Granular clinical history and outcome in 51 patients with primary and secondary malignant meningioma
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Published on: July 5, 2021
Andrea D Maier1,2, Christian Mirian1, Jeppe Haslund-Vinding1
11Departments of Neurosurgery.
Objective:
WHO grade III meningiomas, also known as malignant meningiomas (MMs), are rare, and the heterogenous clinical course in patients with MM is not well described. To characterize the clinical course of patients with MM, granular clinical data were gathered from 51 patients treated at the Department of Neurosurgery and Radiation Oncology, Rigshospitalet, in Copenhagen, Denmark, between 2000 and 2020.
Methods:
The authors investigated outcome and timing in terms of 1) tumor progression and grade transformation in patients previously diagnosed with WHO grade I or II meningiomas (patients with a secondary MM [sMM]); 2) performance status and complications following surgery; and 3) transition to noncurative treatment and ultimately death. Complications, time between recurrences, and outcome (modified Rankin Scale [mRS] score) for every surgery were analyzed, both malignant and premalignant.
Results:
Of the 51 patients, 24 (47%) had an sMM. The time to WHO grade III transformation in the sMM group varied widely (median 5.5 years, range 0.5-22 years), but after transformation to a WHO grade III tumor, patients with an sMM and those with a primary MM (pMM) did not differ significantly in overall survival and cumulative risk of progression. Median overall survival for all 51 patients was 4.2 years (95% CI 2.6-7.2 years). Time from the decision to shift from curative to noncurative treatment until death was 3.8 months and the 30-day mortality rate following surgery was 11.8%. From a cumulative number of 151 surgeries, 10 surgeries were followed by improvement on the mRS, mRS score was unchanged in 70, and it worsened in 71. The MM was the underlying cause of death in 30 of 31 patients who had died at the end of follow-up.
Conclusions:
Together, these findings clearly show a significant morbidity and mortality from the disease itself and from the treatment. These findings warrant studies of prognostic factors for earlier support and adjuvant measures in MM and identify a need for better palliative strategies in this patient group.
Insights
Malignant meningiomas (MMs) cause significant morbidity and mortality. Early support and better palliative strategies are needed for patients with this rare but aggressive tumor.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- WHO grade III meningiomas, or malignant meningiomas (MMs), are rare with a poorly understood clinical course.
- Characterizing the clinical trajectory of MM is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the clinical course of 51 patients with malignant meningiomas (MMs).
- To analyze tumor progression, treatment response, and survival in patients with primary or secondary MMs.
Main Methods:
- Retrospective analysis of clinical data from 51 patients diagnosed with MM between 2000 and 2020.
- Evaluation of tumor progression, grade transformation, surgical complications, performance status (mRS), and survival.
- Distinction between primary MM (pMM) and secondary MM (sMM) from lower-grade meningiomas.
Main Results:
- Of 51 patients, 24 (47%) had sMM. Transformation to WHO grade III varied widely (median 5.5 years).
- Post-transformation, sMM and pMM showed similar survival and progression risks. Median overall survival was 4.2 years.
- High surgical morbidity (11.8% 30-day mortality) and mortality from MM (30/31 deaths).
Conclusions:
- Malignant meningiomas lead to substantial morbidity and mortality from both the disease and its treatment.
- Further research into prognostic factors for early support and adjuvant therapies is warranted.
- Improved palliative care strategies are essential for MM patients.
