Charles Champeaux1,2,3,4, Vincent Jecko3, Deborah Houston4, Lewis Thorne2, Laurence Dunn4, Naomi Fersht5, Akbar Ali Khan4, Matthieu Resche-Rigon1. 1. INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA team, Université Diderot - Paris 7, USPC, Paris, France. 2. Department of Neurosurgery, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 3. Department of Neurosurgery, Pellegrin Hospital, Bordeaux, France. 4. Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom. 5. Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: In contrast to benign meningiomas, malignant meningiomas (MM) are rare and associated with an unfavourable prognosis. Reports on MM concern fairly small cohorts, often comprising less than 30 cases. OBJECTIVE: To describe the outcome MM and identify factors that may influence survival. METHODS: Pathology reports and clinical data of 178 patients treated between 1989 and 2017 for a MM at 6 different international institutions were retrospectively reviewed. Seventy-six patients (42.7%) had a previous history of grade I or grade II meningioma. The patients underwent a total of 380 surgical resections and 72.5% received radiotherapy. Median follow-up was 4.5 yr. RESULTS: At data collection, 111 patients were deceased (63.4%) and only 23 patients (13.7%) were alive without any residual tumor on the most recent scan. Median overall survival was 2.9 yr, 95% confidence interval [CI; 2.4, 4.5]. Overall survival rates at 1, 5, and 10 yr, respectively, were: 77.7%, 95% CI [71.6, 84.3], 40%, 95% CI [32.7, 49], and 27.9%, 95% CI [20.9, 37.3]. In the multivariable analysis, age at MM surgery <65 yr (hazard ratio [HR] = 0.44, 95% CI [0.29, 0.67], P < .001), previous benign or atypical meningioma surgery (HR = 1.9, 95% CI [1.23, 2.92], P = .004), completeness of resection (HR = 0.51, 95% CI [0.34, 0.78], P = .002), and adjuvant radiotherapy (HR = 0.64, 95% CI [0.42, 0.98], P = .039) were established as independent prognostic factors for survival. CONCLUSION: This large series confirms the poor prognosis associated with MM, the treatment of which remains challenging. Patients under 65-yr-old with primary MM may live longer after complete resection and postoperative radiotherapy. Even with aggressive treatments, local control remains difficult to achieve.
BACKGROUND: In contrast to benign meningiomas, malignant meningiomas (MM) are rare and associated with an unfavourable prognosis. Reports on MM concern fairly small cohorts, often comprising less than 30 cases. OBJECTIVE: To describe the outcome MM and identify factors that may influence survival. METHODS: Pathology reports and clinical data of 178 patients treated between 1989 and 2017 for a MM at 6 different international institutions were retrospectively reviewed. Seventy-six patients (42.7%) had a previous history of grade I or grade II meningioma. The patients underwent a total of 380 surgical resections and 72.5% received radiotherapy. Median follow-up was 4.5 yr. RESULTS: At data collection, 111 patients were deceased (63.4%) and only 23 patients (13.7%) were alive without any residual tumor on the most recent scan. Median overall survival was 2.9 yr, 95% confidence interval [CI; 2.4, 4.5]. Overall survival rates at 1, 5, and 10 yr, respectively, were: 77.7%, 95% CI [71.6, 84.3], 40%, 95% CI [32.7, 49], and 27.9%, 95% CI [20.9, 37.3]. In the multivariable analysis, age at MM surgery <65 yr (hazard ratio [HR] = 0.44, 95% CI [0.29, 0.67], P < .001), previous benign or atypical meningioma surgery (HR = 1.9, 95% CI [1.23, 2.92], P = .004), completeness of resection (HR = 0.51, 95% CI [0.34, 0.78], P = .002), and adjuvant radiotherapy (HR = 0.64, 95% CI [0.42, 0.98], P = .039) were established as independent prognostic factors for survival. CONCLUSION: This large series confirms the poor prognosis associated with MM, the treatment of which remains challenging. Patients under 65-yr-old with primary MM may live longer after complete resection and postoperative radiotherapy. Even with aggressive treatments, local control remains difficult to achieve.
Authors: Farshad Nassiri; Justin Z Wang; Karolyn Au; Jill Barnholtz-Sloan; Michael D Jenkinson; Kate Drummond; Yueren Zhou; James M Snyder; Priscilla Brastianos; Thomas Santarius; Suganth Suppiah; Laila Poisson; Francesco Gaillard; Mark Rosenthal; Timothy Kaufmann; Derek S Tsang; Kenneth Aldape; Gelareh Zadeh Journal: Neuro Oncol Date: 2022-05-04 Impact factor: 13.029
Authors: Lorenzo Vagnoni; Sami Aburas; Martina Giraffa; Ivana Russo; Vito Chiarella; Sergio Paolini; Paolo Tini; Giuseppe Minniti Journal: Neurosurg Rev Date: 2022-06-04 Impact factor: 2.800