Meningioma recurrence: the efficacy and cost-effectiveness of current screening

Scanning of post-operative meningioma patients to detect tumour recurrence is common practice. There are however no guidelines for how often this should be performed for meningiomas of differing Simpson Grades of surgical removal and World Health Organisation (WHO) histological grades. A literature search reveals no studies investigating its role in post-operative care. The objective of this study was to determine current post-operative scanning use, in particular its timing and frequency in relation to meningioma recurrence rate. We performed a retrospective analysis of the surgical records of patients that underwent meningioma excision between 1998 and 2003 in Addenbrookes Hospital, and their follow-up scans up to 9 years post-surgery. Age at surgery, Simpson grade of surgical removal, tumour location, WHO histological grade, post-surgical radiotherapy, dates of meningioma recurrences, and dates of post-operative CT and MRI scans up to present, were recorded for each patient. A total of 283 records were analysed. Using logistic regression we found that WHO grade and post-surgical radiotherapy were the strongest predictors of meningioma recurrence. We found that timing and frequency of scans between patients of the same stage and grade is highly variable. Data suggests that the role for regular short term post-operative scanning of WHO grade 1 meningioma patients, a group that form the bulk of meningioma patients, is limited, and should only be performed in select, clinically indicated cases. A time and cost analysis reveals that significant savings can be made by adopting this policy. Data from a greater number of patients with WHO grade 2 and 3 meningiomas needs to analysed before definite conclusions can be made about the regularity of post-operative scanning in these patients. Our audit study has revealed an opportunity for significant monetary and time savings to be made without any compromise of patient care.