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Local control and overall survival in atypical meningioma: a retrospective study
L K Goyal1, J H Suh, D S Mohan
1Department of Radiation Oncology, The Cleveland Clinic Foundation, OH 44195, USA.
Purpose:
To evaluate local control and overall survival after primary surgery for patients with atypical meningiomas.
Methods And Materials:
From the Department of Pathology database, we identified 491 cases of meningioma treated at the Cleveland Clinic Foundation from 1979 through 1995. Thirty-three were diagnosed with atypical meningioma. Eleven of the excluded patients had incomplete records, were lost to follow-up, or received treatment elsewhere. Of the 22 evaluable patients, 15 underwent gross total resection (GTR), 4 had a subtotal resection (STR), and 3 had a resection of unknown extent. Eight patients received radiation therapy (2 after initial resection and 6 after at least one recurrence). The median radiation dose was 5,400 cGy (range 3,500-5,940). The median age at presentation was 55.5 years, the male:female ratio was 14:8, and 19/22 patients had a Karnofsky performance score (KPS) > or =80. The independent variables analyzed for overall survival and local control were gender, KPS (> or =80 vs. < 80), extent of surgery (GTR vs. STR or unknown extent of surgery), and postoperative radiation therapy.
Results:
Median survival was 10.6 years, with a median follow-up of 5.5 years (range 1.5-14.8). Eight of the 22 patients had local recurrence, including 2/15 with GTR, 3/4 with STR, and all 3 patients who underwent resection of unknown extent. At 10 years, patients with GTR had a higher local control rate than those who had either a STR or a resection of unknown extent (87% vs. 17%; p = 0.02). The 5- and 10-year overall survival rates for the entire group were 91% and 76%, respectively. Patients who had GTR had 5- and 10-year overall survival of 87% and 87%, respectively. Patients with STR or resection of unknown extent had 5- and 10-year overall survival rates of 100% and 75%, respectively.
Conclusion:
In patients with atypical meningiomas, gross total resection is associated with a lower recurrence rate than in subtotal resection.
Insights
Gross total resection (GTR) significantly improves local control for atypical meningiomas compared to subtotal resection (STR). GTR offers better long-term outcomes for patients with these brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Atypical meningiomas are rare brain tumors with a higher recurrence rate than typical meningiomas.
- Surgical resection is the primary treatment modality for atypical meningiomas.
- Optimizing surgical techniques is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of primary surgery extent on local control and overall survival in patients with atypical meningiomas.
- To compare outcomes between gross total resection (GTR) and subtotal resection (STR) or resection of unknown extent.
- To identify prognostic factors influencing recurrence and survival.
Main Methods:
- Retrospective analysis of 491 meningioma cases, identifying 22 evaluable patients with atypical meningioma.
- Surgical extent was categorized as GTR, STR, or unknown.
- Patient data including age, Karnofsky performance score (KPS), and use of radiation therapy were analyzed.
- Outcomes assessed included local recurrence and overall survival.
Main Results:
- Gross total resection (GTR) was associated with a significantly higher local control rate at 10 years (87%) compared to subtotal resection (STR) or unknown extent (17%; p = 0.02).
- The 5- and 10-year overall survival rates for the entire cohort were 91% and 76%, respectively.
- Patients undergoing GTR demonstrated superior 10-year overall survival (87%) compared to those with STR or unknown extent (75%).
Conclusions:
- Gross total resection (GTR) is associated with a significantly lower recurrence rate in patients with atypical meningiomas.
- Achieving GTR should be the primary surgical goal to improve local control and long-term survival.
- Further research may explore the role of adjuvant therapies in conjunction with optimal surgical resection.