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Dobeson CB, Baxter M, Rowe M, Kingdon S, Park S, Bond H, Taylor K, Islim AI, King J, Millward CP, Zakaria R, Clynch AL, Keshwara SM, Eltinay A, Kviat L, Robinson R, Haris PA, Samuel R, Venkatesh V, Derby S, Ahmad S, Smith F, Robinson S, Kathirgamakarthigeyan S, Narramneni LR, Hannan CJ, Lewis J. Management Approaches in WHO Grade III Meningioma: A National Oncology Trainees' Collaborative for Healthcare Research (NOTCH) UK Multi-Centre Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:e301-e311. [PMID: 38849235 DOI: 10.1016/j.clon.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024]
Abstract
AIMS WHO Grade 3 (G3) meningiomas are rare tumours with limited data to guide management. This retrospective study documents UK management approaches across 14 centres over 11 years. MATERIALS AND METHODS Patients with WHO G3 meningioma between 01/01/2008 and 31/12/2018 were identified. Data were collected on demographics, management strategy, adjuvant radiotherapy, approach in recurrence setting and survival. RESULTS 84 patients were identified. 21.4% transformed from lower-grade disease. 96.4% underwent primary surgical resection, with 20.8% having evidence of residual disease on their post-op MRI. 59.3% of patients underwent adjuvant radiotherapy (RT) following surgical resection. Overall median PFS and OS were 12.6 months and 28.2 months, respectively. Median OS in the group who underwent complete surgical resection was 34.9 months, compared to 27.5 months for those who had incomplete resection (HR 0.58, 95% CI 0.27-1.23, p = 0.15). Median OS was 33.1 months for those who underwent adjuvant RT and 14.0 months for those who did not (HR 0.48, 95% CI 0.27-0.84, p = 0.004). Median adjuvant RT dose delivered was 60Gy (range 12Gy-60Gy), 45.8% of adjuvant RT was delivered using IMRT. At disease relapse, 31% underwent salvage surgery and 29.3% underwent salvage RT. Of those treated with salvage RT, 64.7% were re-treats and all were treated with hypofractionated RT. CONCLUSION Surgery continues to be the preferred primary management strategy. Post-operative MRI within 48 hours is indicated to assess presence of residual disease and guide further surgical options. Adjuvant radiotherapy plays an important part of the management paradigm in these patients with the data supporting an attached survival advantage. Further surgery and re-irradiation is an option in the disease recurrence setting with radiosurgery frequently utilised in this context.
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Affiliation(s)
- C B Dobeson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, NE77DN, UK.
| | - M Baxter
- Tayside Cancer Centre, Ninewells Hospital, Dundee, NHS Tayside, Scotland, DD1 9SY, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, England, TR1 3LJ, UK
| | - S Kingdon
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - S Park
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - H Bond
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - K Taylor
- The Northern Ireland Cancer Centre, Belfast, Northern Ireland, BT12 6BA, UK
| | - A I Islim
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - J King
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - C P Millward
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - R Zakaria
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - A L Clynch
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - S M Keshwara
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - A Eltinay
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, England, OX3 7LE, UK
| | - L Kviat
- The Royal Marsden Hospital NHS Foundation Trust, London, England, SW3 6JJ, UK
| | - R Robinson
- The Royal Marsden Hospital NHS Foundation Trust, London, England, SW3 6JJ, UK
| | - P A Haris
- University Hospitals of Leicester NHS Trust, England, LE3 9QP, UK
| | - R Samuel
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, England, LS9 7TF, UK
| | - V Venkatesh
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, England, LS9 7TF, UK
| | - S Derby
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, G12 0YN, UK
| | - S Ahmad
- University Hospitals of Leicester NHS Trust, England, LE3 9QP, UK
| | - F Smith
- Nottingham University Hospitals NHS Trust, England, NG7 2UH, UK
| | - S Robinson
- Imperial College Healthcare NHS Trust, London, England, W2 1NY, UK
| | | | - L R Narramneni
- Aberdeen Royal Infirmary, NHS Grampian, Scotland, AB25 2ZN, UK
| | - C J Hannan
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - J Lewis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, NE77DN, UK
