Review of controversies in management of non-benign meningioma

Paldor, Iddo; Awad, Mohammed; Sufaro, Yuval; Kaye, Andrew H.; Shoshan, Yigal

doi:10.1016/j.jocn.2016.03.014

Cited by 35 publications

(19 citation statements)

References 92 publications

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“…Owing to the high recurrence rate and poor outcome of WHO grade III meningiomas, it appears that the majority of neurosurgeons would refer patients with partially resected WHO grade III meningiomas to radiotherapy. [10,21] In our study, 21 patients received adjuvant radiotherapy after surgical resection, but we could not confirm the efficiency of radiotherapy, which was consistent with Champeaux et al [4] On the contrary, several studies addressed the usefulness of radiotherapy in the management of WHO grade III meningiomas. Balasubramanian et al reported that radiotherapy was associated with increased OS, and Zhao et al reported that radiotherapy was associated with increased PFS and OS in WHO grade III meningiomas.…”

Section: Discussionsupporting

confidence: 59%

Prognostic factors for patients with World Health Organization grade III meningiomas treated at a single center

Shan¹,

Zhang²,

Song

et al. 2017

Medicine

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We analyzed the characteristics of patients with World Health Organization (WHO) grade III meningioma to identify factors that may predict tumor recurrence and overall survival (OS).We retrospectively reviewed the patients diagnosed with WHO grade III meningioma who were surgically treated at our institute between 2008 and 2016. Survival outcome was assessed by Kaplan–Meier analysis. Cox regression analyses were performed to identify the prognostic factors associated with tumor recurrence and OS.Forty-two patients were included. The mean follow-up time was 23.2 months (range 2–75 months). At the end of analysis, 30 patients were found with tumor recurrence. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) were 51.6%, 33.9%, and 12.0%, respectively. At final follow-up, 23 patients were deceased, the 1-year, 3-year, and 5-year OS were 66.2%, 39.7%, and 35.8%, respectively. Twenty-eight newly diagnosed patients were included, and the 1-year, 3-year, and 5-year RFS were 63.5%, 44.3%, and 19.4%, respectively, and the 1-year, 3-year, and 5-year OS were 74.6%, 52.5%, and 46.7%, respectively. Extent of resection was the only factor associated with tumor recurrence and OS.WHO grade III meningioma is rare, and difficult to manage with a high rate of recurrence and poor OS. Extent of resection is an independent prognostic factor related to tumor recurrence and OS. We could not confirm the usefulness of Ki-67. We suggest that more aggressive treatment, such as safety maximizing cytoreduction by surgery, would improve treatment outcomes.

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Section: Discussionsupporting

confidence: 59%

Prognostic factors for patients with World Health Organization grade III meningiomas treated at a single center

Shan¹,

Zhang²,

Song

et al. 2017

Medicine

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“…The standard of care for anaplastic meningioma is to perform GTR if possible and to provide adjuvant radiotherapy. 16 Our data revealed that only about a third of all patients received adjuvant radiotherapy despite this standard. Our analysis showed that, compared to GTR alone, patients undergoing both GTR and adjuvant radiotherapy or both STR and adjuvant radiotherapy had significantly lower HRs.…”

Section: Discussionmentioning

confidence: 67%

“…For anaplastic meningiomas, which are highly aggressive and come with a poor prognosis, GTR and subsequent radiotherapy are both indicated. 16 In the present study, in which we conducted the largest-to-date Surveillance, Epidemiology, and End Results (SEER) analysis of primary meningiomas, we aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a causespecific survival benefit. Additionally, we attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas.…”

mentioning

confidence: 99%

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

Reddy¹,

Ryoo²,

Denyer³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.

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“…This case report also highlights the point that, despite being a highly recurrent aggressive tumor, the correct surgical approach and adequate tumor-free margin during resection can still ensure a recurrence-free interval despite no radiotherapy is given. [ 6 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…It is also reported that there is possibility of sarcomatous transformation of meningiomas in the pathogenesis of fibrosarcoma formation, but it usually does not present with classical herring bone pattern on histopathology. [ 4 6 7 ] Moreover, it is usually derived from meningothelial derivative type; however, intraoperatively, the tumor was more representative of anaplastic meningioma which prompted the necessity for complete Simpson 1 excision of tumor, but the final histopathology proves toward a primary fibrosarcoma of a de novo origin. [ 4 7 ]…”

Section: Discussionmentioning

confidence: 99%

Primary Central Nervous System Fibrosarcoma

Vinodh

Harun

Sellamuthu

et al. 2017

Journal of Neurosciences in Rural Practice

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We report a rare case of a young female with primary brain fibrosarcoma, and to the best of our knowledge, we believe that only <50 cases have been reported or described worldwide so far. Fibrosarcoma is a malignant neoplasm, in which histologically the predominant cells are fibroblasts that divide excessively without cellular control and they can invade local tissues or metastasize. Primary central nervous system fibrosarcomas are very aggressive neoplasms and generally have a poor prognosis. This tumor is either from sarcomatous transformation of a meningioma or arises de novo within the brain parenchyma. Our patient, a 48-year-old woman, who presented with progressive speech disorder over the period of 4 months, showed a left temporoparietal lesion with surrounding edema and local mass effect. Total surgical resection was achieved. Histopathology revealed classical fibrosarcoma features and secondary screening revealed no other distant lesion as diagnosis of primary brain fibrosarcoma was established. This case is deemed to be extremely rare because most reports claim that recurrence is within 6 months with poor prognosis; however, this patient is currently recurrence-free at 3 years. This would suggest of the possibility for a relook into this disease's course and recurrence rate when complete excision is achieved. Due to extreme rarity of these tumors, more comparative studies will be needed to improve the disease outcome.

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Review of controversies in management of non-benign meningioma

Cited by 35 publications

References 92 publications

Prognostic factors for patients with World Health Organization grade III meningiomas treated at a single center

Prognostic factors for patients with World Health Organization grade III meningiomas treated at a single center

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

Primary Central Nervous System Fibrosarcoma

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