Revisiting Adjuvant Radiotherapy After Gross Total Resection of World Health Organization Grade II Meningioma

被引:51
作者
Graffeo, Christopher S. [1 ]
Leeper, Heather E. [6 ]
Perry, Avital [1 ]
Uhm, Joon H. [2 ]
Lachance, Daniel J. [2 ]
Brown, Paul D. [3 ]
Ma, Daniel J. [3 ]
Van Gompel, Jamie J. [1 ]
Giannini, Caterina [4 ]
Johnson, Derek R. [2 ,5 ]
Raghunathan, Aditya [4 ]
机构
[1] Mayo Clin, Dept Neurol Surg, Rochester, MN USA
[2] Mayo Clin, Dept Neurol, Rochester, MN USA
[3] Mayo Clin, Dept Radiat Oncol, Rochester, MN USA
[4] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN 55905 USA
[5] Mayo Clin, Dept Radiol, Rochester, MN USA
[6] NorthShore Univ Hlth Syst, Dept Neurol, Evanston, IL USA
关键词
Atypical meningioma; Observation; Overall survival; Progression-free survival; Radiotherapy; Systematic review; ATYPICAL CRANIAL MENINGIOMAS; REPORT PRIMARY BRAIN; UNITED-STATES; POSTOPERATIVE RADIOTHERAPY; ANAPLASTIC MENINGIOMAS; SIMPSON GRADE; TUMORS; MANAGEMENT; CLASSIFICATION; PREDICTORS;
D O I
10.1016/j.wneu.2017.04.095
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Atypical meningioma is a World Health Organization grade II tumor with intermediate prognosis and risk of recurrence. Optimal management after gross total resection (GTR) is controversial, with observation versus adjuvant radiotherapy (RT) contentiously debated. METHODS: Pathologic review was performed of all atypical meningiomas diagnosed at our institution from 1988 to 2011. Retrospective chart review documented patient demographics, extent of surgical resection, history of radiation therapy, progression-free survival (PFS), and overall survival (OS). A supplemental systematic literature review was completed in which English-language articles published since 1979 comparing observation and RT after GTR of atypical meningioma were surveyed. RESULTS: Sixty-nine patients met inclusion criteria. Sixty-one underwent observation, and 8 received RT. Overall, 15 observation and 3 patients undergoing RT experienced tumor recurrence (5-year PFS 79% vs. 88%; P = 0.67); 19 observation and 2 patients undergoing RT died (5-year OS 89% vs. 83%; P = 0.68). Systematic review identified 9 preceding studies reporting extractable data comparing observation and RT outcomes after GTR. Recurrence was 18% and 19% after observation and RT (P = 0.9); total survival was 84% and 93% (P = 0.2). At 5 years, PFS was 81% after observation and 88% after RT (P = 0.2), whereas survival was 87% after observation and 96% after RT (P = 0.4). CONCLUSIONS: Observation alone after GTR of atypical meningioma was not associated with increased risk of tumor recurrence or mortality. Although some preceding authors advocate for RT based on empiric experience, a systematic review also suggests that observation may provide equivalent PFS and OS to RT. Taken together, these findings indicate that observation after GTR may be a safe alternative to RT.
引用
收藏
页码:655 / 663
页数:9
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