Radiotherapy for atypical meningiomas

Clinical article

Richard Mair M.B., Ch.B., M.R.C.S. 1 , Kevin Morris M.D., F.R.C.S.(SN) 2 , Ian Scott M.D., D.Phil., F.R.C.Path. 3 and Thomas A. Carroll M.D., F.R.C.S.I.(NeuroSurg) 1
View More View Less
  • 1 Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield; and
  • 2 Departments of Neurosurgery and
  • 3 Neuropathology, Hull and East Yorkshire NHS Trust, Hull Royal Infirmary, Hull, United Kingdom
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The role of postoperative radiotherapy in patients undergoing first-time resection of WHO Grade II meningioma remains unclear as reflected by varied practices in published clinical studies and national professional surveys. Much of the relevant literature is based on pre-2000 WHO grading criteria for atypical meningiomas. Authors in this study set out to explore the role of postoperative radiotherapy in patients undergoing first-time surgery for WHO Grade II meningiomas diagnosed using revised WHO 2000 criteria, against a background of otherwise limited published literature on this issue.

Methods

The authors retrospectively collected data on 114 consecutive patients who underwent first-time resection of WHO Grade II atypical meningiomas diagnosed using 2000 WHO criteria, and who variably underwent postoperative radiotherapy according to individual surgeon practices. Outcomes, including radiological recurrence, were submitted to Kaplan-Meier and Cox regression analyses.

Results

Postoperative radiotherapy demonstrated a significant benefit only when patients who had undergone gross-total tumor resection and those who had undergone subtotal resection along with postoperative radiosurgery to the tumor remnant were excluded from analysis.

Conclusions

The authors have performed the largest study in the literature to examine the use of radiotherapy for WHO Grade II, atypical, meningiomas following a first-time resection. They suggest that radiotherapy is not appropriate after first-time resection of those lesions in which a gross-total resection (Simpson Grade 1 or 2) has been achieved. They also advise that any tumor remnant radiologically demonstrated on postoperative imaging should be treated with radiosurgery and that postoperative radiotherapy after a first-time resection should be reserved for tumor remnants too large for radiosurgery and for which a second staged operation is not planned.

Abbreviations used in this paper: GTR = gross-total resection; STR = subtotal resection.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Thomas A. Carroll, M.D., F.R.C.S.I. (NeuroSurg), Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom. email: thomas.a.carroll@sth.nhs.uk.

Please include this information when citing this paper: published online June 24, 2011; DOI: 10.3171/2011.5.JNS11112.

  • 1

    Aghi MK, , Carter BS, , Cosgrove GR, , Ojemann RG, , Amin-Hanjani S, & Martuza RL, : Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:5660, 2009

    • Search Google Scholar
    • Export Citation
  • 2

    al-Mefty O, , Kersh JE, , Routh A, & Smith RR: The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 73:502512, 1990

    • Search Google Scholar
    • Export Citation
  • 3

    Condra KS, , Buatti JM, , Mendenhall WM, , Friedman WA, , Marcus RB Jr, & Rhoton AL: Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39:427436, 1997

    • Search Google Scholar
    • Export Citation
  • 4

    Engenhart-Cabillic R, , Farhoud A, , Sure U, , Heinze S, , Henzel M, & Mennel HD, : Clinicopathologic features of aggressive meningioma emphasizing the role of radiotherapy in treatment. Strahlenther Onkol 182:641646, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Girod DA, , McCulloch TM, , Tsue TT, & Weymuller EA Jr: Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck 17:713, 1995

    • Search Google Scholar
    • Export Citation
  • 6

    Goldsmith BJ, , Wara WM, , Wilson CB, & Larson DA: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 80:195201, 1994

    • Search Google Scholar
    • Export Citation
  • 7

    Goyal LK, , Suh JH, , Mohan DS, , Prayson RA, , Lee J, & Barnett GH: Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46:5761, 2000

    • Search Google Scholar
    • Export Citation
  • 8

    Harris AE, , Lee JYK, , Omalu B, , Flickinger JC, , Kondziolka D, & Lunsford LD: The effect of radiosurgery during management of aggressive meningiomas. Surg Neurol 60:298305, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Hoffmann W, , Mühleisen H, , Hess CF, , Kortmann RD, , Schmidt B, & Grote EH, : Atypical and anaplastic meningiomas—does the new WHO-classification of brain tumours affect the indication for postoperative irradiation?. Acta Neurochir (Wien) 135:171178, 1995

    • Search Google Scholar
    • Export Citation
  • 10

    Hug EB, , Devries A, , Thornton AF, , Munzenride JE, , Pardo FS, & Hedley-Whyte ET, : Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol 48:151160, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Jääskeläinen J, , Haltia M, & Servo A: Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 25:233242, 1986

