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Predictors of Treatment Response and Survival Outcomes in Meningioma Recurrence with Atypical or Anaplastic Histology
- Source :
- Neurosurgery. 82:824-832
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Background Recurrence rates for atypical and anaplastic meningiomas range between 9% and 50% after gross total resection and between 36% and 83% after subtotal resection. Optimal treatment of recurrent meningiomas exhibiting atypical/anaplastic histology is complicated because they are often refractory to both surgery and radiation. Objective To evaluate clinical determinants of recurrence and treatment-specific outcomes in patients with recurrent meningiomas exhibiting atypical/anaplastic histology at our institution. Methods A cohort study was conducted using clinical data of all patients treated for meningiomas with atypical/anaplastic histology at first recurrence between January 1985 and July 2014 at a tertiary cancer center. Predictors of second recurrence were analyzed using competing risks regression models. Results Nine hundred eighteen patients with meningioma were screened, of whom 60 (55% female) had recurrent disease with atypical/anaplastic histology at a median age of 58.1 yr at diagnosis. The median follow-up from the time of first recurrence was 36.7 mo, with 32 (53%) patients alive at last follow-up. There was no effect of extent of resection at first recurrence on time to a subsequent recurrence. Inclusion of radiation as primary or adjuvant therapy at first recurrence reduced the risk of progression or subsequent recurrence compared to surgery alone (P = .07). Conclusion Treatment of recurrent meningiomas with atypical/anaplastic histology remains challenging. Our data, from one of the largest cohorts, suggest better tumor control with the addition of radiation and challenges the importance of extent of resection at first recurrence. A multicenter effort is needed to confirm these findings and propose treatment guidelines.
- Subjects :
- Adult
Male
Pathology
medicine.medical_specialty
Cohort Studies
Meningioma
03 medical and health sciences
0302 clinical medicine
Refractory
Meningeal Neoplasms
Adjuvant therapy
medicine
Humans
Combined Modality Therapy
Aged
Retrospective Studies
business.industry
Cancer
Retrospective cohort study
Histology
Middle Aged
medicine.disease
Treatment Outcome
Research—Human—Clinical Studies
030220 oncology & carcinogenesis
Disease Progression
Female
Surgery
Neurology (clinical)
Radiology
Neoplasm Recurrence, Local
business
030217 neurology & neurosurgery
Cohort study
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 82
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....2a22bdb9431d25d3414df2d812b1a499