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Long-term outcomes of multimodality management for parasagittal meningiomas
Lingyang Hua1, Daijun Wang1, Hongda Zhu1
1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.
Purpose:
The aim of this study was to systematically analyze the clinical characteristics of a large cohort of parasagittal meningioma (PM) and to evaluate the patients' outcomes and best treatment strategies based on tumor features.
Methods:
To minimize selection bias we performed a single-institutional review of PM with restricted criteria. One hundred and ninety-two consecutive patients who met criteria for inclusion were reviewed from 2003 to 2011 in our general hospital.
Results:
A total of 131 cases (68.2%) were with WHO grade I, while grade II and grade III PMs constituted 40 (20.8%) and 21 cases (10.9%). Higher histological grade was associated with loss of trimethylation of H3K27 (P = 0.000). For WHO grade I PMs, GTR was significantly associated with a better PFS (P = 0.023); however, adjuvant radiotherapy did not benefit patients with STR (P = 0.215). For de novo high-grade (WHO grade II and III) PMs (n = 37), adjuvant radiotherapy was associated with a significantly longer OS (P = 0.013), while no difference was observed between GTR and STR (P = 0.654). In recurrent high-grade PM patients (n = 24), GTR combined with adjuvant radiotherapy increased PFS (P = 0.005).
Conclusions:
This study demonstrated that PMs were a heterogeneous group of tumors with a high proportion of high-grade tumors that often displayed aggressive clinical behaviors. Low-grade PM benefited from radical resection, whereas high-grade de novo PM did not. Adjuvant radiotherapy significantly prolonged OS for high-grade primary PM, but did not impact survival of patients with subtotally resected low-grade tumors. Long-term outcome of high-grade recurrent PMs was dismal. We thus show that extent of tumor resection, tumor grade and tumor recurrent status inform therapeutic decisions for PMs.
Insights
Parasagittal meningiomas (PMs) show varied clinical behavior. Radical resection benefits low-grade PMs, while adjuvant radiotherapy improves survival for high-grade primary PMs.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Parasagittal meningiomas (PMs) are tumors arising near the superior sagittal sinus.
- Understanding their clinical characteristics and optimal treatment is crucial for patient outcomes.
Purpose of the Study:
- To systematically analyze the clinical features of a large parasagittal meningioma cohort.
- To evaluate patient outcomes and determine the best treatment strategies based on tumor characteristics.
Main Methods:
- Single-institutional review of 192 consecutive parasagittal meningioma patients from 2003-2011.
- Analysis of tumor grade (WHO I, II, III), extent of resection (GTR/STR), and adjuvant radiotherapy impact on survival.
Main Results:
- 131 cases (68.2%) were WHO grade I, 40 (20.8%) grade II, and 21 (10.9%) grade III.
- For WHO grade I PMs, gross total resection (GTR) improved progression-free survival (PFS); adjuvant radiotherapy did not benefit subtotal resection (STR) cases.
- Adjuvant radiotherapy significantly improved overall survival (OS) in de novo high-grade PMs, but not in recurrent high-grade PMs where GTR combined with radiotherapy improved PFS.
Conclusions:
- Parasagittal meningiomas are heterogeneous, with a significant proportion being high-grade and aggressive.
- Treatment decisions for PMs should consider tumor grade, extent of resection, and recurrence status.
- Low-grade PMs benefit from radical resection, while high-grade PMs require tailored approaches including radiotherapy.
