Skull base atypical meningioma: Long term surgical outcome and prognostic factors

Wang, Yu-Chi; Chuang, Chi‐Cheng; Wei, Kuo‐Chen; Hsu, Yung-Hsin; Hsu, Peng‐Wei; Lee, Shih‐Tseng; Wu, Chieh‐Tsai; Tseng, Chen‐Kan; Wang, Chun‐Chieh; Chen, Yao-Liang; Jung, Shih Ming; Chen, Pin-Yuan

doi:10.1016/j.clineuro.2014.11.009

Cited by 45 publications

(42 citation statements)

References 31 publications

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“…2,3,45 These studies reported improved LC or a trend toward improved LC with adjuvant EBRT and GTR versus GTR alone (p = 0.04, p = 0.09, and p = 0.10; tine adjuvant EBRT after GTR (Table 3). 13,24,26,37,46,48,59,78,81,85 Eight of these 10 studies did not detect any significant improvement in PFS with adjuvant EBRT, and the remaining 2 studies did not detect any significant improvement in LC. The discrepancy between these and the aforementioned 3 studies may in part be due to the categorization of less intrinsically aggressive or more radiation-resistant meningiomas as 2000/2007 WHO AMs compared with the 1993 WHO criteria.…”

Section: Adjuvant Ebrt After Gtrmentioning

confidence: 99%

“…The 5-year PFS after GTR is 59%-90% but the 5-year PFS after subtotal resection (STR) is only 30%-70% (Table 2). 13,24,26,46,48,59,77,78,81,85,87 For each of these studies, GTR shows a significant benefit over STR or Simpson Grade IV resection for AMs (EBM Level 3, Grade 1C recommendation). However, "maximal safe resection" may be a more appropriate strategy than GTR, given the surgical morbidity associated with resection in certain locations (e.g., cavernous sinus).…”

Section: Surgical Managementmentioning

confidence: 99%

“…Five of 8 studies using 2000/2007 WHO guidelines demonstrated improved PFS after adjuvant EBRT (Table 4). 24,26,37,46,48,59,77,81 However, Grade II meningiomas represent a heterogeneous group of tumors, 47,51,53 and not all patients may benefit equally from adjuvant EBRT. 24,26,77,85 In particular, histological necrosis has been shown to be a strong predictor of radioresistance in a large study by Sun et al, 77 such that the efficacy of adjuvant EBRT may be limited in AMs with necrosis (EBM Level 3, Grade 2C recommendation).…”

Section: Str and Adjuvant Ebrtmentioning

confidence: 99%

“…Independent prognostic factors for reduced time to recurrence after resection of 2000/2007 WHO AMs include elevated mitotic index (5 of 6 studies), 37,46,57,78,80 elevated Ki 67 index (3 of 8 studies), 8,80,81 brain invasion (2 of 4 studies), 78,80 sheeting (1 of 3 studies), 46 and histological necrosis (1 of 3 studies). 46 Studies supporting adjuvant EBRT may be reporting on more aggressive AMs, which could account for their high recurrence rates after GTR (27%-32%) and the trends toward improved LC with adjuvant EBRT.…”

Section: Adjuvant Ebrt After Gtrmentioning

confidence: 99%

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An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

118

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The management of WHO Grade II “atypical” meningiomas (AMs) and Grade III “malignant” meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.

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Section: Adjuvant Ebrt After Gtrmentioning

confidence: 99%

Section: Surgical Managementmentioning

confidence: 99%

Section: Str and Adjuvant Ebrtmentioning

confidence: 99%

Section: Adjuvant Ebrt After Gtrmentioning

confidence: 99%

See 2 more Smart Citations

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

118

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“…Furthermore interesting results have been found with cavernous sinus meningiomas [59] or parasagittal meningiomas [60] involving the posterior third of the superior sagittal sinus.…”

Section: Radiotherapymentioning

confidence: 72%

Meningiomas’ Management: An Update of the Literature

Cossu¹,

Messerer²,

Parker³

et al. 2016

Neurooncology - Newer Developments

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Meningiomas are the most common primary intracranial tumors in the adult population [1]. They are generally considered benign lesions but after the 2007 WHO classification, the proportion of atypical meningiomas has steeply increased. Surgery is considered the mainstay of the treatment and a complete resection is considered curative in WHO grade I meningiomas. The role of adjuvant treatments like radiotherapy (stereotactic radiosurgery or conventional external beam irradiation) and chemotherapy in more aggressive cases is still discussed, above all in WHO grade II meningiomas. We would like to expose the most important advances in meningiomas' management in accordance with the recent literature evidences.

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Extent of resection and overall survival for patients with atypical and malignant meningioma

Aizer

Kandola

et al. 2015

Cancer

161

109

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BACKGROUND:The prognosis for patients with atypical and malignant meningioma is guarded; whether the extent of resection is associated with survival-based outcomes in this population remains poorly defined. This study investigated the association between gross total resection (GTR) and all-cause mortality in patients with atypical and malignant meningioma. METHODS: The Surveillance, Epidemiology, and End Results program was used to identify 575 and 64 patients betweens the ages of 18 and 70 years who were diagnosed with atypical and malignant meningioma, respectively, between 2004 and 2009. Multivariate Cox proportional hazards regression was used to assess the adjusted impact of GTR versus subtotal resection on all-cause mortality. RESULTS: Baseline patient characteristics were similar for patients who did undergo GTR and patients who did not undergo GTR. The 5-year overall survival rates were 91.3% (95% confidence interval [CI], 86.2%-94.5%) and 78.2% (95% CI, 70.0%-84.3%) for patients with atypical meningioma who did and did not undergo GTR, respectively, and 64.5% (95% CI, 45.9%-78.1%) and 41.1% (95% CI, 17.9%-63.1%) for patients with malignant meningioma who did and did not undergo GTR, respectively. After adjustments for available, pertinent confounding variables, GTR was associated with lower all-cause mortality in patients with atypical (hazard ratio, 0.39; 95% CI, 0.23-0.67; P <.001) and malignant meningioma (hazard ratio, 0.35; 95% CI, 0.15-0.81; P 5.01). CONCLUSIONS: The extent of resection is a powerful predictor of outcome for patients with atypical and malignant meningioma. These data highlight the hazard associated with the presence of gross tumor bulk after surgery and suggest a value for more extensive resections that should be balanced against the additional potential morbidity. Cancer 2015;121:4376-81.

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Skull base atypical meningioma: Long term surgical outcome and prognostic factors

Cited by 45 publications

References 31 publications

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Meningiomas’ Management: An Update of the Literature

Extent of resection and overall survival for patients with atypical and malignant meningioma

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