Long term follow up in 183 high grade meningioma: A single institutional experience

Abstract

Introduction: Meningiomas are usually considered benign lesions, however a proportion of them shows a more aggressive behavior, defined high-grade meningiomas (HGM). Effective medical treatments are lacking, especially at the time of recurrence. Methods: Through a retrospective analysis, we examined epidemiological, diagnostic, therapeutic, recurrence information and survival data of HGM treated at our institution between 2010 and 2018. Results: 183 patients (105 females and 78 males), with median age of 58 years (25-88), were included; 168 were atypical, 12 anaplastic, 3 rhabdoid. Overall, m-PFS was 4.2 years, and m-OS was 10.3 years. Gross-total resection had a 5-year survival rate of 95% compared with subtotal/partial resection (86% and 67%) (p = 0.002). Higher expression of Ki-67/MIB-1 seems associated with higher risk of death (HR:1.06 with 95% CI, 1.00-1.12, p = 0.03). No statistically significant differences were seen in survival between the group managed with a wait-andsee strategy vs the group treated with RT while a difference on PFS was seen (4.1 years vs 5.2 years p = 0.03). After second recurrence, the most employed treatments were systemic therapies with a very limited effect on disease control. Conclusions: Data confirmed the aggressive behavior of HGM. The extent of resection seems to correlate with a favorable outcome regardless histological subtypes. The role of RT remains controversial, with no statistically significant impact on OS but a possible role on PFS. Recurrent HGM remains the real challenge, to date no chemotherapies are able to achieve disease control. Future research should focus on biological/molecular predictors in order to achieve a patient-tailored treatment.

Paired Primary and Recurrent Rhabdoid Meningiomas: Cytogenetic Alterations, BAP1 Gene Expression Profile and Patient Outcome

“…Interestingly, patients undergoing RT after the first surgery presented with a lower number of recurrences suggesting that patients under early adjuvant RT treatment might have prolonged RFS rates and/or time to a second relapse in association with a longer OS. However, these preliminary data are not consistent with previous findings in atypical meningiomas that indicate that early postoperative adjuvant RT has no significant impact on patient OS despite a potential benefit on RFS [48,49], the potential value of RT therapy remaining a matter of debate [44,45,50].…”

Long-term follow-up in high-grade meningioma and outcome analysis

“…where they have found the five-year survival to be 95% and 67% for patients with GTR and STR, respectively. [ 13 ] In our study, individuals who received GTR of the tumor had a 23-fold improved likelihood of survival. As a result, it backs up the current recommendation for maximum safe excision in high-grade meningiomas.…”

Management of Recurrent Meningiomas: State of the Art and Perspectives

“…Amongst predictors of recurrence, the WHO grade and location are the strongest [ 3 , 8 , 29 ], while clinical and radiological parameters are also to be considered [ 69 ]. The role of genomics and genetic profiling is being increasingly discussed [ 70 , 71 , 72 , 73 ]. Besides, PFS is directly related to the EOR in any WHO grade.…”