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Karabacak M, Jazayeri SB, Jagtiani P, Mavridis O, Carrasquilla A, Yong RL, Margetis K. Geriatric grade 2 and 3 gliomas: A national cancer database analysis of demographics, treatment utilization, and survival. J Clin Neurosci 2024; 127:110763. [PMID: 39059334 DOI: 10.1016/j.jocn.2024.110763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/11/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
With increasing life expectancies and population aging, the incidence of elderly patients with grade 2 and 3 gliomas is increasing. However, there is a paucity of knowledge on factors affecting their treatment selection and overall survival (OS). Geriatric patients aged between 60 and 89 years with histologically proven grade 2 and 3 intracranial gliomas were identified from the National Cancer Database between 2010 and 2017. We analyzed patients' demographic data, tumor characteristics, treatment modality, and outcomes. The Kaplan-Meier method was used to analyze OS. Univariate and multivariate analyses were performed to assess the predictive factors of mortality and treatment selection. A total of 6257 patients were identified: 3533 (56.3 %) hexagenerians, 2063 (32.9 %) septuagenarians, and 679 (10.8 %) octogenarians. We identified predictors of lower OS in patients, including demographic factors (older age, non-zero Charlson-Deyo score, non-Hispanic ethnicity), socioeconomic factors (low income, treatment at non-academic centers, government insurance), and tumor-specific factors (higher grade, astrocytoma histology, multifocality). Receiving surgery and chemotherapy were associated with a lower risk of mortality, whereas receiving radiotherapy was not associated with better OS. Our findings provide valuable insights into the complex interplay of demographic, socioeconomic, and tumor-specific factors that influence treatment selection and OS in geriatric grade 2 and 3 gliomas. We found that advancing age correlates with a decrease in OS and a reduced likelihood of undergoing surgery, chemotherapy, or radiotherapy. While receiving surgery and chemotherapy were associated with improved OS, radiotherapy did not exhibit a similar association.
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Affiliation(s)
- Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pemla Jagtiani
- School of Medicine, SUNY Downstate Health Sciences University, New York, NY, United States of America
| | - Olga Mavridis
- Dietrich College of Humanities and Social Sciences, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Alejandro Carrasquilla
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Raymund L Yong
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America
| | - Konstantinos Margetis
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, United States of America.
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Palmieri M, Armocida D, De Pietro R, Chiarello G, Rizzo F, Garbossa D, Marampon F, Santoro A, Frati A. Clinical Efficacy of Adjuvant Radiotherapy for World Health Organization Grade II Intracranial Meningioma. World Neurosurg 2023; 175:e1117-e1123. [PMID: 37088414 DOI: 10.1016/j.wneu.2023.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Maximal surgical resection remains the treatment of choice for grade II meningiomas, and for some authors it is sufficient to guarantee a long indolent course even without postsurgical radiotherapy (RT), but there is no consensus on the use of RT in this patient population. METHODS We retrospectively compared clinical and radiologic outcomes between World Health Organization grade I (group A) and grade II (group B) surgically treated meningiomas, focusing on the role of adjuvant RT. We registered clinical, surgical, and radiologic data to detect differences in survival and functional outcome between the 2 groups. RESULTS The final cohort consisted of 284 patients for group A and 94 patients for group B. Group B showed a higher risk of developing recurrence independently of the extent of resection (7.75% for Group A vs. 27.7% for Group B, P = 0.01). Patients who did not undergo adjuvant RT documented recurrence in 50% of cases, compared with 19% of patients who underwent RT (P = 0.024). There is a weak difference in the risk of developing postoperative seizures in the group submitted to radiotherapy (P = 0.08). Performance status remained stable for both groups, but for Group B it tended to decrease significantly after 1 year with regard to extent of resection and RT. CONCLUSIONS Recurrence is more frequent for grade II meningiomas, even though there are no significant differences in terms of complications and functional outcome. Radiotherapy in grade II meningiomas does indeed lead to better control of recurrence but leads to an increased risk of seizures and reduced performance status.
