Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

Authors

Colin J. Przybylowski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Benjamin K. Hendricks, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Charuta G. Furey, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Joseph D. DiDomenico, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.Follow
Randall W. Porter, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Nader Sanai, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Kaith K. Almefty, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Andrew S. Little, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.

Document Type

Article

Abstract

This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas.  This study is a retrospective volumetric analysis.  This study was conducted at a single institution.  Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007-July 1, 2017).  The main outcome was radiographic tumor progression.  Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm . Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV ( p  = 0.01) and history of more than 1 previous surgery ( p  = 0.03) as independent predictors of tumor progression. In a Kaplan-Meier analysis for PFS, the RTV threshold of 3 cm maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm thresholds ( p  < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm and >3 cm were 76.2 and 32.1%, respectively. When RTV >3 cm was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression ( p  < 0.01).  RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible.

Publication Date

6-1-2022

Publication Title

Journal of neurological surgery. Part B, Skull base

ISSN

2193-6331

Volume

83

Issue

Suppl 2

First Page

e530

Last Page

e536

PubMed ID

35832958

Digital Object Identifier (DOI)

10.1055/s-0041-1733974

Recommended Citation

Przybylowski, Colin J.; Hendricks, Benjamin K.; Furey, Charuta G.; DiDomenico, Joseph D.; Porter, Randall W.; Sanai, Nader; Almefty, Kaith K.; and Little, Andrew S., "Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas" (2022). Neurosurgery. 2179.
https://scholar.barrowneuro.org/neurosurgery/2179