TY - JOUR
T1 - Management of atypical cranial meningiomas, Part 1
T2 - Predictors of recurrence and the role of adjuvant radiation after gross total resection
AU - Sun, Sam Q.
AU - Kim, Albert H.
AU - Cai, Chunyu
AU - Murphy, Rory K.J.
AU - DeWees, Todd
AU - Sylvester, Peter
AU - Dacey, Ralph G.
AU - Grubb, Robert L.
AU - Rich, Keith M.
AU - Zipfel, Gregory J.
AU - Dowling, Joshua L.
AU - Leuthardt, Eric C.
AU - Leonard, Jeffrey R.
AU - Evans, John
AU - Simpson, Joseph R.
AU - Robinson, Clifford G.
AU - Perrin, Richard J.
AU - Huang, Jiayi
AU - Chicoine, Michael R.
N1 - Publisher Copyright:
Copyright © 2014 by the Congress of Neurological Surgeons.
PY - 2014
Y1 - 2014
N2 - CONCLUSION: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression.RESULTS: Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/ EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/ EBRT (P = .8, P . .99).
AB - CONCLUSION: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression.RESULTS: Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/ EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/ EBRT (P = .8, P . .99).
KW - Adjuvant
KW - Local/therapy
KW - Meningioma/mortality
KW - Meningioma/pathology
KW - Meningioma/therapy
KW - Neoplasm recurrence
KW - Prognosis
KW - Radiotherapy
KW - Retrospective studies
UR - http://www.scopus.com/inward/record.url?scp=84923911736&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000000461
DO - 10.1227/neu.0000000000000461
M3 - Article
C2 - 24932707
AN - SCOPUS:84923911736
SN - 0148-396X
VL - 75
SP - 347
EP - 354
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -