Radiotherapy for atypical meningiomas

2011 ◽  
Vol 115 (4) ◽  
pp. 811-819 ◽  
Author(s):  
Richard Mair ◽  
Kevin Morris ◽  
Ian Scott ◽  
Thomas A. Carroll
Keyword(s):  
Cox Regression ◽  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Subtotal Resection ◽  
Who Grade ◽  
Grade Ii ◽  
Atypical Meningiomas ◽  
Tumor Remnant ◽  
First Time

Object The role of postoperative radiotherapy in patients undergoing first-time resection of WHO Grade II meningioma remains unclear as reflected by varied practices in published clinical studies and national professional surveys. Much of the relevant literature is based on pre-2000 WHO grading criteria for atypical meningiomas. Authors in this study set out to explore the role of postoperative radiotherapy in patients undergoing first-time surgery for WHO Grade II meningiomas diagnosed using revised WHO 2000 criteria, against a background of otherwise limited published literature on this issue. Methods The authors retrospectively collected data on 114 consecutive patients who underwent first-time resection of WHO Grade II atypical meningiomas diagnosed using 2000 WHO criteria, and who variably underwent postoperative radiotherapy according to individual surgeon practices. Outcomes, including radiological recurrence, were submitted to Kaplan-Meier and Cox regression analyses. Results Postoperative radiotherapy demonstrated a significant benefit only when patients who had undergone gross-total tumor resection and those who had undergone subtotal resection along with postoperative radiosurgery to the tumor remnant were excluded from analysis. Conclusions The authors have performed the largest study in the literature to examine the use of radiotherapy for WHO Grade II, atypical, meningiomas following a first-time resection. They suggest that radiotherapy is not appropriate after first-time resection of those lesions in which a gross-total resection (Simpson Grade 1 or 2) has been achieved. They also advise that any tumor remnant radiologically demonstrated on postoperative imaging should be treated with radiosurgery and that postoperative radiotherapy after a first-time resection should be reserved for tumor remnants too large for radiosurgery and for which a second staged operation is not planned.

Cordotomy for patients with thoracic malignant astrocytoma

2010 ◽  
Vol 13 (4) ◽  
pp. 418-423 ◽  
Author(s):  
Masaya Nakamura ◽  
Osahiko Tsuji ◽  
Kanehiro Fujiyoshi ◽  
Kota Watanabe ◽  
Takashi Tsuji ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Radical Resection ◽  
Subtotal Resection ◽  
Optimal Management ◽  
Malignant Astrocytoma ◽  
Initial Operation ◽  
Who Grade ◽  
Kaplan Meier ◽  
Malignant Astrocytomas ◽  
Grade Ii

Object The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

scholarly journals Outcomes following Upfront Radiation versus Monitoring in Atypical Meningiomas: 16-year Experience at a Tertiary Medical Center

2021 ◽  
Author(s):  
Peter C Pan ◽  
David J Pisapia ◽  
Rohan Ramakrishna ◽  
Theodore H Schwartz ◽  
Susan C Pannullo ◽  
...  
Keyword(s):  
Medical Center ◽  
Progression Free Survival ◽  
Atypical Meningioma ◽  
World Health ◽  
Subtotal Resection ◽  
Who Grade ◽  
Resection Status ◽  
Grade Ii ◽  
Health Organization ◽  
Atypical Meningiomas

Abstract Background The role of post-operative upfront radiotherapy (RT) in the management of gross totally resected atypical meningiomas remains unclear. This single-center retrospective review of newly-diagnosed histologically-confirmed cases of World Health Organization (WHO) Grade II atypical meningioma at Weill Cornell Medicine from 2004-2020 aims to compare overall survival (OS) and progression free survival (PFS) of post-operative upfront radiotherapy versus observation, stratified by resection status (gross total resection [GTR)] versus subtotal resection [STR]). Methods 90 cases of atypical meningioma were reviewed (56% women; median age 61 years; median follow-up 41 months). Results In patients with GTR, hazard ratio (HR) of PFS was 0.09 for post-operative upfront RT versus observation alone (95% confidence interval [CI] 0.01-0.68; p = 0.02), though HR for OS was not significant (HR 0.46; 95% CI 0.05-4.45; p = 0.5). With RT, PFS was 100% at 12 and 36 months (compared to 84% and 63% respectively with observation); OS at 36 months was 100% (compared to 94% with observation). In patients with STR, though PFS at 36 months was higher for RT arm versus observation (84% versus 74%), OS at 36 months was 100% in both arms. HR was not significant (HR 0.76; 95% CI 0.16-3.5; p = 0.73). Conclusion This retrospective study suggests post-operative upfront radiotherapy following GTR of atypical meningioma is associated with improved PFS compared to observation. Further studies are required to draw conclusions about OS.

