Management of Atypical Cranial Meningiomas, Part 1

Sun, Sam Q.; Kim, Albert H.; Cai, Chunyu; Murphy, Rory K.J.; DeWees, T.A.; Sylvester, Peter; Dacey, Ralph G.; Grubb, Robert L.; Rich, Keith M.; Zipfel, Gregory J.; Dowling, Joshua L.; Leuthardt, Eric C.; Leonard, Jeffrey R.; Evans, John A.; Simpson, Joseph R.; Robinson, C.G.; Perrin, Richard J.; Huang, Jiayi; Chicoine, Michael R.

doi:10.1227/neu.0000000000000461

Cited by 121 publications

(22 citation statements)

References 39 publications

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“…Radiation therapy to treat meningiomas in general is used when there is residual tumor after surgical resection or to treat recurrence of the tumor [11,26,27]. In our study we found that patients who received radiation had earlier tumor related death as compared to patients who did not receive radiation.…”

Section: Discussionmentioning

confidence: 49%

“…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: 70%

“…Some of these characteristics include genetic abnormalities, extent of surgical resection, need for adjuvant radiation, and histological features such as mitotic rates; however, most of these factors have not been verified in a large cohort [5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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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: 49%

Section: Discussionmentioning

confidence: 70%

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Atypical and anaplastic meningioma: outcomes in a population based study

et al. 2017

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“…Several previous studies have attempted to address the controversy about whether PORT can improve the outcome in atypical meningioma patients undergoing GTR. Some studies did not show significant survival benefit from PORT in these patients (8, 10–14). However, the missing significance has been suspected as a result of small sample size, and some studies also found a contradictory result that PORT could improve the outcome (6, 7, 9, 15).…”

Section: Discussionmentioning

confidence: 90%

Effectiveness of Postoperative Radiotherapy on Atypical Meningioma Patients: A Population-Based Study

2019

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Purpose: It is controversial whether atypical meningioma patients undergoing gross-total resection (GTR) can benefit from postoperative radiotherapy (PORT). This study aimed to investigate the effectiveness of PORT on atypical meningioma patients.Methods: Patients diagnosed with atypical meningioma from 2008 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier survival curves were generated, and the log-rank test was used to compare the differences among groups. Univariable and multivariable COX regressions were conducted for survival analyses.Results: A total of 1,014 patients were enrolled. The 5-years survival rate of the overall patients was 79.0%. PORT was performed in 315 (31.1%) patients. The utilization rates of PORT in patients undergoing GTR and undergoing subtotal resection (STR) were 26.7% and 42.2%, respectively. For patients undergoing STR, log-rank test showed that overall survival (OS) time was significantly longer in patients receiving PORT than those not (p = 0.026). For patients undergoing GTR, OS time did not show significant association with PORT (p = 0.339). In addition, patients undergoing STR with PORT had no significantly different OS time compared with those undergoing GTR with PORT (p = 0.398). Multivariable Cox regression analysis showed that receipt of PORT (p = 0.187) was not an independent predictor of OS after adjustment.Conclusion: PORT may not prolong the OS in atypical meningioma patients undergoing GTR. However, patients undergoing STR may benefit from PORT and achieve similar OS to those undergoing GTR.

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“…Radiosurgery may offer greater patient convenience, less adverse effects, and similar local control to traditional XRT techniques [ 9 ]. While it has been used for some time in the definitive or salvage settings for inoperable patients, reports of adjuvant SRS for resected lesions are rare [ 9 - 12 ].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Care and Outcomes of Adjuvant Radiotherapy for Meningiomas: A Surveillance, Epidemiology, and End Results and Medicare Linked Analysis

Amsbaugh

Ugiliweneza

Burton

et al. 2016

Cureus

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Background: The role of adjuvant stereotactic radiosurgery (SRS) and fractionated radiotherapy (XRT) are unknown in patients with resected meningiomas.Objective: To identify patterns of care and outcomes of adjuvant radiotherapy for meningiomas in the Linked Surveillance, Epidemiology, and End Results (SEER) Medicare data.Methods: A total of 1,964 patients older than 66 years included in the SEER-Medicare data, who were diagnosed with meningioma, and underwent craniotomy were included for analysis.Results: Patients were less likely to receive adjuvant therapy if they were older than 75 (OR 0.730, 95% CI 0.548-0.973), female sex (OR 0.731, 95% CI 0.547-0.978), or unmarried (OR 0.692, 95% CI 0.515-0.929). Patients were more likely to receive adjuvant treatment for Grade II/III tumors (OR 5.586, 95% CI 2.135-13.589), tumors over 5 cm (OR 1.850, 95% CI 1.332-2.567), or partial resection (OR 3.230, 95% CI 2.327-4.484). Yearly between 2000 and 2009, 10.65 – 19.77% of patients received adjuvant therapy. Although no survival benefit was seen with the addition of adjuvant therapy (p = 0.1236), the subgroup of patients receiving SRS had a decreased risk of death compared to those receiving surgery alone (aHR 0.544, 95% CI 0.318 – 0.929).Conclusion: Utilization of adjuvant XRT and SRS remained stable between 2000 and 2010. Male sex, young age, marriage, partial resection, Grade II/III tumors, and large tumors predicted the use of adjuvant therapy. For all patients, SRS decreased the risk of death compared to craniotomy alone.

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Management of Atypical Cranial Meningiomas, Part 1

Abstract: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.

Cited by 121 publications

References 39 publications

Atypical and anaplastic meningioma: outcomes in a population based study

Atypical and anaplastic meningioma: outcomes in a population based study

Effectiveness of Postoperative Radiotherapy on Atypical Meningioma Patients: A Population-Based Study

Patterns of Care and Outcomes of Adjuvant Radiotherapy for Meningiomas: A Surveillance, Epidemiology, and End Results and Medicare Linked Analysis

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