Radiotherapy as an adjuvant in the management of intracranial meningiomas: are we practising evidence-based medicine?

Marcus, HJ; Price, Stephen J.; Wilby, Martin; Santarius, Thomas; Kirollos, R. W.

doi:10.1080/02688690802308687

Cited by 82 publications

(45 citation statements)

References 61 publications

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“…A particularly controversial management issue is the role of RT for WHO grade II meningioma treated with MGTR. The treatment approach has largely been extrapolated from data on other meningioma grades, leading to non-uniform practices across institutions, adjuvant RT being used in many centres after subtotal resection of grade I I meningioma [27,28]. According to Kaur et al, the median 5-year survival of patients with atypical meningioma treated by RT was 67.5 % and ranged from 51 to 100 % [28].…”

Section: Surgery and Tumour Locationmentioning

confidence: 99%

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

et al. 2016

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To analyse the outcome of patients with WHO grade II meningioma and identify factors that may influence recurrence and survival. Between January 2007 and September 2015, a retrospective search identified 194 WHO grade II meningiomas at the National Hospital for Neurology and Neurosurgery, London. Survival methods were implemented. 31 patients (16 %) had a previous history of grade I meningioma. The patients underwent a total of 344 surgical resections and 43.3 % received radiotherapy. 55 patients (28.4 %) had been re-operated on for a WHO grade II meningioma relapse. Median follow-up was 4.4 years. At the end of the study, 75 patients (40.1 %) had no residual tumour on the last scan. Surgical recurrence free survival at 5 years was 71.6, 95 % CI [63.5, 80.8]. Secondary grade II meningioma (HR = 2.29, p = 0.010), and, Simpson resection grade 1, 2 and 3 vs. 4 and 5 (HR = 0.57, p = 0.050) were associated with the surgical recurrence-free survival. 32 died from meningioma (16.5 %). Overall survival probability at 5 years was 83.2, 95 % CI [76.6, 90.4]. Age at diagnosis (HR = 0.22, p < 0.001), WHO grade I meningioma progressing into grade II (HR = 3.2, p = 0.001), tumour location (HR = 0.19, p < 0.001), and mitosis count (HR = 0.36, p = 0.010) were independently associated with the overall survival. Patients who received radiotherapy demonstrated neither a reduced risk of recurrence nor a longer overall survival (p = 0.310). In our series shorter survival correlated with older age, increased mitoses, progression from grade I to II and location. We were not able to demonstrate a significant improvement in any of the clinical outcomes after radiotherapy.

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Section: Surgery and Tumour Locationmentioning

confidence: 99%

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

et al. 2016

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“…34,41,49 Three retrospective studies advocated the use of adjuvant EBRT after GTR of AM (Table 3). 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).…”

Section: Adjuvant Ebrt After Gtrmentioning

confidence: 99%

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

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

115

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The management of WHO Grade II “atypical” meningiomas (AMs) and Grade III “malignant” meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.

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“…There are numerous series in literature, describing surgical approaches to skull base and posterior fossa, explaining challenging parts of those surgeries and neuro-functional results (2,5,14,16,22,(38)(39)(40)41,44,45). However, many of those series were published when the SRS was not so common (32). In our series, nearly 52.1% of all meningiomas were located in the skull base or posterior fossa.…”

Section: Group Comparisonsmentioning

confidence: 52%

Retrospective analysis of 449 intracranial meningioma patients operated between years 2007 – 2013 in a single institute

Çeltikçi

Kaymaz²,

Akgül³

et al. 2016

Turkish Neurosurgery

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AIm: Meningioma literature has many large surgical case series, which have been references of text books and neurosurgical practice. Many of those series were published when stereotactic radiosurgery (SRS) was not so common or these series were in terms of World Health Organization (WHO) 2000 classification. In this study, we aimed to make an update to the current literature using WHO 2007 classification system. mATERIAl and mEThODS: Four hundred eighty-eight intracranial meningioma patients underwent open surgery in 2007-2013 and 449 of them were included in this study. All pathological specimens were re-evaluated in terms of WHO 2007 classification. All demographical and follow-up records and imaging archives were investigated by using our center's central automation system and National Central Population Management System. If records were not available or not adequate, investigators made phone calls to patients. Pediatric patients were excluded. RESulTS:Three hundred twenty-six female (76.2%) and 123 male (27.4%) patients were analyzed. Their ages ranged from 18 to 84 years (mean=51.6±11.9 years). The most common subtype of meningioma was meningothelial meningioma (51.7%), followed by atypical meningioma (20.3%). WHO Grade I meningiomas had statistically random localization distribution, but WHO Grade II meningiomas were more common in the convexity, parasagittal and middle fossa. Younger age was found to be significantly related with tumor recurrence or progression. Seventy-three (16.2%) patients underwent SRS and 64 (14.2%) patients underwent adjuvant radiotherapy (ART) after surgery. Convexity localization was found to be associated with recurrence, mortality and higher WHO 2007 grade.CONCluSION: Convexity meningiomas are associated with recurrence, mortality and higher WHO 2007 grade. Convexity meningiomas should be totally resected in order to achieve maximum benefit from surgery,

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Radiotherapy as an adjuvant in the management of intracranial meningiomas: are we practising evidence-based medicine?

Cited by 82 publications

References 61 publications

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

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

Retrospective analysis of 449 intracranial meningioma patients operated between years 2007 – 2013 in a single institute

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