Atypical meningioma - grade II

Abstract BACKGROUND Adjuvant radiotherapy (RT) in atypical meningioma, especially for gross-totally resected tumors, remains controversial. METHODS We retrospectively identified histologically-confirmed cases of WHO Grade II atypical meningioma at a large academic institution from 2004–2018. Clinicodemographic, surgical, radiation therapy (RT), and histopathologic data were collected, as well as imaging and clinical outcomes, with a median follow-up time of 26 months (IQR 32). Patients were stratified by resection status and whether or not upfront RT was administered. Additionally, subanalyses were performed to compare external beam RT (EBRT) and stereotactic radiosurgery (SRS). Progression was defined by radiology report. RESULTS Of 122 patients, 45 were excluded for lacking adequate records of previous treatment, less than 3 months follow-up, or lacking MR imaging. Of 77 patients analyzed, 57% (44/77) were female; median 59-years-old. 48% (24/50) of gross-total-resections (GTR) received upfront RT – only a single case progressed, at 39 months. Of 26 GTR patients without upfront RT, 8/26 (31%) progressed at median 19.5 months – of these, 2 were lost to follow-up, 5 received salvage RT, and 1 had surgery alone. Adjuvant RT was associated with superior progression free survival (PFS) in GTR (Cox proportional hazard ratio 0.15, likelihood-ratio p=0.025; median PFS not reached). Of 15 subtotal resections (STR) receiving upfront RT, 11 received EBRT and 4 received SRS – 6 progressed (median 37 months), all after EBRT. Upfront SRS demonstrated superior PFS over EBRT following STR (p=0.036). Across the cohort there was one confirmed death, a GTR patient (without RT) who suffered an ischemic stroke at 11 months. CONCLUSION This large single-center retrospective analysis indicates adjuvant RT improves PFS in GTR atypical meningiomas, in concordance with prior studies. It is limited by short median follow-up, possibly related to long-term stability in treated patients. In STR tumors, SRS may contribute to improved PFS compared to EBRT.

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Major complications from radiotherapy following treatment for atypical meningiomas

Neurosurgical FOCUS ◽

10.3171/2019.3.focus1930 ◽

2019 ◽

Vol 46 (6) ◽

pp. E5 ◽

Cited By ~ 1

Author(s):

Troy Dawley ◽

Zaker Rana ◽

Hussam Abou-Al-Shaar ◽

Anuj Goenka ◽

Michael Schulder

Keyword(s):

Cognitive Decline ◽

Treatment Options ◽

Mass Effect ◽

Postoperative Management ◽

Atypical Meningioma ◽

Normal Brain ◽

Who Grade ◽

Cerebrospinal Fluid Diversion ◽

Major Complications ◽

Grade Ii

OBJECTIVEComplications from radiotherapy (RT), in a primary or adjuvant setting, have overall been described as uncommon, with few detailed descriptions of major complications. The authors present two cases involving significant complications and their management in their review of patients undergoing RT for treatment of atypical meningioma.METHODSThe authors conducted a retrospective review of all patients with pathologically confirmed atypical meningioma (WHO grade II) treated with primary or adjuvant RT from February 2011 through February 2019. They identified two patients with long-term, grade 3 toxicity. The cases of these patients are described in detail.RESULTSTwo patients had major complications associated with postoperative RT. Patients 1 and 2 both were treated with postoperative RT for pathologically confirmed atypical meningioma. Patient 1 experienced worsening behavioral changes, cognitive decline, and hydrocephalus following treatment. This required cerebrospinal fluid diversion. Patient 2 developed radiation necrosis with mass effect and cognitive decline. Neither patient returned to his/her initial post-RT status after steroid therapy, and each remained in need of supportive care. Both patients remained free of tumor progression at 52 and 38 months following treatment.CONCLUSIONSThe postoperative management of patients with atypical meningioma continues to be defined, with questions remaining regarding timing of RT, dose, target delineation, and fractionation. Both of the patients in this study received fractionated RT, which included a greater volume of normal brain than more focal treatment options such as would be required by stereotactic radiosurgery (SRS). Further research is needed to compare SRS and fractionated RT for the management of patients with grade II meningiomas. The more focused nature of SRS may make this a preferred option in certain cases of focal recurrence.

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Adjuvant Radiotherapy Versus Watchful Waiting for World Health Organization Grade II Atypical Meningioma: A Single-Institution Experience

Neurosurgery ◽

10.1093/neuros/nyaa580_s124 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S124-S124

Author(s):

David P Bray ◽

Joseph W Quillin ◽

Robert H Press ◽

Yilin Yang ◽

Zhengjia Chen ◽

...

