Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection

Sam Q. Sun, Albert H. Kim, Chunyu Cai, Rory K.J. Murphy, Todd DeWees, Peter Sylvester, Ralph G. Dacey, Robert L. Grubb, Keith M. Rich, Gregory J. Zipfel, Joshua L. Dowling, Eric C. Leuthardt, Jeffrey R. Leonard, John Evans, Joseph R. Simpson, Clifford G. Robinson, Richard J. Perrin, Jiayi Huang, Michael R. Chicoine

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

CONCLUSION: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.

BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.

OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.

METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression.

RESULTS: Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/ EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/ EBRT (P = .8, P . .99).

Original languageEnglish (US)
Pages (from-to)347-354
Number of pages8
JournalNeurosurgery
Volume75
Issue number4
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Meningioma
Radiotherapy
Radiation
Recurrence
Disease-Free Survival
Nonparametric Statistics
Brain
Mitotic Index
Survival
Kaplan-Meier Estimate
Cohort Studies
Multivariate Analysis
Survival Rate
Retrospective Studies
Observation
Bone and Bones

Keywords

  • Adjuvant
  • Local/therapy
  • Meningioma/mortality
  • Meningioma/pathology
  • Meningioma/therapy
  • Neoplasm recurrence
  • Prognosis
  • Radiotherapy
  • Retrospective studies

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Sun, S. Q., Kim, A. H., Cai, C., Murphy, R. K. J., DeWees, T., Sylvester, P., ... Chicoine, M. R. (2014). Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection. Neurosurgery, 75(4), 347-354.

Management of atypical cranial meningiomas, Part 1 : Predictors of recurrence and the role of adjuvant radiation after gross total resection. / Sun, Sam Q.; Kim, Albert H.; Cai, Chunyu; Murphy, Rory K.J.; DeWees, Todd; Sylvester, Peter; Dacey, Ralph G.; Grubb, Robert L.; Rich, Keith M.; Zipfel, Gregory J.; Dowling, Joshua L.; Leuthardt, Eric C.; Leonard, Jeffrey R.; Evans, John; Simpson, Joseph R.; Robinson, Clifford G.; Perrin, Richard J.; Huang, Jiayi; Chicoine, Michael R.

In: Neurosurgery, Vol. 75, No. 4, 01.01.2014, p. 347-354.

Research output: Contribution to journalArticle

Sun, SQ, Kim, AH, Cai, C, Murphy, RKJ, DeWees, T, Sylvester, P, Dacey, RG, Grubb, RL, Rich, KM, Zipfel, GJ, Dowling, JL, Leuthardt, EC, Leonard, JR, Evans, J, Simpson, JR, Robinson, CG, Perrin, RJ, Huang, J & Chicoine, MR 2014, 'Management of atypical cranial meningiomas, Part 1: Predictors of recurrence and the role of adjuvant radiation after gross total resection', Neurosurgery, vol. 75, no. 4, pp. 347-354.
Sun, Sam Q. ; Kim, Albert H. ; Cai, Chunyu ; Murphy, Rory K.J. ; DeWees, Todd ; Sylvester, Peter ; Dacey, Ralph G. ; Grubb, Robert L. ; Rich, Keith M. ; Zipfel, Gregory J. ; Dowling, Joshua L. ; Leuthardt, Eric C. ; Leonard, Jeffrey R. ; Evans, John ; Simpson, Joseph R. ; Robinson, Clifford G. ; Perrin, Richard J. ; Huang, Jiayi ; Chicoine, Michael R. / Management of atypical cranial meningiomas, Part 1 : Predictors of recurrence and the role of adjuvant radiation after gross total resection. In: Neurosurgery. 2014 ; Vol. 75, No. 4. pp. 347-354.
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abstract = "CONCLUSION: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression.RESULTS: Of 151 patients, 13 (8.6{\%}) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8{\%}; median, 44 months) and 2 of 39 with GTR/EBRT (5.1{\%}; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/ EBRT were 97{\%}, 86{\%}, and 68{\%} vs 100{\%}, 100{\%}, and 78{\%}. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/ EBRT (P = .8, P . .99).",
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T1 - Management of atypical cranial meningiomas, Part 1

T2 - Predictors of recurrence and the role of adjuvant radiation after gross total resection

AU - Sun, Sam Q.

AU - Kim, Albert H.

AU - Cai, Chunyu

AU - Murphy, Rory K.J.

AU - DeWees, Todd

AU - Sylvester, Peter

AU - Dacey, Ralph G.

AU - Grubb, Robert L.

AU - Rich, Keith M.

AU - Zipfel, Gregory J.

AU - Dowling, Joshua L.

AU - Leuthardt, Eric C.

AU - Leonard, Jeffrey R.

AU - Evans, John

AU - Simpson, Joseph R.

AU - Robinson, Clifford G.

AU - Perrin, Richard J.

AU - Huang, Jiayi

AU - Chicoine, Michael R.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - CONCLUSION: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression.RESULTS: Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/ EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/ EBRT (P = .8, P . .99).

AB - CONCLUSION: Brain invasion and high mitotic rates may predict recurrence. After GTR of AMs, EBRT appears not to affect progression-free survival and overall survival, suggesting that observation rather than EBRT may be indicated after GTR.BACKGROUND: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.OBJECTIVE: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.METHODS: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.0 months) were examined for possible predictors of recurrence (age, sex, location, volume, bone involvement, brain invasion). The Fisher exact and Wilcoxon rank-sum tests were used to analyze the association between these predictors and use of EBRT. The impact on recurrence for these predictors and EBRT was analyzed with Kaplan-Meier and Cox regression.RESULTS: Of 151 patients, 13 (8.6%) experienced recurrence after GTR (median, 47.0 months). Multivariate analysis identified elevated mitotic index (P = .007) and brain invasion (P = .002) as predictors of recurrence. Larger volume (P = .96) was not associated with recurrence but was more likely to prompt EBRT (P = .001). Recurrences occurred in 11 of 112 with GTR (9.8%; median, 44 months) and 2 of 39 with GTR/EBRT (5.1%; median, 133 months). The 2-, 5-, and 10-year progression-free survival rates after GTR vs GTR/ EBRT were 97%, 86%, and 68% vs 100%, 100%, and 78%. Kaplan-Meier analysis demonstrated no difference in progression-free survival or overall survival after GTR vs GTR/ EBRT (P = .8, P . .99).

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KW - Local/therapy

KW - Meningioma/mortality

KW - Meningioma/pathology

KW - Meningioma/therapy

KW - Neoplasm recurrence

KW - Prognosis

KW - Radiotherapy

KW - Retrospective studies

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