Management of atypical cranial meningiomas, part 1: predictors of recurrence and the role of adjuvant radiation after gross total resection
Document Type
Article
Abstract
BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear. OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study. METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression. RESULTS: Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/EBRT (P = .8, P > .99). CONCLUSION: 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.
Medical Subject Headings
Adult; Aged; Brain Neoplasms (surgery); Cohort Studies; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Meningeal Neoplasms (mortality, pathology, surgery); Meningioma (mortality, pathology, surgery); Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local (mortality, radiotherapy, surgery); Radiotherapy, Adjuvant; Retrospective Studies; Treatment Outcome
Publication Date
10-1-2014
Publication Title
Neurosurgery
E-ISSN
1524-4040
Volume
75
Issue
4
First Page
347
Last Page
54; discussion 354
PubMed ID
24932707
Digital Object Identifier (DOI)
10.1227/NEU.0000000000000461
Recommended Citation
Sun, Sam Q.; Kim, Albert H.; Cai, Chunyu; Murphy, Rory K.; DeWees, Todd; 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; Simpson, Joseph R.; Robinson, Clifford G.; Perrin, Richard J.; Huang, Jiayi; and Chicoine, Michael R., "Management of atypical cranial meningiomas, part 1: predictors of recurrence and the role of adjuvant radiation after gross total resection" (2014). Neurosurgery. 1483.
https://scholar.barrowneuro.org/neurosurgery/1483