Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection

Sam Q. Sun; Albert H. Kim; Chunyu Cai; Rory K.J. Murphy; Todd DeWees; Peter Sylvester; Ralph G. Dacey; Robert L. Grubb; Keith M. Rich; Gregory J. Zipfel; Joshua L. Dowling; Eric C. Leuthardt; Jeffrey R. Leonard; John Evans; Joseph R. Simpson; Clifford G. Robinson; Richard J. Perrin; Jiayi Huang; Michael R. Chicoine

doi:10.1227/neu.0000000000000461

Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection

Sam Q. Sun, Albert H. Kim, Chunyu Cai, Rory K.J. Murphy, Todd DeWees, Peter Sylvester, Ralph G. Dacey, Robert L. Grubb, Keith M. Rich, Gregory J. Zipfel, Joshua L. Dowling, Eric C. Leuthardt, Jeffrey R. Leonard, John Evans, Joseph R. Simpson, Clifford G. Robinson, Richard J. Perrin, Jiayi Huang, Michael R. Chicoine

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87 Scopus citations

Abstract

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).

Original language	English (US)
Pages (from-to)	347-354
Number of pages	8
Journal	Neurosurgery
Volume	75
Issue number	4
DOIs	https://doi.org/10.1227/neu.0000000000000461
State	Published - 2014

Keywords

Adjuvant
Local/therapy
Meningioma/mortality
Meningioma/pathology
Meningioma/therapy
Neoplasm recurrence
Prognosis
Radiotherapy
Retrospective studies

ASJC Scopus subject areas

Surgery
Clinical Neurology

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Sun, S. Q., Kim, A. H., Cai, C., Murphy, R. K. J., DeWees, T., Sylvester, P., Dacey, R. G., Grubb, R. L., Rich, K. M., Zipfel, G. J., Dowling, J. L., Leuthardt, E. C., Leonard, J. R., Evans, J., Simpson, J. R., Robinson, C. G., Perrin, R. J., Huang, J., & Chicoine, M. R. (2014). Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection. Neurosurgery, 75(4), 347-354. https://doi.org/10.1227/neu.0000000000000461

Sun, SQ, Kim, AH, Cai, C, Murphy, RKJ, DeWees, T, Sylvester, P, Dacey, RG, Grubb, RL, Rich, KM, Zipfel, GJ, Dowling, JL, Leuthardt, EC, Leonard, JR, Evans, J, Simpson, JR, Robinson, CG, Perrin, RJ, Huang, J & Chicoine, MR 2014, 'Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection', Neurosurgery, vol. 75, no. 4, pp. 347-354. https://doi.org/10.1227/neu.0000000000000461

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title = "Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection",

abstract = "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).",

keywords = "Adjuvant, Local/therapy, Meningioma/mortality, Meningioma/pathology, Meningioma/therapy, Neoplasm recurrence, Prognosis, Radiotherapy, Retrospective studies",

author = "Sun, {Sam Q.} and Kim, {Albert H.} and Chunyu Cai and Murphy, {Rory K.J.} and Todd DeWees and Peter Sylvester and Dacey, {Ralph G.} and Grubb, {Robert L.} and Rich, {Keith M.} and Zipfel, {Gregory J.} and Dowling, {Joshua L.} and Leuthardt, {Eric C.} and Leonard, {Jeffrey R.} and John Evans and Simpson, {Joseph R.} and Robinson, {Clifford G.} and Perrin, {Richard J.} and Jiayi Huang and Chicoine, {Michael R.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2014 by the Congress of Neurological Surgeons.",

year = "2014",

doi = "10.1227/neu.0000000000000461",

language = "English (US)",

volume = "75",

pages = "347--354",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "4",

}

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.

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

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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 -

Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection

Abstract

Keywords

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