Atypical Meningiomas: Recurrence, Reoperation, and Radiotherapy

Klinger, Daniel R.; Flores, Bruno C.; Lewis, Jo; Hatanpaa, Kimmo J.; Choe, Kevin S.; Mickey, Bruce; Barnett, Samuel L.

doi:10.1016/j.wneu.2015.04.033

Cited by 74 publications

(36 citation statements)

References 29 publications

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“…In contrast, the rate after the second and third surgery in our cohort was higher than the series reported in the literature (23.8% vs. 14%). This main be explained by the high proportion of skull-base meningiomas in our cohort (up to 50%), since these meningiomas represents an increased surgical challenge and an increased risk of postoperative morbidity in case of surgical re-treatment at the site of a previous surgery 10,28 .…”

Section: Discussionmentioning

confidence: 94%

“…While the literature on predictive factors and management of meningioma recurrence is abundant, little is known on the natural history of repeated meningioma recurrence, its therapeutic management and its impact on tumor evolution 5,6,[10][11][12][13] . In this study, based on one of the largest consecutive population-based cohorts to date, we identified the rate of surgical re-intervention for recurrent meningiomas, the predictive factors of recurrence, as well as postoperative outcomes of recurrent surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Benefits of re-do surgery for recurrent intracranial meningiomas

Lemée

Corniola

Meling

2020

Sci Rep

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Meningiomas are the most common intracranial extra-axial tumor. While the literature is abundant on the therapeutic management of meningioma recurrence after the initial surgery, the natural history of repeated recurrences is poorly described, as well as and their respective management. A partly retrospective, partly prospective review was conducted in a Norwegian cohort of 1469 consecutive cases of meningioma surgically treated, totaling 11 414 patient-years of follow-up. 114 recurrences (7.7%) were treated surgically with a risk a surgical retreatment of 1% per patient-year of follow-up. 36 patients were operated on 3 times or more. The time-to-retreatment (TTR) decreased significantly and steadily between surgeries, from 4.3 ± 4 years after the first surgery to 2.4 ± 2.9 years after the third surgery. The primary driver for recurrence was the WHO grade (OR 7.13 [4.40;11.55], p < 0.001 for the first recurrence and OR 4.13 [1.49;12.15], p 0.008 for the second), the second predictive factor being a skull base location (OR 2.76 [1.95;3.99] p < 0.001 and OR 0.24 [0.09;0.65], p0.006 respectively). The rates of postoperative hematomas and infections were not influenced by the number of surgeries, whereas the rate of postoperative neurological worsening increased from 3.9% to 16.6% and 13.9%, respectively, after the first, second, and third surgeries. We observed that the TTR decreased significantly between surgeries in patients requiring repeated resections, indicating that surgical treatment of recurrences does not reset the clock but is indeed a "race against time". This should be considered when assessing the benefit-to-risk ratio of patients undergoing repeated surgeries for a recurrent meningioma. Meningiomas are the most frequent intracranial extra-cerebral tumors 1,2. They are classified according to the World Health Organization (WHO) in histopathological grades from I to III 3. The therapeutic management is primarily surgical, aimed at a complete resection of the tumor with its dural tail 4 , followed by a clinico-radiological follow-up 5,6. This "intervention-first" paradigm allows for high rates of disease-control 6,7. However, the majority of meningiomas show slow growth, making their therapeutic management similar to a chronic disease with a lengthy clinico-radiological follow-up 8,9. Should the tumor recur, the treatment is surgical whenever possible, according to the patient's functional status and Karnofsky Performance Scale (KPS). Stereotactic or conventional radiation therapies are privileged otherwise. Therefore, early recognition of recurrence and its management is of paramount importance for neurosurgeons. While the literature is abundant on the therapeutic management of meningioma recurrence after the initial surgery, the natural history of repeated recurrences and their therapeutic management is poorly described. Furthermore, there is little information regarding the interval between surgeries (or any treatment) and successive recurrences. Such information would be useful to assess the benefit-...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Benefits of re-do surgery for recurrent intracranial meningiomas

Lemée

Corniola

Meling

2020

Sci Rep

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“…Moreover, invasive growth was found to correlate with both survival and progression in irradiated patients harboring atypical meningiomas, while investigations on other histopathological criteria were not included in their analyses 10 and further studies could not show any correlation of brain invasion with prognosis. 8,12 Finally, although different subtypes of brain invasion have been previously described, [12][13][14] as the first study so far we investigated and excluded correlations of invasion patterns with any prognostic variable.…”

Section: Brain Invasion and Prognosismentioning

confidence: 99%

“…anaplastic or irradiated atypical meningiomas. [8][9][10][11] Moreover, correlations with clinical variables 10 and studies on different invasion subtypes are even more uncommonly reported. [12][13][14] Thus, we aimed to investigate the frequency of brain invasion in a large series of meningiomas diagnosed between 1994 and 2009 and its correlation with clinical variables and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Brain Invasion in Meningiomas: Incidence and Correlations with Clinical Variables and Prognosis

et al. 2016

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“…11 Furthermore, a lower MIB-1 did not correlate with increased RFS, which is in contrast with case series of atypical meningiomas. 16 Other studies have also suggested that GTR may improve RFS and OS compared with subtotal resection. 8,11 The lack of significant difference in local recurrence based on extent of resection in the current study is likely due to insufficient cohort size.…”

Section: Factors Associated With Recurrence and Metastasismentioning

confidence: 98%

Intracranial Hemangiopericytomas: Recurrence, Metastasis, and Radiotherapy

et al. 2017

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Intracranial hemangiopericytomas (HPCs) are characterized by high recurrence rates and extracranial metastases. Radiotherapy provides an adjunct to surgery, but the timing of therapy and the patients most likely to benefit remain unclear. A retrospective review of 20 patients with HPC treated at the University of Texas Southwestern Medical Center between 1985 and 2014 was conducted. Recurrence and metastasis rates along with overall survival (OS) were characterized based on therapeutic approach and tumor pathology using Kaplan-Meier and Cox regression analyses. The mean age was 45.6 years (range: 19-77). Gross total resection (GTR) was achieved in 13 patients, whereas 5 patients underwent subtotal resection. Median follow-up was 91.5 months (range: 8-357). The 5-, 10-, and 15-year recurrence-free survival (RFS) rates were 61, 41, and 20%, respectively. Six patients developed metastases at an average of 113 months (range: 42-231). OS at last follow-up was 80%. Importantly, immediate postoperative adjuvant radiotherapy (IRT) did not influence RFS compared with surgery alone or OS compared with delayed radiotherapy at the time of recurrence. HPCs have high recurrence rates necessitating close follow-up. Surgery remains an important first step, but the timing of radiotherapy for optimal control and OS remains uncertain.

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Atypical Meningiomas: Recurrence, Reoperation, and Radiotherapy

Cited by 74 publications

References 29 publications

Benefits of re-do surgery for recurrent intracranial meningiomas

Benefits of re-do surgery for recurrent intracranial meningiomas

Brain Invasion in Meningiomas: Incidence and Correlations with Clinical Variables and Prognosis

Intracranial Hemangiopericytomas: Recurrence, Metastasis, and Radiotherapy

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