Intracranial meningiomas: Prognostic factors and treatment outcome in patients undergoing postoperative radiation therapy

Anvari, Kazem; Hosseini, Sare; Rahighi, Saeid; Toussi, Mehdi Seilanian; Roshani, Nasrin; Torabi-Nami, Mohammad

Intracranial meningiomas: Prognostic factors and treatment outcome in patients undergoing postoperative radiation therapy

Authors

¹ Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

² Department of Surgery, Mashhad Branch, Islamic Azad University, Shiraz, Iran

³ Department of Medical Sciences, Mashhad Branch, Islamic Azad University, Shiraz, Iran

⁴ Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Meningioma constitutes 20% of the intracranial neoplasms. Followed by surgery as the primary treatment for most patients, radiotherapy becomes indicated in high-grade tumors with incomplete surgical removal. We evaluated the prognostic factors and overall outcome in meningioma patients who underwent radiotherapy.
Materials and Methods: In this retrospective analysis, data from all patients with documented diagnosis of meningioma who referred to the Omid and Ghaem Oncology Centers (Mashhad, Iran) from 2002 to 2013 were included. We calculated the overall survival rates using the Kaplan–Meier method and compared the survival curves between groups by the log-rank test.

Results: Eighty-three patients with a median age of 50 years (ranging: 16–84) were included. Grade I, II, and III meningiomas were seen in 40 (48%), 31 (37%), and 12 (15%) patients, respectively. Radiation therapy was indicated due to tumor recurrence, incomplete excision, or tumor grade in 32, 8, and 43 patients, respectively. Tumor grade had a significant effect on the overall survival with a 3-year overall survival of 76.7%, 43.5%, and 13.3% in Grade I, II, and III, respectively (P < 0.001). Gender, age, and tumor location were not correlated with the overall survival. Moreover, patients with Grade II and III who underwent total resection had a significantly higher overall survival than those with subtotal resection or biopsy alone (5-year survival rates of 82% vs. 17.1%, respectively; P = 0.008).
Conclusion: Tumor grade was the most important prognostic factor in meningioma patients undergoing radiation therapy. In patients with Grade II and III tumors, the extent of surgical resection is significantly correlated with the overall survival.

Keywords

References

1.	Halperin EC, Perez CA, Brady LW, editors. Principles and Practice of Radiation Oncology. 6^th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2013. p. 672-4.
2.	Richardwinn H. Youmans Neurological Surgery. 6^th ed. Philadelphia: Elsevier; 2011. p. 1426-49.
3.	Rowland L, Pedley T. Merritt's Neurology. 12^th ed. New York: Wolters Kluwer Lippincott Williams and Wilkins; 2010. p. 386-92.
4.	Bradley W, Daroff R, Fenichel G, Jankovic J. Neurology in Clinical Practice. 5^th ed. Amsterdam: Butterworth Heinemann, Elsevier; 2008. p. 1327-8.
5.	Ohba S, Kobayashi M, Horiguchi T, Onozuka S, Yoshida K, Ohira T, et al. Long-term surgical outcome and biological prognostic factors in patients with skull base meningiomas. J Neurosurg 2011;114:1278-87.
6.	Adeberg S, Harman C, Welzel T, Rieken S, Habermehl D, Von Delmling A, et al. Long term outcome after radiotherapy in patients with atypical and malignant meningiomas – Clinical result in 85 patients treated in a single institution leading to optimized guidelines for early radiation therapy. Int J Radiat Oncol Biol Phys 2012;83:859-64.
7.	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 1994;80:195-201.
8.	Zaher A, Mattar MA, Zayed DH, Ellatif RA, Ashamallah SA. Atypical meningioma: A study of prognostic factors. World Neurosurg 2013;68:1236-42.
9.	Pechlivanis I, Wawrzyniak S, Engelhardt M, Schmieder K. Evidence level in the treatment of meningioma with focus on the comparison between surgery versus radiotherapy. A review. J Neurosurg Sci 2011;55:319-28.
10.	Haddad GF, Al-Mefty O. Meningiomas: An overview. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. 2^nd ed., Vol. 1, 56. New York: McGraw-Hill; 2011. p. 833-42.
11.	Aboukais R, Baroncini M, Zairi F, Reyns N, Lejeune JP. Early postoperative radiotherapy improves progression free survival in patients with grade 2 meningioma. Acta Neurochir (Wien) 2013;155:1385-90.
12.	Liu Y, Liu M, Li F, Wu C, Zhu S. Malignant mengiomas: A retrospective study of 22 cases. Elenctronic J Oncol 2007;94:10027-37.
13.	Stafford SL, Perry A, Suman VJ, Meyer FB, Scheithauer BW, Lohse CM, et al. Primarily resected meningiomas: Outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 1998;73:936-42.
14.	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 2000;46:57-61.

Advanced Biomedical Research