Anaplastic Meningioma: Clinical Characteristics, Prognostic Factors and Survival Outcome

Abstract

Background Anaplastic meningioma is very rare and is generally known to have a poor prognosis. However, due to its rarity, the relationship between clinical prognosis and prognostic factors is not clear. We analyzed the prognostic factors influencing survival outcomes of patients with anaplastic meningioma. Moreover, we analyzed on the progression pattern and the response to treatment about anaplastic meningioma. Methods Retrospective review of 48 patients with diagnosis of World Health Organization (WHO) grade 3 meningioma was performed. According to diagnosis type, primary anaplastic meningioma was included in 28 cases and secondary anaplastic meningioma in 20 cases. Gross total resection was performed in 36 patients (75.0%), and 32 patients (66.7%) received adjuvant radiotherapy after tumor resection with confirmed WHO grade 3 meningioma. Kaplan-Meier survival curve and Cox proportional hazards modeling were used for outcome analysis. Results The median progression-free survival (PFS) and overall survival (OS) were 13.9 months (95% confidence interval [CI], 8.8 to 19.1) and 56.9 months (95% CI, 24.1 to 89.7), respectively. Adjuvant radiotherapy was a robust prognostic factor for PFS and OS. Extent of resection and diagnosis type which appeared to be significant prognostic factors in univariate analysis were failed to prove statistical significance in multivariate analysis. Conclusion Adjuvant radiotherapy is an essential treatment arm in patients with anaplastic meningiomas. Stereotactic radiosurgery seems to play an important role as a salvage treatment. But chemotherapy seems to have limited efficacy. Because of the disseminated nature of the disease, further investigations to improve survival outcome are needed.

Re-Irradiation of Anaplastic Meningioma: Higher dose and concomitant Bevacizumab may improve progression-free survival

“…3 Meningiomas harboring homozygous deletions of CDKN2A/B are characterized by high recurrence rates independent of WHO grade, DNA methylation class, sex, age, and tumor location. 4 Additionally, heterozygous loss, mutations, and promoter methylation of CDKN2A were strongly associated with recurrent meningiomas and a high Ki-67 index. 8 Physiologically, the proteins encoded by CDKN2A/B halt the cell cycle; consequently, homozygous loss leads to dysregulated cell cycle progression and uncontrolled proliferation.…”

“…2 The histopathological hallmark of anaplastic meningioma is high mitotic activity, cellular atypia, and frequent necrosis, with 2021 WHO incorporating genomics and molecular data into this classi cation. 3,4 These aggressive features underscore the urgent need for effective management strategies, especially in recurrent diseases, where treatment guidelines are notably scarce. Literature on the toxicity associated with re-irradiation in this speci c clinical setting is conspicuously limited, accentuating the necessity for a comprehensive evaluation of outcomes related to local control, overall survival, and treatment-related adverse events.…”

Intracranial meningiomas at a tertiary hospital: Spectrum of MRI findings with histopathologic correlation

“…An isolated case of anaplastic meningioma was also present. A fact sometimes overlooked and under-investigated is that these rare meningiomas can metastasize to extracranial locations, reported in up to 16.6% of cases in a recent retrospective review by Seo et al 39 and carry an overall poor prognosis. These tumours may exhibit suspicious features; however, some studies showed no significant differences in appearance of benign and anaplastic subtypes.…”

Paths of Evolution of Progressive Anaplastic Meningiomas: A Clinical and Molecular Pathology Study

“…Age and clinical status are well-established prognosticators [ 24 ]. As concerns the extent of resection, while GTR is a common goal in lower grade meningioma, its role in grade III meningioma management is still not clear [ 25 , 26 ]. In progressive meningioma, GTR can be very difficult to achieve due to previous treatments.…”