    • Search Google Scholar
    • Export Citation
  • 12

    Kleihues P, & Cavenee WK: World Health Organization Classification of Tumours: Pathology and Genetics: Tumours of the Nervous System ed 2 Lyon, IARC Press, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Ko KW, , Nam DH, , Kong DS, , Lee JI, , Park K, & Kim JH: Relationship between malignant subtypes of meningioma and clinical outcome. J Clin Neurosci 14:747753, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Kokubo M, , Shibamoto Y, , Takahashi JA, , Sasai K, , Oya N, & Hashimoto N, : Efficacy of conventional radiotherapy for recurrent meningioma. J Neurooncol 48:5155, 2000

    • Search Google Scholar
    • Export Citation
  • 15

    Laurent MR, & Vickers TJ: Seeking health information online: does Wikipedia matter?. J Am Med Inform Assoc 16:471479, 2009

  • 16

    Lawrence YR, , Li XA, , el Naqa I, , Hahn CA, , Marks LB, & Merchant TE, : Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys 76:3 Suppl S20S27, 2010

    • Search Google Scholar
    • Export Citation
  • 17

    Mahmood A, , Qureshi NH, & Malik GM: Intracranial meningiomas: analysis of recurrence after surgical treatment. Acta Neurochir (Wien) 126:5358, 1994

    • Search Google Scholar
    • Export Citation
  • 18

    Malik I, , Rowe JG, , Walton L, , Radatz MWR, & Kemeny AA: The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg 19:1320, 2005

    • Search Google Scholar
    • Export Citation
  • 19

    Marcus HJ, , Price SJ, , Wilby M, , Santarius T, & Kirollos RW: Radiotherapy as an adjuvant in the management of intracranial meningiomas: are we practising evidence-based medicine?. Br J Neurosurg 22:520528, 2008

    • Search Google Scholar
    • Export Citation
  • 20

    Mathiesen T, , Kihlström L, , Karlsson B, & Lindquist C: Potential complications following radiotherapy for meningiomas. Surg Neurol 60:193200, 2003

    • Search Google Scholar
    • Export Citation
  • 21

    Milosevic MF, , Frost PJ, , Laperriere NJ, , Wong CS, & Simpson WJ: Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 34:817822, 1996

    • Search Google Scholar
    • Export Citation
  • 22

    Modha A, & Gutin PH: Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 57:538550, 2005

  • 23

    Palma L, , Celli P, , Franco C, , Cervoni L, & Cantore G: Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 86:793800, 1997

    • Search Google Scholar
    • Export Citation
  • 24

    Pasquier D, , Bijmolt S, , Veninga T, , Rezvoy N, , Villa S, & Krengli M, : Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 71:13881393, 2008

    • Search Google Scholar
    • Export Citation
  • 25

    Pearson BE, , Markert JM, , Fisher WS, , Guthrie BL, , Fiveash JB, & Palmer CA, : Hitting a moving target: evolution of a treatment paradigm for atypical meningiomas amid changing diagnostic criteria. Neurosurg Focus 24:5 E3, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Perry A, , Louis DN, , Scheithauer BW, , Budka H, & von Deimling A, Meningiomas. Louis DN, , Ohgaki H, & Wiestler OD, : WHO Classification of Tumours of the Central Nervous System Lyon, IARC Press, 2007. 164172

    • Search Google Scholar
    • Export Citation
  • 27

    Simon M, , Boström J, , Koch P, & Schramm J: Interinstitutional variance of postoperative radiotherapy and follow up for meningiomas in Germany: impact of changes of the WHO classification. J Neurol Neurosurg Psychiatry 77:767773, 2006

    • Search Google Scholar
    • Export Citation
  • 28

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:2239, 1957

  • 29

    Smith SJ, , Boddu S, & Macarthur DC: Atypical meningiomas: WHO moved the goalposts?. Br J Neurosurg 21:588592, 2007

  • 30

    Taylor BW Jr, , Marcus RB Jr, , Friedman WA, , Ballinger WE Jr, & Million RR: The meningioma controversy: postoperative radiation therapy. Int J Radiat Oncol Biol Phys 15:299304, 1988

    • Search Google Scholar
    • Export Citation
  • 31

    Walsh MC, , Trentham-Dietz A, , Schroepfer TA, , Reding DJ, , Campbell B, & Foote ML, : Cancer information sources used by patients to inform and influence treatment decisions. J Health Commun 15:445463, 2010

    • Search Google Scholar
    • Export Citation
  • 32

    Wise SK, , Harvey RJ, , Neal JG, , Patel SJ, , Frankel BM, & Schlosser RJ: Factors contributing to failure in endoscopic skull base defect repair. Am J Rhinol Allergy 23:185191, 2009

    • Search Google Scholar
    • Export Citation
  • 33

    Yano S, & Kuratsu J: Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg 105:538543, 2006

    • Search Google Scholar
    • Export Citation
  • 34

    Yang SY, , Park CK, , Park SH, , Kim DG, , Chung YS, & Jung HW: Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574580, 2008

    • Search Google Scholar
    • Export Citation
  • 35

    Younis GA, , Sawaya R, , DeMonte F, , Hess KR, , Albrecht S, & Bruner JM: Aggressive meningeal tumors: review of a series. J Neurosurg 82:1727, 1995

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 595 257 13
Full Text Views 235 43 11
PDF Downloads 190 25 1
EPUB Downloads 0 0 0