scholarly journals Single-fraction Stereotactic Radiosurgery for Atypical Meningiomas (WHO grade II): Treatment Results Based on a 25-year Experience

2021 ◽  
Author(s):  
Hirotaka Hasegawa ◽  
Kunal Vakharia ◽  
Link J Michael ◽  
Scott L Stafford ◽  
Paul D Brown ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Salvage Treatment ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Beam Radiation ◽  
Who Grade ◽  
Increased Risk ◽  
Grade Ii ◽  
Atypical Meningiomas

Abstract PurposeTo clarify the role of stereotactic radiosurgery (SRS) for atypical meningiomas (AM).MethodsA retrospective analysis of 68 patients with AM having SRS from 1995 until 2019. Nineteen patients (28%) had undergone prior external beam radiation therapy (EBRT) (median dose, 54 Gy). The median follow-up period was 52 months.ResultsEighteen (26%), 17 (25%), and 33 (49%) patients received SRS as an upfront adjuvant (≤ 6 months), early salvage (7-18 months), or late salvage treatment (> 18 months), respectively. The 3-, 5-, and 10-year progression-free survivals (PFSs) were 52%, 35%, and 25%, respectively. The 3-, 5-, and 10-year disease-specific survivals (DSSs) were 85%, 78%, and 61%, respectively. Adverse radiation events (AREs) were observed in 12 patients (18%), with increased or new seizures being the most frequent complication (n=7). Prior EBRT was associated with reduced PFS (HR = 5.92, P <0.01), reduced DSS (HR = 5.84, P <0.01), and an increased risk of ARE (HR = 3.31, P = 0.04). Timing of SRS was correlated with reduced PFS for patients having early salvage treatment compared to upfront adjuvant (HR = 3.17, P = 0.01) or late salvage treatment (HR = 4.39, P <0.01). ConclusionPFS for patients with residual/recurrent AM remains poor despite SRS. Prior EBRT was associated with worse tumor control, higher tumor-related mortality, and an increased risk of ARE. Further study on the timing of SRS is needed to determine if upfront adjunctive SRS improves tumor control compared to salvage SRS.

The role of radiotherapy following gross-total resection of atypical meningiomas

2012 ◽  
Vol 117 (4) ◽  
pp. 679-686 ◽  
Author(s):  
Ricardo J. Komotar ◽  
J. Bryan Iorgulescu ◽  
Daniel M. S. Raper ◽  
Eric C. Holland ◽  
Kathryn Beal ◽  
...  
Keyword(s):  
Postoperative Radiotherapy ◽  
Prospective Trial ◽  
Gross Total Resection ◽  
Recurrence Rates ◽  
Total Resection ◽  
Who Grade ◽  
Strong Trend ◽  
Time To Recurrence ◽  
Atypical Meningiomas

Object Atypical (WHO Grade II) meningiomas comprise a heterogeneous group of tumors, with histopathology delineated under the guidance of the WHO and a spectrum of clinical outcomes. The role of postoperative radiotherapy for patients with atypical meningiomas who have undergone gross-total resection (GTR) remains unclear. In this paper, the authors sought to clarify this role by reviewing their experience over the past 2 decades. Methods The authors retrospectively analyzed all patients at their institution who underwent GTR between 1992 and 2011 with a final histology demonstrating atypical meningioma. Information regarding patients, tumor characteristics, and postoperative adjuvant therapy was gleaned from medical records. Time to recurrence and overall survival were analyzed using univariate, multivariate, and Kaplan-Meier survival analyses. Results Forty-five patients who met the inclusion criteria underwent GTR for atypical meningiomas. By a median follow-up of 44.1 months, 22% of atypical meningiomas had recurred. There was no recurrence in 12 (92%) of 13 patients who received postoperative radiotherapy or in 19 (59%) of 32 patients who did not undergo postoperative radiotherapy (p = 0.085), demonstrating a strong trend toward improved local control with postoperative radiotherapy. No other factors were significantly associated with recurrence in univariate or multivariate analyses. Conclusions This retrospective series supports the observation that postoperative radiotherapy likely results in lower recurrence rates of gross totally resected atypical meningiomas. Although a multicenter prospective trial will ultimately be needed to fully define the role of radiotherapy in managing gross totally resected atypical meningiomas, the authors' results contribute to a growing number of series that support routine postoperative radiotherapy as an adjuvant treatment for these lesions.

