001, p = 0.030, and p = 0.173, respectively). Although, radiotherapy did not improve PFS and OS for overall patients, PFS of the patients with subtotal and partial removal for WHO grade II SBMs was significantly improved by the radiotherapy. Multivariate analysis identified WHO grade II or III and multiple lesions as independent prognostic factors for shorter PFS (p < 0.0001 and p = 0.040, respectively). It is essential to estimate the risks associated with shorter PFS for patients with recurrent SBMs to aid in the development of appropriate postoperative strategies.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

Kuranari

Tamura

Tsuda

et al. 2019

JCM

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“…After surgery, radiation is usually used as adjuvant therapy at many institutions for patients with grade III meningiomas (even after GTR) and incompletely resected grade II meningiomas [7]. It has been reported that GTR and adjuvant radiation were associated with improved local control of the tumor [5, 9, 10]. However, the long-term impacts of GTR and radiotherapy for patients’ survival are still unclear, even on the modern management of high-grade meningiomas according to the adapted WHO diagnostic criteria (WHO 2000/2007 editions) [2, 7].…”

Section: Introductionmentioning

confidence: 99%

Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas

Jiang

Shijie

et al. 2019

J Neurooncol

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PurposeWe aim to investigate the impacts of extent of resection and adjuvant radiotherapy on survival of high-grade meningiomas (WHO grade II–III) according to modern diagnosis and management.MethodsPatients with high-grade meningiomas were identified in the Surveillance Epidemiology and End Results (SEER) database between 2000 and 2015 and used for survival analysis. Propensity score matching (PSM) was conducted to reduce selection bias. Another 92 patients from Sun Yat-sen University Cancer Center (SYSUCC) were used for validation.Results530 patients were enrolled from SEER. Patients with gross total resection (GTR) had no significantly different overall survival (OS) compared with those with subtotal resection (STR), even after performing PSM between these two groups. Multivariable analysis found that age ≥ 65 years (HR 2.22, P < 0.001), tumor diameter > 6 cm (HR 1.59, P = 0.004) and grade III tumor (HR 4.31, P < 0.001) were associated with worse OS. Stratification analysis showed that adjuvant radiotherapy conferred significantly improved OS for grade III meningiomas, but not for grade II meningiomas, regardless of resection extent. In SYSUCC cohort, resection extent was also not significantly associated with OS. However, patients with GTR (Simpson grade I–III) had distinctly increased progression-free survival (PFS) than those with STR (P < 0.001). Additionally, for grade II meningiomas after GTR, radiotherapy was unable to improve OS and PFS.ConclusionOn modern management of high-grade meningiomas, GTR does not improve OS, but seems to be associated with increased PFS. Radiotherapy is reasonable as a supplement for treating grade III meningiomas, whereas its effect for grade II meningiomas remains uncertain and needs further validation by prospective study.Electronic supplementary materialThe online version of this article (doi:10.1007/s11060-019-03278-w) contains supplementary material, which is available to authorized users.

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Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma

Zhu

Aizer

et al. 2019

Cancer Medicine

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The effect of adjuvant radiotherapy in management for high‐grade meningiomas, especially atypical meningiomas, remains controversial. We aimed to explore the role of adjuvant radiotherapy in this population. A total of 162 adults with high‐grade meningiomas (99 atypical meningiomas and 63 anaplastic meningiomas) were treated from 2003 to 2008 at Huashan Hospital. One hundred and seventeen patients presented with primary and 45 with recurrent disease. One hundred and fifteen patients (70.9%) were treated with adjuvant radiotherapy after surgical resection. The median follow‐up was 76.5 months (range 1‐142 months). Kaplan‐Meier survival curve and Cox proportional hazards modeling were used for analyses. Adjuvant radiotherapy was associated with prolonged progression‐free survival (PFS) and overall survival (OS) in patients with newly diagnosed anaplastic meningiomas irrespective of extent of resection (PFS, P = .001; OS, P = .003). Gross total resection was the only independent prognostic factor for those with newly diagnosed atypical meningiomas (PFS, P < .001; OS, P = .012). A survival benefit for adjuvant radiation was also found in subgroup analysis of patients with high‐grade meningiomas who underwent subtotal resection (PFS, P = .023; OS, P = .013). Among recurrent high‐grade meningiomas, radiotherapy offered no statistically significant improvement in either PFS or OS. Adjuvant radiotherapy is associated with improved survival in patients with newly diagnosed anaplastic meningiomas and those high‐grade meningiomas following subtotal resection. However, there was no significant correlation identified between postoperative radiation and outcome for recurrent high‐grade meningiomas. Future prospective randomized trials may help clarify the optimal tailored treatment for patients with high‐grade meningioma.

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Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma

Cited by 70 publications

References 26 publications

Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas

Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma

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