Risk Factors for Regrowth of Intracranial Meningiomas after Gamma Knife Radiosurgery: Importance of the Histopathological Grade and MIB-1 Index

Nakaya, Kotaro; Chernov, Mikhail; Kasuya, Hidetoshi; Izawa, Masahiro; Hayashi, Motohiro; Kato, Koichi; Kubo, Osami; Muragakı, Yoshihiro; Iseki, Hiroshi; Hori, Tomokatsu; Okada, Yoshikazu; Takakura, Kintomo

doi:10.1055/s-0029-1243244

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…Thus, 52 tumors with an MIB-1 LI of <10% did not recur within 10 years, whereas 97% of 31 tumors with an MIB-1 LI of ≥10% recurred. Nakaya et al [19] reported that an MIB-1 LI cutoff value of 3% was significantly associated with meningioma regrowth after GKRS. Although that study was not confined to nonbenign meningiomas, it suggested that MIB-1 LI could predict the radiosurgical outcomes of patients with meningiomas significantly.…”

Section: Discussionmentioning

confidence: 99%

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Radiosurgery for Atypical and Anaplastic Meningiomas: Histopathological Predictors of Local Tumor Control

Kim¹,

Kim²,

Paek³

et al. 2012

Stereotact Funct Neurosurg

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Objectives: We investigated the radiosurgical outcomes of patients with nonbenign meningiomas retrospectively and sought to identify prognostic factors for local tumor control after radiosurgery with an emphasis on histopathology. Methods: Between 1998 and 2010, 35 patients with 49 atypical or anaplastic meningiomas were treated with radiosurgery. The mean tumor volume and marginal irradiation dose were 3.5 cm³ (range 0.3–25.3) and 16 Gy (range 12–21), respectively. Results: The actuarial local tumor control rates for patients with atypical meningiomas at 1, 2 and 3 years after radiosurgery were 78, 53 and 36%, respectively, whereas those for anaplastic meningiomas were 35% at 1 year and 10% at 2 years. Multivariate analysis revealed that the mitotic count (≤8 per 10 high-power fields; HPF) and the MIB-1 proliferation marker labeling index (LI; ≤8%) were significant favorable prognostic factors for the radiosurgical outcomes of patients with nonbenign meningiomas (p = 0.014 and p = 0.012, respectively). Conclusions: Radiosurgery could be a treatment option for patients with atypical meningiomas, but more aggressive treatments are needed for those with anaplastic meningiomas. Histopathological factors such as mitotic count and MIB-1 LI are significant prognostic factors for the radiosurgical outcomes of patients with nonbenign meningiomas and should be considered before radiosurgery.

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Section: Discussionmentioning

confidence: 99%

“…In addition, the proliferative indices such as mitotic counts or proliferation marker MIB-1 labeling index (LI) are well known to be significant prognostic factors in the majority of brain tumors; however, their potential roles in predicting radiosurgical outcomes for patients with nonbenign meningiomas remain unclear [2,17,18,19,20,21]. …”

Section: Introductionmentioning

confidence: 99%

Radiosurgery for Atypical and Anaplastic Meningiomas: Histopathological Predictors of Local Tumor Control

Kim¹,

Kim²,

Paek³

et al. 2012

Stereotact Funct Neurosurg

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“…Currently, radiotherapy, particularly stereotactic irradiation, is used because surgical resection is difficult, but is not always effective. 2,4,8,10,13,23) On the other hand, good outcome is not necessarily secured even though the diagnosis is benign grade I. If the type of benign meningioma likely to require re-treatment could be preoperatively predicted, surgical methods aimed at preventing regrowth of the residual tumor could be proposed, although residual tumor is unavoidable.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,13,23,30) However, radiotherapy is not always effective, and may be dependent on the residual tumor size (volume). 4,11,17) If a residual tumor inevitably remains, its volume affects the later treatment.…”

Section: Discussionmentioning

confidence: 99%

Radiological Predictive Factors for Regrowth of Residual Benign Meningiomas

Fujimoto¹,

Ishida²,

Uchiyama³

et al. 2011

Neurol. Med. Chir.(Tokyo)

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The pre-and postoperative radiological predictive factors for the regrowth of residual benign meningiomas were investigated in 80 of 327 patients who underwent first surgery for intracranial meningioma, who met the following conditions: residual tumor observed on postoperative imaging, follow up for more than 5 years or until regrowth of the residual tumor, histological diagnosis of World Health Organization grade I, and no additional therapy performed within 1 month after surgery. These 80 patients were divided into those with no regrowth during the follow-up period (Group A, n ＝ 54) and those with regrowth (Group B, n ＝ 26), and the clinical characteristics and pre-and postoperative imaging findings were compared. Univariate analysis of factors influencing regrowth showed 6 factors were significant: tumor size AE4 cm (p ＝ 0.043), tumor volume AE30 cm 3 (p ＝ 0.026), presence of edema (p ＝ 0.036), unclear brain-tumor interface (p º 0.001), presence of a pial-cortical blood supply (p ＝ 0.031), and residual tumor volume AE3.0 cm 3 (p º 0.001). Multivariate analysis showed only residual tumor volume AE3.0 cm 3 was significant (p ＝ 0.001). Generally, the significant imaging findings on univariate analysis suggest malignant meningioma. Similar findings may be observed even in grade I cases, and residual tumors may regrow in such cases. The possibility is particularly high if the residual tumor volume exceeds 3.0 cm 3 , so early radiotherapy should be performed to prevent regrowth.

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“…Durch die Integration der stereotaktischen Radiochirurgie mittels Gammaknife-Behandlung sowie durch die stereotaktische Bestrahlung mittels Linearbeschleuniger (LINAC) und mittels Protonenbestrahlung hat die Therapie von komplexen Schädelbasisläsionen weitere wichtige Facetten hinzugewonnen [1,11,15]. Auch der robotergeführte Linearbeschleuniger (Cyberknife) wird insbesondere im kraniozervikalen Übergang und im Bereich der Wirbelsäule sein Haupteinsatzgebiet haben [24].…”

Section: Präzisionsbestrahlung Und Strahlenchirurgieunclassified

Moderne Schädelbasischirurgie aus Sicht des Neurochirurgen

Spetzger

2011

HNO

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At present, modern skull base surgery is a highly sophisticated interdisciplinary collaboration of various diagnostic and therapeutic disciplines. The overall goal is the treatment of complex tumorous, traumatic, vascular and inflammatory processes or developmental disorders of the skull base with preservation of function. The paper presents modern concepts, procedures and minimally invasive strategies in skull base surgery and also critically discusses the current trend to endoscopic and robot-assisted surgical techniques.

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Risk Factors for Regrowth of Intracranial Meningiomas after Gamma Knife Radiosurgery: Importance of the Histopathological Grade and MIB-1 Index

Abstract: Radiosurgery is a highly effective management option for benign intracranial meningiomas, but growth control of non-benign ones is significantly worse. It requires close neuroradiological follow-up and necessitates the search for modified treatment strategies.

Cited by 18 publications

References 22 publications

Radiosurgery for Atypical and Anaplastic Meningiomas: Histopathological Predictors of Local Tumor Control

Radiosurgery for Atypical and Anaplastic Meningiomas: Histopathological Predictors of Local Tumor Control

Radiological Predictive Factors for Regrowth of Residual Benign Meningiomas

Moderne Schädelbasischirurgie aus Sicht des Neurochirurgen

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