Prognostic role of extent of resection and adjuvant radiotherapy in de novo anaplastic meningiomas

Pauline Marijon ^1,2, Martin Planet ¹, Suzanne Tran ³

¹Sorbonne Universités - Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
²Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225 - Brain Institute, Hôpital de La Pitié-Salpêtrière, Paris, France.
³Department of Neuropathology, Sorbonne University, AP-HP, La Pitié-Salpêtrière Hospital, Paris, France.
⁴Neurosurgery Department, Gui de Chauliac Hospital, Montpellier University Medical Center, 91 Avenue Augustin Fliche, 34090, Montpellier, France.
⁵Department of Endocrine Biochemistry and Oncology, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
⁶Saint-Antoine Research Center, ISERM U938, Biology and Oncology Therapeutics, IUC, Sorbonne University, Paris, France.
⁷Department of Neurosurgery, Henri Mondor Hospital, APHP, 1 Rue Gustave Eiffel, 94000, Créteil, France.
⁸Department of Neurosurgery, Beaujon Hospital, APHP, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
⁹Department of Neurosurgery, Sainte-Anne Hospital, APHP, 1 Rue Cabanis, 75014, Paris, France.
¹⁰Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, 75014, Paris, France.
¹¹Department of Neuropathologie, Beaujon Hospital, APHP, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
¹²Department of Neuropathology, Sainte-Anne Hospital, APHP, 1 Rue Cabanis, 75014, Paris, France.
¹³Sorbonne Universités - Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Boulevard de L'Hôpital, 75013, Paris, France. matthieu.peyre@aphp.fr.
¹⁴Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225 - Brain Institute, Hôpital de La Pitié-Salpêtrière, Paris, France. matthieu.peyre@aphp.fr.

⁰Sorbonne Universités - Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.

Acta Neurochirurgica +

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November 28, 2024

View abstract on PubMed

Summary

For de novo anaplastic meningiomas, combining gross-total resection with adjuvant radiotherapy improved progression-free survival. This combination therapy is crucial for managing these aggressive tumors.

Area Of Science

Neuro-oncology
Surgical oncology
Radiation oncology

Background

Grade 3 meningiomas are rare but aggressive tumors with high morbidity and mortality.
The optimal management strategies, including surgical resection extent and adjuvant radiotherapy, remain debated.
Anaplastic meningiomas are often studied in heterogeneous cohorts, complicating treatment outcome analysis.

Purpose Of The Study

To evaluate the impact of surgical resection extent and adjuvant radiotherapy on outcomes in patients with de novo anaplastic meningiomas.
To analyze prognostic factors influencing progression-free and overall survival in this specific patient population.
To clarify treatment effectiveness for de novo anaplastic meningiomas based on pathological grading.

Main Methods

Retrospective multicentric study of patients operated for de novo anaplastic meningioma (1999-2021).
Centralized pathological review using 2016 WHO criteria.
Exclusion of patients with prior radiotherapy or NF2-related Schwannomatosis.

Main Results

Sixty-five patients were analyzed; median progression-free survival was 23 months, and median overall survival was 2 years.
Neither gross-total resection nor adjuvant radiotherapy alone predicted better overall survival.
The combination of gross-total resection and adjuvant radiotherapy significantly impacted progression-free survival (HR=0.47, p=0.027).
Tumors graded on mitosis number showed poorer prognosis than those graded on overt anaplasia.
In tumors with high mitotic scores, postoperative radiotherapy (HR=0.44, p=0.020) and the combination of gross-total resection plus adjuvant radiotherapy (HR=0.44, p=0.024) improved progression-free survival.

Conclusions

Simpson grade did not impact overall survival in this cohort.
Gross-total resection combined with adjuvant radiotherapy favorably influenced progression-free survival in de novo anaplastic meningiomas.
Treatment strategies should consider the combination of maximal surgical resection and adjuvant radiotherapy for aggressive meningiomas.

Keywords:

Adjuvant radiotherapy Malignant meningioma Meningioma Upfront radiotherapy WHO grade 3