Prognostic Factors and Treatment Strategies for Elderly Patients with Malignant Meningioma: A SEER Population-Based Study

Abstract

ObjectiveMalignant meningioma (MM) is a relatively rare disease with poor survival. Few studies had focused on MM in the elderly population. This study aims to explore the prognostic factors and optimal therapeutic strategy in elderly patients with MM.MethodsWe took advantage of the Surveillance, Epidemiology, and End Results (SEER) database to include 275 adult patients with histologically confirmed MM between 2011 and 2018. The Kaplan–Meier curves were plotted by different covariates to reveal the survival probability. Univariate and multivariable Cox proportional hazard regression analyses were applied to identify prognostic factors for cancer-specific survival (CSS).ResultsThe multivariable analysis in the elderly group revealed that when compared with patients receiving gross total resection (GTR), patients receiving biopsy had significantly worse CSS (HR = 3.72; 95% CI: 1.35–10.21; P = 0.011), whereas patients receiving subtotal resection (STR) had nearly the same CSS (HR = 0.83; 95% CI: 0.37–1.86; P = 0.653). Meanwhile, postoperative radiotherapy (PORT) showed no significant association with CSS in the elderly patient group (HR = 0.94; 95% CI: 0.42–2.12; P = 0.888).ConclusionSurgical resection is recommended for elderly patients with MM in the absence of surgical contraindications, but GTR does not present survival benefit in the elderly patients compared with STR. Additional large-scale clinical studies are needed to explore the survival benefit of PORT applied in patients with MM.

Grade 3 meningioma survival and recurrence outcomes in an international multicenter cohort

“…7,10 Worse survival rates among elderly patients with meningioma may be explained by higher rates of perioperative and treatment-related complications. 19,23 Interestingly, several recent studies have questioned the use of adjuvant radiotherapy in older patients given the associated complications. 23,27 However, when we stratified our analysis by age, postoperative radiotherapy remained a significant independent predictor of improved OS in patients aged ≥ 65 years, supporting its use in older individuals with grade 3 meningioma.…”

“…7,11,12,21,22 Selection of thresholds for stratification by age and KPS was based on a combination of data-driven approaches and prior research. 10,12,23 Locations were divided into convexity, parafalcine, spheno-orbital/orbital, posterior, and anterior and middle cranial fossae, and survival comparisons made with convexity as the reference location. We explored the relationship between baseline characteristics, histopathological features, and OS and PFS using Cox regression models.…”

The safety and use of perioperative dexamethasone in the perioperative management of primary sporadic supratentorial meningiomas

“…corticosteroid use during adjuvant radiation in meningioma requires caution due to its impact on survival and treatment efficacy, as reported in glioma therapies ( 46 ). Current practices for adjuvant radiotherapy in WHO grade 3 meningioma, based on EANO guidelines and various studies, are not uniform, with some showing no survival benefit in older patients ( 47 , 48 ), while others suggest improved outcomes ( 49 ). However, it is advised to limit steroid use for asymptomatic or mildly symptomatic edema due do the risks of prolonged administration.…”