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Recurrent Atypical Meningiomas: Combining Surgery and Radiosurgery in One Effective Multimodal Treatment
Andrea Talacchi1, Francesco Muggiolu1, Antonella De Carlo1
1Department of Neurological Science and Movement, University of Verona, Verona, Italy.
Objective:
Owing to their rarity and proteiform pathologic features, the clinical behavior of atypical meningiomas is not yet well characterized. Though the extent of resection is believed to be a key determinant of prognosis, limited data exist regarding optimal management of patients with recurrent disease.
Methods:
In this 20-year retrospective case series, we reviewed the medical records of 46 patients with recurrent atypical meningiomas (185 lesions, 89 of which were local, 78 marginal, and 18 distant recurrences); treatment was radiosurgery (n = 60), surgery (n = 56), or both (n = 8). The median follow-up period was 53 months. Outcome measures were length of overall survival and disease-free intervals and prognostic factors for survival.
Results:
Overall, the median progression-free survival was 26 months at the first recurrence and 100 months thereafter (the sum of the later intervals). Multivariate analysis showed that no treatment-related factors influenced prognosis, whereas recurrence at the skull base was a significant tumor-related factor limiting further treatment. Irrespective of treatment type, the recurrence-free interval was increasingly shorter during the clinical course, with a higher occurrence of marginal and distant lesions migrating to the midline and to the skull base. In sporadic cases, disease-free intervals were longer after wide craniotomy, tumor and dural resection with tumor-free margin.
Conclusions:
The disease-free interval was substantially similar after surgery and radiosurgery for treating recurrent disease in patients with atypical meningiomas. Surgery is the mainstay for prolonging survival, while radiosurgery can be an adjuvant strategy to gain time for clinical observation and planning aggressive surgical treatment.
Insights
For recurrent atypical meningiomas, surgery offers the best chance for prolonged survival, while radiosurgery can aid in managing the disease. Skull base recurrence is a key factor impacting prognosis in these rare tumors.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Radiation Oncology
Background:
- Atypical meningiomas are rare tumors with variable behavior.
- Optimal management strategies for recurrent atypical meningiomas remain unclear.
- Prognosis is influenced by factors like extent of resection and tumor location.
Observation:
- A 20-year retrospective study analyzed 46 patients with recurrent atypical meningiomas.
- Treatments included radiosurgery, surgery, or both.
- Median follow-up was 53 months, assessing survival and disease-free intervals.
Findings:
- No treatment-related factors significantly impacted prognosis.
- Recurrence at the skull base was a significant negative prognostic factor.
- Disease-free intervals shortened with each recurrence, with lesions migrating to the skull base.
Implications:
- Surgery is crucial for extending survival in recurrent atypical meningiomas.
- Radiosurgery can serve as an adjuvant to facilitate further treatment planning.
- Understanding tumor recurrence patterns, especially at the skull base, is vital for patient management.
