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Long term follow up in 183 high grade meningioma: A single institutional experience
G Simonetti1, A Silvani1, I Tramacere2
1Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy.
Insights
High-grade meningiomas (HGM) exhibit aggressive behavior, with gross-total resection improving survival. Current treatments for recurrent HGM are ineffective, necessitating research into targeted therapies.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pathology
Background:
- Meningiomas are typically benign, but a subset, high-grade meningiomas (HGM), display aggressive behavior.
- Effective medical treatments for HGM, particularly upon recurrence, are currently lacking.
Purpose of the Study:
- To analyze epidemiological, diagnostic, therapeutic, recurrence, and survival data for HGM patients treated between 2010 and 2018.
- To identify prognostic factors and evaluate treatment outcomes for high-grade meningiomas.
Main Methods:
- Retrospective analysis of 183 patients diagnosed with high-grade meningiomas (atypical, anaplastic, rhabdoid).
- Evaluation of treatment modalities including surgical resection extent, radiation therapy (RT), and systemic therapies.
- Analysis of survival data, progression-free survival (PFS), and overall survival (OS).
Main Results:
- Gross-total resection was associated with significantly better 5-year survival rates (95%) compared to subtotal/partial resection.
- Higher Ki-67/MIB-1 expression correlated with an increased risk of death (p=0.03).
- Radiation therapy showed no significant impact on overall survival but a potential benefit for progression-free survival (p=0.03). Systemic therapies demonstrated limited efficacy in controlling recurrent disease.
Conclusions:
- The study confirms the aggressive nature of high-grade meningiomas.
- Extent of surgical resection is a critical factor for favorable outcomes in HGM.
- Recurrent HGM present a significant therapeutic challenge, highlighting the need for novel, targeted treatments based on molecular predictors.
Introduction:
Meningiomas are usually considered benign lesions, however a proportion of them shows a more aggressive behavior, defined high-grade meningiomas (HGM). Effective medical treatments are lacking, especially at the time of recurrence.
Methods:
Through a retrospective analysis, we examined epidemiological, diagnostic, therapeutic, recurrence information and survival data of HGM treated at our institution between 2010 and 2018.
Results:
183 patients (105 females and 78 males), with median age of 58 years (25-88), were included; 168 were atypical, 12 anaplastic, 3 rhabdoid. Overall, m-PFS was 4.2 years, and m-OS was 10.3 years. Gross-total resection had a 5-year survival rate of 95% compared with subtotal/partial resection (86% and 67%) (p = 0.002). Higher expression of Ki-67/MIB-1 seems associated with higher risk of death (HR:1.06 with 95% CI, 1.00-1.12, p = 0.03). No statistically significant differences were seen in survival between the group managed with a wait-and-see strategy vs the group treated with RT while a difference on PFS was seen (4.1 years vs 5.2 years p = 0.03). After second recurrence, the most employed treatments were systemic therapies with a very limited effect on disease control.
Conclusions:
Data confirmed the aggressive behavior of HGM. The extent of resection seems to correlate with a favorable outcome regardless histological subtypes. The role of RT remains controversial, with no statistically significant impact on OS but a possible role on PFS. Recurrent HGM remains the real challenge, to date no chemotherapies are able to achieve disease control. Future research should focus on biological/molecular predictors in order to achieve a patient-tailored treatment.
