Table 7.
Eleven selected series reporting treatment outcomes for patients with anaplastic meningioma.
| Anaplastic (WHO Grade III) Meningioma | |||||||
|---|---|---|---|---|---|---|---|
| Author (year) |
n |
F/Ua (study period) |
Grading Scheme |
Treatment Regimen |
RT Dosea |
Outcome |
Comments |
| Jaaskelainen (1986) | 11 | not reported (1953–1980) |
Modified WHO 1979 |
Post-op & salvage surgery alone or surgery + EBRT |
not reported |
PFS 5 yr 22% |
Atypia and anaplasia developed in previously benign tumors without radiotherapy. 4 of 5 anaplastic tumors treated w/ surg + EBRT recurred. EBRT doses not reported. |
| Milsoevic (1996) | 42 | Not reported (1966–1990) |
Modified WHO 1979 |
Post-op & salvage surg + EBRT or salvage EBRT alone. |
EBRT 50 Gy |
CSS 2 yr 63% 5 yr 34% |
Malignancy often diagnosed (60%) by brain invasion (60%), some hemangiopericytomas. Negative predictive fxs (CSS): age ≥58, EBRT before 1975, dose <50Gy. Morbidity 3.4%. Recommend immediate post-op EBRT. |
| Dziuk (1998) | 38 | 29–39 mob (1984–1992) |
Russell & Rubinstein 1977 [R&R 1977] |
Initial & salvage surg alone or with EBRT |
EBRT 54Gy |
PFS 2 yr 24% 5 yr 25% |
5yr PFS: 39% after GTR, 0% STR. 28% GTR alone, 57% GTR+EBRT. Intital post-op EBRT improved 5yr PFS 15% to 80%, and salvage EBRT 2yr PFS 50% to 89%, but no benefit at 60 mo. 11 had hemangiopericytoma. No distant failures. |
| Hug (2000) | 16 | 59 mo (1973–1995) |
WHO 1993 | Post-op & salvage photon + proton EBRT |
EBRT photon + proton 58 CGE |
LC 5 yr 52% 8 ys 17% |
LC & OS improved w/ EBRT ≥60 Gy. 5 & 8yr LC 100% & 33% w/ ≥60 CGE versus 0% w/ <60 CGE. Late morbidity 9%. |
| Mattozo (2007) | 5 | 42 mo (1992–2004) |
WHO 2000 | Post-op & salvage SRS or stereotactic EBRT |
SRS 15.5 Gy EBRT 49.3Gy |
PFS 3 yr 0% |
All patients had recurrent tumors. Median SRS treatment vol 2.2cc, median EBRT vol 21.3cc. 77% of recurrences were within the original resection cavity. |
| Kondziolka (2008) | 29 | 48 mo (not reported) |
Based upon “previous histo-path” |
Post-op & salvage single fraction SRS |
SRS 14 Gy |
LC 15mo 17% 5yr 9%¶ |
Median tumor vol 7.4cc. 5y CSS 22%¶ Morbidity 7%, including symptomatic edema in 4% |
| Boskos (2009) | 5 | 32 mo (1999–2006) |
WHO 1993 | Post-op & salvage photon + proton EBRT. 1 patient hypofractionated protons alone |
EBRT photon + proton 65 CGE |
Mean RFI 23 mo |
Median CTV 151cc. Mean RFI for grade II tumors 28.3mo. OS & CSS improved w/ EBRT >60 Gy, and possibly further w/ >65 Gy. Late morbidity in 1 patient, necrosis. |
| Rosenberg (2009) | 13 | not reported (1984–2006) |
WHO 2007 | Post-op & salvage EBRT or SRS. 2 received systemic therapy (1 temozolomide, 1 immunotherapy) |
EBRT 50–60 Gy SRS 14–24 Gy 5 Gy x 5 |
PFS 1 yr 52% 2 yr 17% 3 yr 8.7% |
Median time to recurrence 9.6 mo. Med OS 2.5 yr w/o vs 5.4 yr w/ initial EBRT (p=.13). 5 & 8 yr OS 47.2%, 12.2%. RT morbidity 2 patients, both necrosis. Recommend upfront RT. |
| Sughrue (2010) | 63 | 60 mo (not reported) |
WHO 2007 | Post-op fractionated EBRT & some salvage brachy or SRS, newly diagnosed & recurrent. 25% pre- operative embolization |
EBRT doses not reported |
PFS 2yr 80% 5yr 57% 10yr 40% |
Mean tumor vol 78cc. 2,5&10 yr OS 82%, 61%, 40%. Better survival with NTR than with GTR. Signif neuro morbidity from attempted GTR. |
| El-Khatib (2011) | 7 | 60 mo (1990–2003) |
WHO 2007 | Post-op & salvage single fraction SRS, newly diagnosed & recurrent |
SRS 14 Gy |
PFS 3yr 57% 5yr 57% 10yr 43% |
Median tumor vol 4.8cc. PFS 57% 5yr, 43% 10yr. Negative predictive fx (tumor control) age ≥50. Morbidity 3.5%. |
| Pollock (2012) | 13 | 38 mo (1990–2008) |
WHO 2000 & 2007 |
Post-op & salvage single fraction SRS, newly diagnosed & recurrent |
SRS 15 Gy |
CSS 1 yr 69% 5 yr 27% |
Median tumor vol 14.6cc. Negative predictive fxs (CSS): prior EBRT & tumor vol >14.6cc. Morbidity 26%. Emphasize early SRS. |
n: number of patients, F/U: follow-up, RT: radiation therapy, WHO: World Health Organization, Post-op: post-operative, EBRT: external beam radiation therapy, PFS: progression-free survival, w/: with, surg: surgery, fx(s): factor(s), CSS: cause-specific survival, mo: month, GTR: gross total resection, STR: subtotal resection, yr: year,LC: local control, CGE: cobalt Gray equivalent), vol: volume, histo-path: histo-pathology, RFI: relapse-free interval, CTV: clinical target volume, OS: overall survival,SRS: stereotactic radiosurgery, brachy: brachytherapy, NTR: near total resection (>90% removal), neuro: neurological, vs: versus.
¶
Actuarial percentage measured from graph.
a
Mean or median
b
follow-up listed by study groups, and varied accordingly.