The Role of Adjuvant Radiotherapy After Gross Total Resection of Atypical Meningiomas

Hasan, Shaakir; Young, Michael; Albert, Trevine; Shah, Ashish H.; Okoye, Christian C.; Bregy, Amadé; Lo, Simon S.; Ishkanian, F.; Komotar, Ricardo J.

doi:10.1016/j.wneu.2014.12.037

Cited by 69 publications

(33 citation statements)

References 28 publications

(54 reference statements)

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“…Early adjuvant radiation for AAM has been analyzed in a multicenter study and was not found to be beneficial to atypical meningioma patients [11,28] This lack of effect on survival or PFS was independent of extent of resection, however, there was selection bias present in this study. Other studies have shown benefit of radiation therapy in PFS but not in OS [19,29,30]. Interestingly, one study demonstrated that patients who receive radiation therapy are more likely to undergo repeat surgery for recurrence, this is to be considered in the context that patients that receive radiation may not have gross total resection of the tumor prompting surgeons to proceed with adjuvant radiation [20].…”

Section: Discussionmentioning

confidence: 99%

Atypical and anaplastic meningioma: outcomes in a population based study

et al. 2017

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Atypical and anaplastic meningiomas (AAM) are aggressive tumors. This study is aimed at examining associations between patient and tumor-related factors and tumor-related death in patients with AAM. We conducted a population-based cohort study utilizing prospectively collected data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with diagnosis of AAM from 1973 to 2012 in the SEER database were included. Patients lacking clinical information were excluded. Multivariate analysis between patient and lesion characteristics, and AAM-related death was performed to adjust for confounding factors. We identified and included 522 patients in our study. Mean age at diagnosis was 60.8 ± 15.7 years. The majority of patients were White(73%), 15.5% Black, and 9.8% Asian. Average tumor size was 48.2 ± 20.3 mm. The tumor was locally confined in 57.1%, whereas it had intracranial extension in 29.3%, and extracranial extension in 8.8% of patients. The vast majority (94.8%) of tumors were supratentorial. Gross total resection (GTR) was documented in 65.5% of patients. Age at diagnosis (p = 0.001), tumor size (p = 0.003), surgery result (GTR vs. subtotal resection, p = 0.027), and radiation therapy (p = 0.2) were found to be significantly different between the comparison groups. In a multivariate proportional competing risk regression analysis age (HR 1.03, CI [1.01,1.04], p < 0.001), infratentorial location (HR 2.81, CI [1.20, 6.56], p = 0.017), tumor size (HR 1.01, CI [1.00,1.02], p = 0.032),and radiation treatment (HR 1.52, CI [1.11, 2.09], p = 0.01) were significantly associated with tumor-related death. The association of age at diagnosis, tumor size, location, and radiotherapy with overall survival in patients with AAM is demonstrated. The results provide a context for individualized treatment plans in patients with AAM. Additional studies focusing on issues such as the use of radiation and chemotherapy will clarify the best modality to achieve disease control.

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Section: Discussionmentioning

confidence: 99%

Atypical and anaplastic meningioma: outcomes in a population based study

et al. 2017

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“…11,25,26 However, we could not determine the effect of PORT on outcomes of AM patients due to the small number of patients who received that therapy. Two recent meta-analyses have shown a benefit from PORT; 27,28 in terms of reducing tumor recurrence and improving local control, but not survival, even after GTR; 28 however, the concern about the low statistical power of the included studies remains a significant issue. Many retrospective series showed that PORT was beneficial after STR [6][7][8][9][10] , and some showed a benefit after GTR, 6,9,[11][12][13] while some others did not show any benefit of PORT after either STR 14,15 or GTR.…”

Section: Discussionmentioning

confidence: 99%

Atypical Meningioma: Referral Patterns, Treatment and Adherence to Guidelines

Alghamdi

Olivotto²,

Easaw

et al. 2017

Can. J. Neurol. Sci.

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“…Recurrence of atypical or primary intraosseous meningiomas has been reported to occur up to 2 years after resection, but histologically benign tumors have been reported to recurrent up to 10 years after surgery [3]. Given the high rate of recurrence of atypical meningiomas, many scholars preferred to administer immediately postsurgical adjuvant radiotherapy to achieve a lower recurrence rate [5]. However, we believe that for elderly patients in whom surgery has achieved a Simpson grade I resection, the indications for postoperative radiotherapy should be cautious and long term follow-up is required.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of elderly patients with primary osteolytic atypical meningioma: a case report and review of the literature

Tang

Zhao

et al. 2017

Chin Neurosurg Jl

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Background: Elderly patients with primary intracranial osteolytic and externally growing atypical meningiomas are rare and easy to be misdiagnosed. Recently, a patient with an atypical meningioma was treated in our department and analyzed the case by reviewing the historical literature. Case presentation: We describe a 63-year-old female with primary intracranial osteolytic atypical meningioma at our neurosurgery department, and retrospectively reviewed previous literatures about its diagnosis, surgical treatment, pathological results, and clinical outcome. Simpson grade I resection was accomplished through a pterional approach. First-stage skull reconstruction was performed, and the patient underwent an uneventful recovery. Conclusions: The final diagnosis of the primary osteolytic atypical meningioma is dependent on a pathological examination. First-stage skull reconstruction could avoid a secondary lesion and improve the patient's quality of life.

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The Role of Adjuvant Radiotherapy After Gross Total Resection of Atypical Meningiomas

Cited by 69 publications

References 28 publications

Atypical and anaplastic meningioma: outcomes in a population based study

Atypical and anaplastic meningioma: outcomes in a population based study

Atypical Meningioma: Referral Patterns, Treatment and Adherence to Guidelines

Surgical treatment of elderly patients with primary osteolytic atypical meningioma: a case report and review of the literature

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