Journal Article

Long term follow up in 183 high grade meningioma: A single institutional experience

Erbetta, A., Silvani, A., Pollo, B., Gaviani, P., Pinzi, V., Simonetti, G., Farinotti, M., Legnani, F., Tramacere, I.

2021

Overview

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. Through a retrospective analysis, we examined epidemiological, diagnostic, therapeutic, recurrence information and survival data of HGM treated at our institution between 2010 and 2018. 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. 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. •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.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: 2-Methylisoborneol / Adult / Aged / Aged, 80 and over / Anaplastic meningioma / Aphasia / Atypical meningioma / Brain cancer / Chemotherapy / Combined Modality Therapy - methods / Disease control / Epidemiology / Female / Follow-Up Studies / Hematoma / High grade meningioma / Humans / Male / Medical treatment / Meningeal Neoplasms - pathology / Meningeal Neoplasms - therapy / Meningioma / Meningioma - pathology / Meningioma - therapy / Metastasis / Middle Aged / Neurology / Neurosurgery / Neurosurgical Procedures - methods / Patients / Radiation therapy / Radiotherapy / Radiotherapy, Adjuvant - methods / Retrospective Studies / Statistical analysis / Surgery / Survival / Treatment Outcome / Tumors