Keyword(s):

World Health Organization ◽

Adjuvant Radiotherapy ◽

Watchful Waiting ◽

Atypical Meningioma ◽

World Health ◽

Single Institution ◽

Grade Ii ◽

Health Organization

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

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab094 ◽

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.

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Role of Gamma Knife surgery for intracranial atypical (WHO Grade II) meningiomas

Journal of Neurosurgery ◽

10.3171/2013.8.jns13343 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1410-1414 ◽

Cited By ~ 16

Author(s):

Shunya Hanakita ◽

Tomoyuki Koga ◽

Hiroshi Igaki ◽

Naoya Murakami ◽

Soichi Oya ◽

...

Keyword(s):

Gamma Knife ◽

Local Control ◽

Univariate Analysis ◽

Atypical Meningioma ◽

Gamma Knife Surgery ◽

Tumor Control ◽

Karnofsky Performance Scale ◽

Who Grade ◽

Fractionated Radiotherapy ◽

Grade Ii

Object Atypical meningioma often recurs even after resection. As a salvage modality, radiotherapy or stereotactic radiosurgery (SRS) is attempted for this aggressive tumor. This retrospective study was performed to evaluate the efficacy of SRS that involved Gamma Knife surgery (GKS) for atypical meningioma. Methods The authors reviewed records from 22 patients with histologically proven atypical meningioma who underwent GKS for 28 lesions at the authors' institute. The median patient age was 70 years (range 24–91 years), and the median tumor volume for each procedure was 6.0 cm3 (range 1.6–38.7 cm3). The margin dose ranged from 14 to 20 Gy (median 18 Gy). Follow-up periods ranged from 3 months to 98 months (median 23.5 months). Results In total, 39 GKS procedures were performed for 28 lesions. The local control rates at 1, 2, and 5 years were 74%, 39%, and 16%, respectively. Volume less than 6 cm3 (p = 0.01), a margin dose higher than 18 Gy (p = 0.02), and a Karnofsky Performance Scale (KPS) score of 90 or more (p = 0.02) were factors associated with a longer duration of tumor control in the univariate analysis. Conclusions Atypical meningioma could be more successfully controlled when a higher margin dose was used to treat patients with a good performance (KPS score of ≥ 90) status and smaller tumor volumes. It would be desired if patients are treated with a relatively higher margin dose, ideally as high as the dose applied for malignant tumor. A boost SRS after fractionated radiotherapy may be effective to achieve better local control.

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NCOG-56. THE NATURAL COURSE OF ATYPICAL MENINGIOMA AFTER GROSS TOTAL RESECTION WITHOUT ADJUVANT TREATMENT

Neuro-Oncology ◽

10.1093/neuonc/noaa215.594 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii142-ii142

Author(s):

Hee Jun Yoo ◽

Jeong Hoon Kim

Keyword(s):

Adjuvant Treatment ◽

Tumor Resection ◽

Atypical Meningioma ◽

Natural Course ◽

Gross Total Resection ◽

Adjuvant Radiation ◽

Total Resection ◽

Resection Group ◽

Simpson Grade ◽

Grade Ii

Abstract Atypical meningioma represent more aggressive clinical behaviors than WHO grade I meningiomas. In this study, We research natural course of atypical meningioma after gross total resection without adjuvant treatment. MATERIAL AND METHODS: We retrospectively reviewed the records of patients with histopathologically diagnosed atypical meningiomas between June 1990 and December 2015 at Asan Medical Center, Korea. Patients treated with Simpson grade I, II resection were included. Patients variably underwent adjuvant radiation therapy according to each surgeon’s preferences. RESULTS: In this study, 117 patients were enrolled and the average follow-up was 43 months (range 3~228 months). In Simpson grade I tumor resection group, recurrence was confirmed in 10 out of 63 patients without adjuvant treatment, and 1 out of 13 patients with adjuvant radiation treatment. There were 12 recurrence cases in Simpson grade II tumor resection and no adjuvant treatment group, of the total 32 cases. There was 4 recurrence case of total 8 cases of Simpson grade II tumor resection with adjuvant radiation treatment group. In groups with no adjuvant treatment, Simpson grade I resection group had a better prognosis on 5-year PFS (82.9% vs 54.9%, p=0.005) compared to Simpson grade II resection group. DISCUSSION: The results of this study show that there is a significant difference in 5-year PFS between the Simpson grade I and II groups without adjuvant treatment, commonly referred to as the gross total resection group. Although this study report adjuvant RT is not superior to observation, more intensive post-operative imaging surveillance protocols would be considered in Simpson grade II resection group without adjuvant treatment. CONCLUSION: The natural course of atypical meningioma after gross total resection without adjuvant treatment signified Simpson grade I and II resection show significant different prognosis.

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