Predictors of tumor progression among children with gangliogliomas

2009 ◽  
Vol 3 (6) ◽  
pp. 461-466 ◽  
Author(s):  
Mostafa El Khashab ◽  
Lynn Gargan ◽  
Linda Margraf ◽  
Korgun Koral ◽  
Farideh Nejat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tumor Progression ◽  
Cox Regression ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Initial Presentation ◽  
Subtotal Resection ◽  
Low Grade ◽  
Cox Regression Analysis ◽  
Presenting Symptoms

Object Few reports describe the outcome and prognostic factors for children with gangliogliomas. The objective of this report was to describe the progression-free survival (PFS) for children with low-grade gangliogliomas and identify risk factors for tumor progression. Methods A retrospective study was performed in children with low-grade gangliogliomas who were evaluated and treated in the neuro-oncology department between 1986 and 2006 to determine risk factors for subsequent tumor progression. Results A total of 38 children with newly diagnosed gangliogliomas were included in this report. Thirty-four children were treated with surgery alone, 3 with subtotal resection and radiation therapy, and 1 with subtotal resection and chemotherapy. The follow-up ranged from 4 months to 15.8 years (mean 5.7 ± 4.2 years [± SD]). Seven children have experienced tumor progression, and 1 child died after his tumor subsequently underwent malignant transformation. The 5-year PFS was calculated to be 81.2% using Kaplan-Meier survival analysis. Initial presentation with seizures (p = 0.004), tumor location in the cerebral hemisphere (p = 0.020), and complete tumor resection (p = 0.035) were associated with prolonged PFS. Further analysis of the above significant variables by a Cox regression model identified initial presentation with seizures as being associated with prolonged PFS (p = 0.028). Conclusions The PFS and overall survival of children with gangliogliomas are good. Tumors located in the cerebral hemispheres, the achievement of total resection, and seizures at presentation were associated with prolonged PFS. Cox regression analysis identified presenting symptoms including seizures as significant predictive factors of PFS. Prospective studies with larger numbers of children are needed to define the significant factors of tumor progression.

scholarly journals The Role of Extent of Resection in IDH1 Wild-Type or Mutant Low-Grade Gliomas

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 808-814 ◽  
Author(s):  
Toral Patel ◽  
Evan D Bander ◽  
Rachael A Venn ◽  
Tiffany Powell ◽  
Gustav Young-Min Cederquist ◽  
...  
Keyword(s):  
Cox Regression ◽  
Extent Of Resection ◽  
World Health ◽  
Low Grade ◽  
Wild Type ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Low Grade Gliomas ◽  
Grade Ii ◽  
The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) improves outcomes in adults with World Health Organization (WHO) grade II low-grade gliomas (LGG). However, recent studies demonstrate that LGGs bearing a mutation in the isocitrate dehydrogenase 1 (IDH1) gene are a distinct molecular and clinical entity. It remains unclear whether maximizing EOR confers an equivalent clinical benefit in IDH mutated (mtIDH) and IDH wild-type (wtIDH) LGGs. OBJECTIVE To assess the impact of EOR on malignant progression-free survival (MPFS) and overall survival (OS) in mtIDH and wtIDH LGGs. METHODS We performed a retrospective review of 74 patients with WHO grade II gliomas and known IDH mutational status undergoing resection at a single institution. EOR was assessed with quantitative 3-dimensional volumetric analysis. The effect of predictor variables on MPFS and OS was analyzed with Cox regression models and the Kaplan–Meier method. RESULTS Fifty-two (70%) mtIDH patients and 22 (30%) wtIDH patients were included. Median preoperative tumor volume was 37.4 cm3; median EOR of 57.6% was achieved. Univariate Cox regression analysis confirmed EOR as a prognostic factor for the entire cohort. However, stratifying by IDH status demonstrates that greater EOR independently prolonged MPFS and OS for wtIDH patients (hazard ratio [HR] = 0.002 [95% confidence interval {CI} 0.000-0.074] and HR = 0.001 [95% CI 0.00-0.108], respectively), but not for mtIDH patients (HR = 0.84 [95% CI 0.17-4.13] and HR = 2.99 [95% CI 0.15-61.66], respectively). CONCLUSION Increasing EOR confers oncologic and survival benefits in IDH1 wtLGGs, but the impact on IDH1 mtLGGs requires further study.

