Treatment Response and Prognosis After Recurrence of Atypical Meningiomas

doi:10.1016/j.wneu.2015.05.032

World Neurosurgery

Volume 84, Issue 4, October 2015, Pages 1014-1019

https://doi.org/10.1016/j.wneu.2015.05.032 Get rights and content

Objective

Intracranial atypical meningiomas have a greater rate of recurrence than benign meningiomas. Scant literature, however, is available regarding the treatment and prognosis of these tumors after recurrence. The objective of this study was to analyze the treatment outcomes and prognostic factors of atypical meningiomas after recurrence of disease.

Methods

Forty-one cases with clinical characteristics and follow-up data were available in our department from 2000 to 2013. Certain factors, such as sex, age, preoperative Karnofsky Performance Status Scale score, location, prerecurrence tumor precursor, interval time, Simpson grade, histologic grade after recurrence, and radiotherapy, were selected to study the relationship with the prognosis of the tumors.

Results

The mean progression-free survival (PFS) and overall survival (OS) in our cases were 40.5 ± 4.7 and 57.1 ± 5.8 months, respectively. The 1-, 3-, and 5-year PFS rates were 79.8%, 44.1%, and 39.2%, respectively, and the corresponding OS rates were 92.4%, 66.1%, and 48.8%, respectively. The precursors of recurrent tumors were transformed meningiomas, an interval time less than 24 months, and a postrecurrence histologic diagnosis of anaplastic meningioma might predict an unfavorable outcome. Surgery Simpson I and II can improve the PFS and OS of tumors. Because of the limited number of cases, we could not identify a relationship between radiotherapy and prognosis.

Conclusions

Recurrent atypical meningiomas are intractable tumors with a high rate of recurrence and death. Total resection of the tumors under relatively safe conditions remains the most suitable treatment strategy.

Introduction

Meningiomas represent 13%–30% of all primary brain tumors, making it the most common benign intracranial tumor, with an annual incidence of 4.5–6 per 100,000 individuals 2, 10. Under the World Health Organization (WHO) 2007 classification, meningiomas have been classified into 3 grades (I–III), with 16 different variants or subtypes. Atypical meningiomas and the other 2 rare variants (chordoid and clear-cell type) comprise the WHO grade II group 14, 17. As the main type of grade II tumors, atypical meningiomas account for 4.6%–9.6% of all meningiomas. Atypical meningiomas are tumors with frequent mitotic (≥4 per 10 high-power fields) activity or that have at least 3 of the following characteristics: sheeting architecture, hypercellularity (focal or diffuse), prominent nucleoli, small cells with a high nuclear to cytoplasmic ratio, and foci of spontaneous necrosis 11, 17. Atypical meningiomas occupy an intermediate-risk group between benign and anaplastic meningiomas; thus, they have a greater rate of recurrence compared with benign tumors and are associated with increased morbidity and mortality 12, 18, 19.

Some literature sources have reported on the treatment and prognosis of atypical meningiomas, and the recurrence rate of the tumors was found to be approximately 40%–50% at 5 years in these studies 3, 5. Because of the limited cases of this tumor type, studies regarding its management and prognosis after recurrence are rare. Concerning atypical meningioma recurrence, variable strategies have been provided by physicians, including surgery, radiotherapy (RT), and radiosurgery. Controversy exists regarding the optimal treatment of the tumor after recurrence 3, 16.

In this study, we analyzed the data of 41 recurrent patients with atypical meningiomas at a single institution and detected certain factors for predicting the outcome. The related investigation will improve the management of these tumors.

Section snippets

Patient Selection

Approval for this study was granted by the Capital Medical University committee on human research. We reviewed retrospectively our case database and pathologic records at our hospital between May 2000 and September 2013. In our database, there were 106 cases whose diagnosis was atypical meningiomas, with 49 (46%) cases whose tumor recurrence received another surgery at our department. Among the 49 cases, the tumor precursors of 15 cases were transformed tumors (from their symptoms and

Clinical Characteristics

The mean age at the time of diagnosis was 54 years, with a range of 8–78 years. There were 17 (41.5%) men and 24 (58.5%) women. The presenting symptoms included headache (41.5%), neurologic deficits (34.1%), epilepsy (9.8%), and asymptomatic symptoms (14.6%). All of the patients underwent an MRI contrast scan before surgery. According to the MRI scan and operative records, the tumor locations were classified as follows: convexity (17.1%), falx (17.1%), parasagittal (29.3%), cranial base

Discussion

Because of the rarity of this tumor type, the literature regarding atypical meningioma is limited. The available references have been limited to only studies on primary atypical meningiomas 15, 16, 20. However, atypical meningiomas (WHO II) are associated with an approximately 8-fold increased risk of recurrence compared with that of grade I (14). After tumor recurrence, the management offered to patients should be cautious. If the patients received secondary or further surgery, the

Conclusions

Recurrent atypical meningiomas are intractable tumors with a high rate of recurrence and death. The precursors of these tumors were transformed meningiomas, with an interval time less than 24 months, and a postrecurrence histological diagnosis of anaplastic meningioma might predict an unfavorable outcome. Total resection of the tumors under relatively safe conditions remains the suitable strategy of treatment.

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: Conflict of interest statement: This work was supported in part by the Natural Science Foundation of China (No. 81341059) and Beijing Nova program (No. 2012033).

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Original ArticleTreatment Response and Prognosis After Recurrence of Atypical Meningiomas

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Patient Selection

Clinical Characteristics

Discussion

Conclusions

Hum Pathol

Int J Radiat Oncol Biol Phys

Surg Neurol

J Clin Neurosci

Int J Radiat Oncol Biol Phys

Lancet

Epidemiology and etiology of intracranial meningiomas: a review

J Neurooncol

WHO grade II and III meningiomas: a study of prognostic factors

J Neurooncol

Long-term survival analysis of atypical meningiomas: survival rates, prognostic factors, operative and radiotherapy treatment

Acta Neurochir (Wien)

Anatomic location is a risk factor for atypical and malignant meningiomas

Cancer

Original Article
Treatment Response and Prognosis After Recurrence of Atypical Meningiomas