Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features

Abstract

The 2000 WHO classification has identified the truly aggressive meningiomas better than did the previous criteria. A precise meningioma grading system may help to avoid over-treatment of patients with an atypical meningioma as, once the tumour has "declared itself" by recurrence and histological features, it becomes a tumour that is poorly amenable to current therapies.

DNA Microarray Analysis Identifies CKS2 and LEPR as Potential Markers of Meningioma Recurrence

“…Recent data showed that gene expression of cyclin-dependent kinase subunit Cks2 is repressed by the tumor suppressor p53 [38]. Although p53 mutations are rare in meningiomas [39], several reports showed higher expression in atypical and anaplastic meningiomas [40,41] and in one set of data based on an analysis of 80 meningiomas, specifically in grade I relapsing meningiomas [42]. These observations support future investigations on the relationship between higher p53 and CKS2 expression levels in meningiomas that switch to aggressive patterns of growth.…”

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

“…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.…”

“…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. Interestingly, studies have shown that after controlling for EOR, a skull base location does not correlate with recurrence in AMs (8 of 8 studies), 24,37,46,48,57,77,78,85 and therefore should not necessarily trigger a recommendation of adjuvant EBRT after GTR.…”

“…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). If supported by additional validation studies, necrosis may become a valuable biomarker with which to tailor treatment for patients.…”

“…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).…”