Atypical and Malignant Meningiomas

Mahmood, Asim; Caccamo, Darío V.; Tomecek, Frank J.; Malik, Ghaus M.

doi:10.1097/00006123-199312000-00001

Cited by 37 publications

(30 citation statements)

References 21 publications

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“…77 A number of other reports have suggested that GTR alone is sufficient for these patients. 39,73,75,102,105 Jaaskelainen reported a 38% 5-year local recurrence after GTR, and did not find that adjuvant RT was of utility. 55 However, no randomized trials have been completed; many of the studies in the literature had small cohorts, used pre-WHO 2000 grading criteria, included patients with newly diagnosed and recurrent tumors, or used RT doses that were, as will be discussed subsequently, likely too low to be effective.…”

Section: Resultsmentioning

confidence: 90%

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Rogers

Barani

Chamberlain

et al. 2015

JNS

526

402

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Evolving interest in meningioma, the most common primary brain tumor, has refined contemporary management of these tumors. Problematic, however, is the paucity of prospective clinical trials that provide an evidence-based algorithm for managing meningioma. The current review summarizes the published literature regarding the treatment of newly diagnosed and recurrent meningioma, with an emphasis on outcomes stratified by World Health Organization (WHO) tumor grade. In particular this review focuses on patient outcomes following treatment (either adjuvant or at recurrence) with surgery or radiation therapy inclusive of radiosurgery and fractionated irradiation. Phase II trials for patients with meningioma have recently completed accrual within the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) consortia, and phase III studies are being developed. However, at present, there are no completed prospective, randomized trials assessing the role of either surgery or radiotherapy. Successful completion of future studies will require a multidisciplinary effort, dissemination of the current knowledge base, improved implementation of WHO grading criteria, standardization of response criteria and other outcome endpoints, and concerted efforts to address weaknesses in present treatment paradigms, particularly for patients with progressive or recurrent low grade meningioma, or with high-grade meningioma. In parallel efforts, Response Assessment in Neuro-Oncology (RANO) subcommittees are developing a manuscript on systemic therapies for meningioma, and a separate article proposing standardized endpoint and response criteria for meningioma.

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Section: Resultsmentioning

confidence: 90%

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Rogers

Barani

Chamberlain

et al. 2015

JNS

526

402

View full text Add to dashboard Cite

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“…Although females have an overall increased incidence of meningiomas, other studies have also reported an increased risk for atypical and malignant meningiomas associated with male gender 21, 32 . The mechanism by which male gender increases risk is currently unclear.…”

Section: Discussionmentioning

confidence: 95%

“…The possibility that skull base meningiomas are at decreased risk for high-grade behavior has been suggested for some time 21, 22 , however there are fewer papers on the subject attempting to establish the true risk in a statistically sound manner, raising the possibility that the risk reduction conferred by a skull base location has been overestimated by the failure to control for confounders. In this study, we utilize multivariate logistic regression to test the hypothesis that skull base meningiomas are less likely to be a grade II or III meningioma, after controlling for other confounding variables.…”

Section: Introductionmentioning

confidence: 99%

Anatomic location is a risk factor for atypical and malignant meningiomas

Kane

Sughrue

Rutkowski

et al. 2010

Cancer

175

101

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Background Grade II and III meningiomas have higher rates of tumor recurrence than grade I meningiomas after surgery and/or external irradiation. As the utility of non-invasive treatments for brain tumors increases, it is becoming increasingly important to assess the likelihood that a tumor is not benign before treatment initiation. Hence, we have reviewed a large-series of our patients to determine risk-factors for higher-grade pathology with particular interest paid towards tumor location. Methods We reviewed 378 patients presenting to our institution from 2000 to 2007 with: histologically confirmed meningioma, central pathology grading according to the WHO 2000 guidelines, and tumor location confirmed with preoperative imaging. We performed univariate and multivariate logistic regression on potential risk-factors for high-grade pathology. Results Risk-factors for grade II/III pathology included non-skull base location (twofold) and male gender (two-fold). Patients with prior surgery had a three-fold increased incidence of higher-grade meningiomas at presentation to our center. We controlled for this referral bias by performing a multivariate regression, and analysis without patients receiving prior treatment. 97% of operations were performed for tumor size and clinical symptoms, while less than 3% for interval growth or features concerning of higher-grade pathology. Conclusion Non-skull-base meningiomas, male gender, and prior surgery impart increased risk for grade II or III pathology. This increased risk translates to probable poorer prognosis and increased likelihood of recurrence after treatment. Thus, it is prudent to take these specific variables into consideration in conjunction with the complete clinical presentation when advising patients regarding their prognosis.

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“…Typical benign meningiomas are easily diagnosed, but their distinction from more malignant by using conventional MRI is still a difficulty (2). Heterogeneous appearance and enhancement, edema around the lesion, and irregular cerebral surface are not consistent and unique neuroimaging features for diagnosing malignant meningiomas (3 –6). To define a diagnostic method is desirable for accurate differentiation between benign and malignant meningiomas before surgery, to aid in surgical and treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of apparent diffusion coefficient for the accurate assessment and differentiation of intracranial meningiomas

Bano

Waraich

Khan

et al. 2013

Acta Radiologica Short Reports

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BackgroundDiffusion-weighted imaging (DWI) along with the calculation of apparent diffusion coefficient (ADC), is a novel, non-invasive, and reliable technique of choice for accurate assessment and for the treatment planning of different types of brain tumors. It is more advantageous in the distinction and differentiation of benign from malignant meningiomas on the basis of ADC values.PurposeTo investigate the utility of DW magnetic resonance imaging (MRI), and to compare the apparent diffusion coefficient (ADC) obtained at two b-values for an authentic and preoperative characterization of meningiomas.Material and MethodsTwenty-six patients with clinically diagnosed or histologically verified meningioma (18 benign and 8 malignant) underwent imaging including DWI at 1.5 T. DW images were obtained at b = 1000 s/mm2 and b = 2000 s/mm2, ADC maps were generated at both the b-values. Signal intensities (SIs) and ADCs for solid tumorous tissues, contralateral normal tissues, and peritumoral edema were calculated and normalized ADC (NADC) ratio were determined for tumorous tissues. SI scores, ADC maps, and ADC values were analyzed visually and quantitatively, and were compared at both the b-values.ResultsDW images at b = 2000 s/mm2 were more conspicuity (either hyperintense or hypointense) with improved contrast. The mean ADC of malignant meningiomas (0.64 ± 0.05 and 0.42 ± 0.03) was significantly lower (P < 0.05) as compared with benign meningiomas (1.04 ± 0.12 and 0.80 ± 0.07) at both the b-values. Mean NADC ratio in the malignant type was also significantly lower (P < 0.05) than the benign type at both the b-values. Mean ADC values for peritumoral edema do not differ between benign and malignant meningiomas.Conclusion1.5-T DWI using high b-values improved our ability to differentiate benign from malignant meningiomas. DWI may play an important role in the preoperative radiological evaluation and the recognition of these types for proper surgical treatment.

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Atypical and Malignant Meningiomas

Cited by 37 publications

References 21 publications

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Anatomic location is a risk factor for atypical and malignant meningiomas

Diagnostic value of apparent diffusion coefficient for the accurate assessment and differentiation of intracranial meningiomas

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