Primary management of atypical meningioma: treatment patterns and survival outcomes by patient age

Barthélemy, Ernest J.; Loewenstern, Joshua; Konuthula, Neeraja; Pain, Margaret; Hall, Jordan; Govindaraj, Satish; Bederson, Joshua B.; Shrivastava, Raj

doi:10.1007/s00432-018-2618-4

Cited by 25 publications

(19 citation statements)

References 34 publications

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“…The majority of data that supports this approach comes from retrospective analyses [27,28], including previous NCDB descriptions of aggressive meningiomas (anaplastic and papillary) [11,12], which may explain the differences in practice patterns with less than 23% of grade II and 51.1% of grade III tumors reporting its use. Interestingly, an NCDB investigation for atypical meningiomas showed an age related benefit of radiation (<55 years and >75 years) [9]. Older age was a risk factor for mortality in our analysis, and was also a protective factor for receiving radiation, markedly between 65 and 74 years of age.…”

Section: Discussionmentioning

confidence: 48%

“…Treatment approaches for meningiomas include either observation alone, radiation alone, or surgical resection with or without radiation, and rarely, in cases with progression, a trial of systemic treatment, although there are no FDA approved therapies. Patients may be treated conservatively in small, asymptomatic tumors, whereas radiation therapy is reserved to prevent further growth in high grade lesions or in cases where a complete resection cannot be performed [9], with limited level 1 evidence on treatment recommendations.…”

Section: Introductionmentioning

confidence: 99%

“…An early investigation using the National Cancer Database (NCDB) included cases from 1985 to 1988 and 1990 to 1992 [10]. Subsequent analyses of the NCDB focused on discussions of high-grade meningiomas [9,[11][12][13] and limited their cohorts to patients with surgical or histological confirmation; these investigations may not be representative of treatment or decision estimates of all patients with diagnosis of meningioma. In addition, a recent NCDB analysis focused on grade I intracranial meningiomas that included cases without WHO grade as grade I [14].…”

Section: Introductionmentioning

confidence: 99%

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Initial management of meningiomas: Analysis of the National Cancer Database

García

Slone

Chau

et al. 2019

Cancer Epidemiology

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Background: Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States. Methods: We analyzed the National Cancer Database from 2004-2014, for all patients with diagnosis of meningioma. Results: 201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial management of meningiomas: Analysis of the National Cancer Database

García

Slone

Chau

et al. 2019

Cancer Epidemiology

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“…5 In atypical meningioma, the standard of care is GTR when possible, although there is no consistency regarding the role of radiotherapy. 2,3,19 Our analysis showed that more than a quarter of all atypical meningiomas were treated with adjuvant radiotherapy. In cases in which STR was performed with adjuvant radiotherapy, there was a significantly increased hazard as compared to GTR alone.…”

Section: Discussionmentioning

confidence: 87%

“…5 For atypical meningiomas, which have a higher rate of recurrence, standard practice is to perform GTR when possible; however, there is ongoing debate over whether adjuvant radiotherapy should be provided in cases in which GTR is successful, with studies showing various effects on survival. 2,3,19 The advent of newer, more focused radiotherapy options has added to the question of whether to radiate in these cases and whether that radiation will improve outcomes. For anaplastic meningiomas, which are highly aggressive and come with a poor prognosis, GTR and subsequent radiotherapy are both indicated.…”

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confidence: 99%

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

Reddy¹,

Ryoo²,

Denyer³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.

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Incidence and survival of benign, borderline, and malignant meningioma patients in the United States from 2004 to 2018

Cao

Yan

et al. 2022

Intl Journal of Cancer

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Meningioma is the most common primary central nervous system tumor, and its incidence is increasing. A systematic epidemiological and clinical analysis is required to better estimate its public health impact and understand its prognostic factors. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2018 for all types of meningiomas without an age restriction.Age-adjusted incidence rates (IRs) and 95% confidence intervals were estimated according to sex, age, race, ethnicity, and tumor location. Kaplan-Meier analysis and multivariate Cox proportional hazard models were used to analyze the overall survival (OS). The competing risk regression model of Fine-Gray was used to analyze cause-specific survival. Data from a total of 109 660 meningioma patients were analyzed. A majority of patients were older than 60 years, and only 0.41% of patients were 0-19 years. The meningioma IRs were higher in females, Black, and non-Hispanic patients than in males, White, and Hispanic patients, respectively, and IRs increased with age. The ratio of IRs for females to males was 2.1 and also increased with age, peaking at 3.6 in the 45-49-year-old group. Older and male patients with all types of meningiomas, Black patients with benign and borderline meningiomas, and patients with larger borderline and malignant meningiomas showed poorer prognosis. For all meningioma types, surgical resection improved survival. The reported incidence rates and survival trends covered all demographics and subtypes of meningiomas. Older age, male sex, Black race, and tumor size may be important prognostic factors for meningioma cases, and tumor resection can substantially improve survival among meningioma patients.

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Primary management of atypical meningioma: treatment patterns and survival outcomes by patient age

Cited by 25 publications

References 34 publications

Initial management of meningiomas: Analysis of the National Cancer Database

Initial management of meningiomas: Analysis of the National Cancer Database

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

Incidence and survival of benign, borderline, and malignant meningioma patients in the United States from 2004 to 2018

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