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Affiliation(s)
- Mauro Palmieri
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy
| | - Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy; Sperimental Neurosurgery, IRCCS "Neuromed", Pozzilli, Isernia, Italy.
| | - Raffaella De Pietro
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Giuseppina Chiarello
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Francesca Rizzo
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Francesco Marampon
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy
| | - Alessandro Frati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy; Sperimental Neurosurgery, IRCCS "Neuromed", Pozzilli, Isernia, Italy
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Lee G, Shih HA. The Role of Radiotherapy in the Treatment of Higher-Grade Meningioma. Neurosurg Clin N Am 2023; 34:463-478. [DOI: 10.1016/j.nec.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Tatman PD, Wroblewski TH, Fringuello AR, Scherer SR, Foreman WB, Damek DM, Lillehei KO, Jensen RL, Youssef AS, Ormond DR, Graner MW. Targeting DNA Methyl Transferases with Decitabine in Cultured Meningiomas. World Neurosurg 2022; 162:e99-e119. [PMID: 35248772 DOI: 10.1016/j.wneu.2022.02.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Meningiomas are a common primary central nervous system tumor that lack a US FDA-approved pharmacotherapy. Approximately 20-35% of meningiomas are classified as higher grade with poor outcome, while patients with lower grade meningiomas are known to have long-term neurological deficits and reduced overall survival. Recent efforts to understand the epigenetic landscape of meningiomas have highlighted the importance of DNA methylation for predicting tumor outcomes and prognosis; therefore, inhibition of these pathways may present a viable therapy for these tumors. METHODS In this study, we perform dose response curves of decitabine, a DNA methyl transferase inhibitor, on patient-cultured tumors and meningioma cell lines. RESULTS Thirty total samples were evaluated, including 24 patient cultured tumors and 6 established meningioma cell lines. Meningiomas were found to have a significant reduction in cell viability after decitabine treatment in a dose dependent manner. The effect was primarily driven by 11 of the 30 tumors in our cohort, or 36.7%. Decitabine significantly reduced cell viability across all grades, tumors from different genders, recurrent and primary tumors, as well as tumors without a history of prior radiation. Surprisingly, our single radiation-induced tumor did demonstrate greater viability after decitabine treatment. CONCLUSIONS Our work has identified a potential drug candidate in decitabine for the treatment of meningiomas regardless of clinical subgroup. These data require further evaluation in pre-clinical models and the conclusions based on clinical subgroups need to be evaluated in a larger cohort to achieve appropriate statistical power.
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Affiliation(s)
- Philip D Tatman
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA; University of Colorado, Anschutz Medical Campus, Medical Scientist Training Program, Aurora, Colorado, USA; University of Colorado, Anschutz Medical Campus, Department of Pharmacology, Aurora, Colorado, USA
| | - Tadeusz H Wroblewski
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA; University of Colorado, Anschutz Medical Campus, Department of Neurology, Aurora, Colorado, USA
| | - Anthony R Fringuello
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA
| | - Samuel R Scherer
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA; University of Colorado, Anschutz Medical Campus, Department of Neurology, Aurora, Colorado, USA
| | - William B Foreman
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA; University of Colorado, Anschutz Medical Campus, Department of Neurology, Aurora, Colorado, USA
| | - Denise M Damek
- University of Colorado, Anschutz Medical Campus, Department of Neurology, Aurora, Colorado, USA
| | - Kevin O Lillehei
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA
| | - Randy L Jensen
- Huntsman Cancer Institute, University of Utah, Department of Neurosurgery, Salt Lake City, Utah, USA
| | - A Samy Youssef
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA
| | - D Ryan Ormond
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA
| | - Michael W Graner
- University of Colorado, Anschutz Medical Campus, Department of Neurosurgery, Aurora, Colorado, USA
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Zoli M, Della Pepa GM, Carretta A, Bongetta D, Somma T, Zoia C, Raffa G. Adjuvant radiotherapy in grossly total resected grade II atypical meningiomas. A protective effect on recurrence? A systematic review and meta-analysis. J Neurosurg Sci 2021; 66:240-250. [PMID: 34763391 DOI: 10.23736/s0390-5616.21.05522-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Management of grade II Atypical Meningiomas (AM) remains controversial. Conflicting evidences exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival. EVIDENCE ACQUISITION Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery+ART. Only grossly total resected AMs (Simpson grade 1,2,3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery+ART. EVIDENCE SYNTHESIS 11 studies were considered eligible. 8 were included for the outcome "crude recurrence"; 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery+ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery+ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach. CONCLUSIONS Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone.
