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Abstract

Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for postsurgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed. Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p=0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p=NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p=0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p=0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy, and recurrence status are independent prognostic factors. Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control.

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

“…As is the case with lower grade meningioma, recurrence corresponds to the extent of tumor removal. 28,39,102,111 However, the success of surgery alone has not been satisfactory. Jaaskelainen reported a 5-year recurrence rate of 78% following GTR for patients with anaplastic meningioma, less than half of whom received any adjuvant therapy.…”

Atypical and anaplastic meningiomas in a public hospital in São Paulo State, Brazil

“…The wide range in the relative frequency of atypical (3.6 and 7.5%) and anaplastic meningiomas (0.4 to 2.8%) 1,2,3,5,8,9,10,11 , can be explained by variable pathological criteria for their classification. However, the use of the WHO criteria improved comparisons among more recent series.…”

“…Recurrence rate is lower for patients submitted to total (17%) compared with subtotal (87%) resection 3 . Survival is longer in patients that had Simpson 1 resection 13 , and RFS is longer in patients with total resection 3 .…”

“…The 5-year survival rate for patients with atypical and anaplastic meningiomas was found to be 58% and the 5-year RFS rate was 48% 24 , the 2-year RFS rate was 89% for irradiated patients compared to 50% for patient not irradiated. The overall survival rate was better for patients submitted immediately to radiation therapy 3 . Therefore, the consensus favors fractionated radiation therapy for patients submitted to total or subtotal resection of atypical and anaplastic meningiomas 11 , even though this recommendation is not supported by prospective controlled trials.…”

Prognostic Factors for Survival in Patients with High-Grade Meningioma and Recurrence-Risk Stratification for Application of Radiotherapy

“…In terms of Grade III meningioma, previous reports evidently recommended postoperative radiotherapy regardless of the extent of resection [14], [15]. Durand et al evaluated the prognostic factors for high-grade meningioma on 199 adult patients.…”