Journal article
Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study
Neurosurgery, v 88(5), pp 980-988
May 2021
PMID: 33469655
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Atypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described.
OBJECTIVE: To define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs.
METHODS: An international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model.
RESULTS: A total of 271 patients received SRS for AMs (n = 233, 85.9%) or MMs (n = 38, 14.0%). Single-fraction SRS was most commonly employed (n = 264, 97.4%) with a mean target dose of 14.8 Gy. SRS was used as adjuvant treatment (n = 85, 31.4%), salvage therapy (n = 182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR) = 1.01, P < .05) and a Ki-67 index > 15% (HR = 1.66, P < .03) negatively correlated with PFS. MMs (HR = 3.21, P < .05), increased age (HR = 1.04, P = .04), and reduced KPS (HR = 0.95, P = .04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR = 0.99, P = .02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively.
CONCLUSION: AM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.
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- Title
- Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study
- Creators
- Matthew J. Shepard - University of Virginia Health SystemZhiyuan Xu - University of Virginia Health SystemKathryn Kearns - University of Virginia Health SystemChelsea Li - University of Virginia Health SystemAjay Chatrath - University of Virginia Health SystemKimball Sheehan - University of Virginia Health SystemDarrah Sheehan - University of Virginia Health SystemAndrew Faramand - University of Pittsburgh Medical CenterAjay Niranjan - University of Pittsburgh Medical CenterHideyuki Kano - University of Pittsburgh Medical CenterJason Gurewitz - NYU Langone Hlth Syst, Dept Neurosurg, New York, NY USAKenneth Bernstein - NYU Langone HealthRoman Liscak - Na Homolce HospitalKhumar Guseynova - Na Homolce HospitalInga S. Grills - Beaumont HealthJacob S. Parzen - Beaumont HealthChristopher P. Cifarelli - West Virginia UniversityAzeem A. Rehman - West Virginia UniversityAhmet Atik - Cleveland ClinicJoshua Bakhsheshian - University of Southern CaliforniaGabriel Zada - University of Southern CaliforniaEric Chang - University of Southern CaliforniaSteven Giannotta - University of Southern CaliforniaHerwin Speckter - Mayfield Clin, Dept Neurol Surg, Cincinnati, OH USAHsiu-Mei Wu - Birmingham Repertory TheatreDouglas Kondziolka - University of PittsburghJohn G. Golfinos - University of PittsburghDavid Mathieu - Université de SherbrookeCheng-Chia Lee - Taipei Vet Gen Hosp, Dept Radiol, Taipei, TaiwanRonald E. Warnick - Mayfield Brain & SpineL. Dade Lunsford - University of Pittsburgh Medical CenterJason P. Sheehan - University of Virginia Health System
- Publication Details
- Neurosurgery, v 88(5), pp 980-988
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000642441000048
- Scopus ID
- 2-s2.0-85104370066
- Other Identifier
- 991022154809204721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery