Anaplastic meningioma: an analysis of the National Cancer Database from 2004 to 2012

Abstract

OBJECTIVE Anaplastic meningiomas represent 1%-2% of meningioma diagnoses and portend a poor prognosis. Limited information is available on practice patterns and optimal management. The purpose of this study was to define treatment patterns and outcomes by treatment modality using a large national cancer registry. METHODS The National Cancer Database was used to identify patients diagnosed with anaplastic meningioma from 2004 to 2012. Log-rank statistics were used to compare survival outcomes by extent of resection, use of adjuvant radiotherapy (RT), and use of adjuvant chemotherapy. Least-squares linear regression was used to evaluate the utilization of RT over time. Logistic regression modeling was used to identify predictors of receipt of RT. Cox proportional hazards modeling was used to evaluate the effect of RT, gross-total resection (GTR), and chemotherapy on survival. RESULTS A total of 755 adults with anaplastic meningioma were identified. The 5-year overall survival rate was 41.4%. Fifty-two percent of patients received RT, 7% received chemotherapy, and 58% underwent GTR. Older patients were less likely to receive RT (OR 0.98, p < 0.01). Older age (HR 1.04, p < 0.01), high comorbidity score (HR 1.33, p = 0.02), and subtotal resection (HR 1.57, p = 0.02) were associated with increased risk of death on multivariate modeling, while RT receipt was associated with decreased risk of death (HR 0.79, p = 0.04). Chemotherapy did not have a demonstrable effect on survival (HR 1.33, p = 0.18). CONCLUSIONS Anaplastic meningioma portends a poor prognosis. Gross-total resection and RT are associated with improved survival, but utilization of RT is low. Unless medically contraindicated, patients with anaplastic meningioma should be offered RT.

Adjuvant treatment of meningioma with stereotactic radiation surgery and hypofractionated stereotactic radiation surgery: Patterns of care and survival in a large, hospital database

“…Even though the need for adjuvant radiation for anaplastic meningiomas is more or less established, the role of adjuvant radiation in the treatment of atypical and certain benign meningiomas is less clear 6 , 20 and often based on clinical and pathologic factors such as the extent of the resection, the presence of symptoms, and whether or not the tumor is recurrent. 6 , 8 , 10 , 11 , 21 A recent analysis of the NCDB demonstrated that GTR in combination with adjuvant radiation was found to be the most important factor for improved survival even though GTR was associated with lower rates of adjuvant radiation usage. 22 The Radiation Therapy Oncology Group investigated the role of postoperative radiation in the treatment of meningiomas on the basis of risk stratification ( https://clinicaltrials.gov/ct2/show/NCT00895622 ).…”

“… 2 , 3 The decision to use adjuvant radiation in the treatment of meningiomas is somewhat more nuanced but again depends on the grade of the tumor as well as the extent of the surgical resection. 4 Adjuvant radiation has been suggested to improve survival in anaplastic meningiomas 5 , 6 , 7 and recent data support its use for select benign or atypical meningiomas. 8 , 9 , 10 , 11 …”

A rare subtype of meningioma

“…The primary treatments for anaplastic meningioma are resection and adjuvant radiotherapy. [ 17 ] A study by Orton et al [ 7 ] indicated that adjuvant radiotherapy improved survival in patients with anaplastic meningioma. Another study by Garzon-Muvdi et al [ 18 ] also indicated an association between radiotherapy and improved clinical outcomes.…”

“…In a study of 755 cases, Orton et al [ 7 ] found that the 5-year overall survival rate of patients with anaplastic meningioma was 41.4%. In addition, they found that the factors associated with poor prognosis included older age, high comorbidity score, and subtotal resection.…”

“…In addition, they found that the factors associated with poor prognosis included older age, high comorbidity score, and subtotal resection. [ 7 ] Moreover, a study by Moliterno et al [ 8 ] revealed that patients with primary anaplastic meningioma had better survival than those with anaplastic meningioma arising from low-grade meningioma.…”