Abstract
Meningiomas account for up to 20 % of all primary intracranial neoplasms; although the majority of these have a benign course, as many as 5–10 % can display more aggressive behavior and a higher incidence of disease progression. The benefit of immediate adjuvant radiotherapy is still being debated for atypical and malignant meningiomas. This study aimed to retrospectively assess prognostic factors and outcome in 68 patients with atypical and malignant meningiomas. Sixty-eight meningioma patients were treated with radiotherapy after initial resection or for recurrence, between January 1993 and December 2011. Surgery was macroscopically complete in 80 % of the patients; histology was atypical and malignant in 51 patients and 17 patients, respectively. Mean dose of radiotherapy was 54.6 Gy. Fifty-six percent of all patients received radiotherapy after surgical resection, 26 % at the first relapse, and 18 % at the second relapse. Median follow-up was 6.7 years, (range 1.5–19.9 years). The 5- and 10-year actuarial overall survival (OS) rates were 74.1 and 45.6 %, respectively. At univariate analysis age >60 years, radiotherapy dose >52 Gy showed statistical significance, (p = 0.04 and p = 0.03, respectively). At the multivariate analysis radiotherapy dose >52 Gy maintained the statistical significance, (p = 0.037). OS of patients treated with radiotherapy at diagnosis was longer than the survival of patients treated with salvage radiotherapy; however this difference did not reach statistical significance when tested for the entire series or for the subgroups of grade 2 and grade 3 patients. The 5- and 10-year disease-free survival (DFS) rates were 76.5 and 69.5 %, respectively, and were significantly influenced by size >5 cm (p = 0.04) and grading (p = 0.003) on univariate analysis. At multivariate analysis, size and grading both remained significant prognostic factors, p = 0.044 and p = 0.0006, respectively. Grade ≤ 2 acute side effects were seen during radiotherapy treatment in 16 % of the patients, with no ≥ grade 3 acute toxicity, based on the Common Terminology Criteria for Adverse Events. In this mono-institutional retrospective study, age and radiotherapy dose were associated with a longer OS, while preoperative size and grading of the tumor influenced DFS. Although there were some advantages in terms of OS for patients treated with postoperative radiotherapy, the benefit did not reach the significance. Multicenter prospective studies are necessary to clarify the management and the correct timing of radiotherapy in such a rare disease.
Similar content being viewed by others
References
Bondy M, Ligon BL (1996) Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol 29:197–205
Cushing HW, Eisenhardt LC (1938) Meningiomas. Their classification, regional behavior, life history, and surgical end results. Thomas CC, Springfield, pp 47–50, 669–719
Louis DN, Scheithauer BW, Budka H et al (2000) Meningiomas. In: Kleihues P, Cavenee WK (eds) Pathology and genetics. Tumors of the nervous system, WHO classification of tumors. IARC Press, Lyon, p 176–184
Kleihues P, Cavanee WK (eds) (2000) Pathology and genetics: tumours of the nervous system. IARC Press, Lyon, p 176
Engenhart-Cabillic R, Farhoud A, Sure U, Heinze S, Heinzel M, Mennel HD et al (2006) Clinicopathologic features of aggressive meningioma emphasizing the role if radiotherapy in treatment. Strahlenther Onkol 182:641–646
Aghi MK, Carter BS, Cosgrove GR, Ojemann RG, Amin-Hanjani S, Martuza RL et al (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56e60
Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39
Stessin A, Schwartz A, Judanin G, Pannullo S, Boockvar J, Schwartz T et al (2012) Does adjuvant external-beam radiotherapy improve outcomes for nonbenign meningiomas? A Surveillance, Epidemiology, and End Results (SEER)–based analysis. J Neurosurg 117:669–675
Rosenberg L, Prayson R, Lee J, Reddy C, Chao S, Barnett G et al (2009) Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution. Int J Radiat Oncol Biol Phys 74(2):427–432
Pasquier D, Bijmolt S, Veninga T et al (2008) Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the rare cancer network. Int J Radiat Oncol Biol Phys 71(5):1388–1393
Milosevic MF, Frost PJ, Laperriere NJ, Wong CS, Simpson WJ (1996) Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 34(4):817–822
Goldsmith BJ, Wara WM, Wilson CB et al (1994) Postoperative irradiation for subtotally resected meningiomas: a retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195–201
Dzuik T, Woo S, Butler B et al (1998) Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 37:177–188
Palma L, Celli P, Franco C et al (1997) Long-term prognosis for atypical and malignant meningiomas: A study of 71 surgical cases. J Neurosurg 86:793–800
Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan P (1999) ‘‘Malignancy’’ in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 85:2046–2056
Adeberg S, Hartmann C, Welzel T, Rieken S, Habermehl D et al (2012) Long-term outcome after radiotherapy in patients with atypical and malignant meningiomas-clinical results in 85 patients treated in a single institution leading to optimized guidelines for early radiation therapy. Int J Radiat Oncol Biol Phys 83(3):859–864
Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH et al (2000) Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46(1):57–61
Jaaskelainen J, Haltia M, Servo A (1986) Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy and outcome. Surg Neurol 25:233–242
Yang S-Y, Park C-K, Park S-H, Kim D, Chung YS, Jung H-W (2008) Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574–580
Bruna J, Brell M, Ferrer I, Gimenez-Bonafe P, Tortosa P (2007) Ki-67 proliferative index predicts clinical outcome in patients with atypical or anaplastic meningioma. Neuropathology 27:114–120
Ho M-T, Hsu C-Y, Ting L-T, Chiang H (2002) Histopathology and MIB-1 labelling index predicted recurrence of meningiomas. A proposal of diagnostic criteria for patients with atypical meningioma. Cancer 94(5):1538–1547
Pourel N, Auque J, Bracard S, Hoffstettter S, Luporsi E, Vignaud JM, Bey P (2001) Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience. Radiat Oncol 61:65–70
Modha A, Gutin P (2005) Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 57:538–550
Milker-Zabel S, Zabel A, Schulz-Ertner D et al (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61:809–816
Komotar RJ, Iorgulescu JB, Raper DM, Holland EC, Beal K, Bilsky MH et al (2012) The role of radiotherapy following gross-total resection of atypical meningiomas. J Neurosurg 117:679–686
Jo K, Park HJ, Nam DH, Lee JI, Kong DS, Park K, Kim JH (2010) Treatment of atypical meningioma. J Clin Neurosci 17(11):1362–1366
Mair R, Morris K, Scott I, Carroll TA (2011) Radiotherapy for atypical meningiomas. J Neurosurg 115:811–819
Conflict of interest
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Detti, B., Scoccianti, S., Di Cataldo, V. et al. Atypical and malignant meningioma: outcome and prognostic factors in 68 irradiated patients. J Neurooncol 115, 421–427 (2013). https://doi.org/10.1007/s11060-013-1239-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-013-1239-7