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Affiliation(s)
- Matteo Zoli
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Bio-Medical and Neuro-Motor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giuseppe M Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy -
| | - Alessandro Carretta
- Department of Bio-Medical and Neuro-Motor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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Oya S, Ikawa F, Ichihara N, Wanibuchi M, Akiyama Y, Nakatomi H, Mikuni N, Narita Y. Effect of adjuvant radiotherapy after subtotal resection for WHO grade I meningioma: a propensity score matching analysis of the Brain Tumor Registry of Japan. J Neurooncol 2021; 153:351-360. [PMID: 34002302 DOI: 10.1007/s11060-021-03775-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to improve the understanding of the role of adjuvant radiotherapy (AR) after subtotal resection (STR) of World Health Organization (WHO) grade I meningiomas. METHODS We retrospectively reviewed the Brain Tumor Registry of Japan database. Among 7341 patients diagnosed with intracranial meningioma during 2001-2008, we identified 406 patients with WHO grade I meningioma treated with STR as initial treatment. Data on progression-free survival (PFS) were assessed for their relevance to clinical factors including age, sex, tumor location and size, presence of preoperative symptoms, and AR. RESULTS AR was administered for 73 patients (18.0%). Regrowth occurred in 90 cases (22.2%) during the median follow-up period of 6.0 years (interquartile range, 2.7-7.7 years). Multivariate Cox regression analysis of the entire cohort showed that no AR was associated with significantly shorter PFS (hazard ratio [HR] 2.52, 95% confidence interval [CI] 1.33-5.42, p = 0.004). The therapeutic effect of AR was confirmed for skull base, but not non-skull base, meningiomas (p = 0.003 and 0.69, respectively). Propensity score matching analysis balanced the influence of confounding factors to generate AR+ and AR- cohorts of 73 patients each. PFS was significantly longer in the AR+ cohort than in the AR- cohort (HR 3.46, 95% CI 1.53-8.59, p = 0.003). Subgroup analysis demonstrated the favorable effect of AR only for skull base meningiomas. CONCLUSIONS Our study revealed that AR improves tumor control after STR in WHO grade I meningiomas. However, this beneficial effect might be limited to skull base meningiomas.
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Affiliation(s)
- Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | | | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
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Papillary meningioma of the central nervous system: a SEER database analysis. Neurosurg Rev 2021; 44:2777-2784. [PMID: 33415520 DOI: 10.1007/s10143-020-01449-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023]
Abstract
Papillary meningioma (PM) is a rare central nervous system tumor. We aimed to analyze the characteristics and outcomes of patients with PM (WHO grade III) and identify risk factors that influence survival using the Surveillance, Epidemiology, and End Results (SEER) database. Clinical characteristics, tumor features, and outcomes of 108 PM patients included in the SEER database between 1990 and 2016 were retrieved. Risk factors related to prognosis of PM were assessed by Kaplan-Meier curves and the Cox proportional hazards model. All 108 patients, including 65 males and 43 females (1.5:1), with a median age of 52 years (range, 9 to > 85 years) had undergone surgical resection. Gross total resection (GTR) was achieved in 50%, and 50% underwent subtotal resection (STR). While 55.6% underwent postoperative radiation therapy, 48% did not. The median disease-specific survival (DSS) was 128 months, and the 5-year DSS rate was 77%. In multivariate analysis, age ≤ 52 years and GTR were both independently associated with higher probability of DSS (p = 0.033 and p = 0.029, respectively). Stratification analysis showed that postoperative radiotherapy had no significant impact on the DSS, irrespective of resection extent (p = 0.172). Our SEER analysis showed that age and extent of resection were prognostic factors for PM, but race, tumor size, gender, chemotherapy, and postoperative radiotherapy did not significantly impact DSS of PM patients. There was no significant improvement in survival of patients who underwent radiotherapy and GTR, or radiotherapy and STR, compared with GTR or STR alone.
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