Surgery for Diffuse WHO Grade II Gliomas: Volumetric Analysis of a Multicenter Retrospective Cohort From the German Study Group for Intraoperative Magnetic Resonance Imaging

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. E64-E74 ◽  
Author(s):  
Moritz Scherer ◽  
Hajrulla Ahmeti ◽  
Constantin Roder ◽  
Florian Gessler ◽  
Christine Jungk ◽  
...  
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Study Group ◽  
Incomplete Resection ◽  
Who Grade ◽  
German Study ◽  
Significant Survival ◽  
Idh Mutations ◽  
Grade Ii ◽  
Who Grade Ii Gliomas

Abstract BACKGROUND In diffuse WHO grade II gliomas (LGG), the extent of resection (EOR) required to achieve significant survival benefits remains elusive. OBJECTIVE To evaluate the association of residual volume (RV) and EOR with progression-free survival (PFS) or overall survival (OS) in LGG in a retrospective, multicenter series by the German study group of intraoperative MRI (GeSGIM). METHODS Consecutive cases were retrospectively assessed from 5 centers. Tumors were volumetrically quantified before and after surgery, and clinical data were analyzed, including IDH mutations and neurologic deficits. Kaplan–Meier estimates, accelerated failure time models (AFT), and multivariate Cox regression models were calculated to identify determinants of survival. RESULTS A total of 140 cases were analyzed. Gross total resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (P = .009). A significant survival disadvantage was evident even for small (&gt;0-5 ml) residuals and increased for moderate (&gt;5-20 ml) and large remnants (&gt;20 ml) P = .001). Accordingly, PFS increased continuously for 20% incremental steps of EOR (P &lt; .001). AFT models supported the notion of a continuous association of RV and EOR with PFS. Multivariate Cox regression models confirmed RV (P = .01) and EOR (P = .005) as continuous prognosticators of PFS. Univariate analysis showed significant associations of RV and EOR with OS. CONCLUSION Our data support the hypothesis of a continuous relationship of RV and EOR with survival for LGG with superiority seen for GTR. Hence, GTR should be achieved whenever safely feasible, and resections should be maximized whenever tumor has to be left behind to spare function.

scholarly journals Long-term efficacy of surgical resection with or without adjuvant therapy for treatment of secondary glioblastoma in adults

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Ruoyu Huang ◽  
Guanzhang Li ◽  
Yiming Li ◽  
Yinyan Wang ◽  
Pei Yang ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Prognostic Factors ◽  
Adjuvant Therapy ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Postoperative Radiotherapy ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Secondary Glioblastoma

Abstract Background There are limited studies on treatment strategies and associated clinical outcomes in patients with secondary glioblastoma (sGBM). We sought to investigate the prognostic factors and treatment decisions in a retrospective cohort of patients with sGBM. Methods One hundred and seventy-one patients with sGBM who met the screening criteria were included in this study. Kaplan–Meier survival analysis and Cox survival analysis were used to detect prognostic factors. R (v3.5.0) and SPSS software (v25.0, IBM) were used to perform statistical analyses. Results The median overall survival was 303 days (range 23–2237 days) and the median progression-free survival was 229 days (range 33–1964 days) in patients with sGBM. When assessing the relationship between adjuvant treatment outcome and extent of resection (EOR), the results showed that patients underwent gross total resection can benefit from postoperative radiotherapy and chemotherapy, but not in patients underwent subtotal resection. In addition, we also found that aggressive adjuvant therapy can significantly improve clinical outcomes of IDH1-mutated patients but no significant prognostic value for IDH1-wildtyped patients. The univariate Cox regression analyses demonstrated that EOR, adjuvant therapy, and postoperative Karnofsky Performance Scores were prognostic factors for patients with sGBM, and multivariate COX analysis confirmed that adjuvant therapy and EOR were independent prognostic factors. Conclusions For patients with sGBM, aggressive postoperative adjuvant therapy after gross total resection was recommended. However, we did not detect a benefit in IDH1-wildtype patients in our cohort.

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