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Longitudinal experience with WHO Grade III (anaplastic) meningiomas at a single institution

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Abstract

To retrospectively analyze and assess the outcomes and prognostic factors in patients with anaplastic meningioma (AM) (WHO Grade III). Clinical data and outcome [overall (OS) and progression-free (PFS) survival] from 18 patients with Grade III meningioma (AM, based on World Health Organization 2016 definition) initially treated between March 2000 and June 2015 were analyzed. Eleven patients (61%) were male, median age at diagnosis was 63 (range 48–86), and 55% (10/18 patients) had good performance status (KPS ≥ 80). Eight patients (45%) had lower grade disease (Grade I—n = 2; Grade II—n = 6) prior to being upgraded to AM. Ten patients had fractionated radiation after primary surgery, eight patients had salvage fractionated RT, stereotactic radiosurgery (SRS) boost along with primary RT in 1 patient, and salvage SRS to 18 separate areas in 14 patients. Salvage chemotherapy was mainly considered in third or fourth recurrences. 13 (72%) patients recurred and 10 (56%) have died. Median PFS was 14.5 months (95% CI 6.9–22.2). The 5-year survival rate was 40 ± 15% and median OS was 55.8 months (95% CI 27.7–80.3). Of all factors examined, only Karnofsky performance status (KPS) affected outcome (PFS p = 0.0003; OS p = 0.0003). With median OS of 55 months (4.6 years) our results are consistent with existing reports of the poor outcomes for AM patients. From the available data, surgical resection followed by RT and salvage radiosurgery and/or chemotherapy can lead to extended survival; however the benefit may decrease with successive treatments.

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Abbreviations

CBTRUS:

Central Brain Tumor Registry of the United States

EBRT:

External beam radiation therapy

GTR:

Gross total resection

IMRT:

Intensity-modulated radiation therapy

KPS:

Karnofsky performance score

AM:

Anaplastic meningioma

NPCR:

National Program of Cancer Registries

OS:

Overall survival

PFS:

Progression-free-survival

RTOG:

Radiation Therapy Oncology Group

RT:

Radiation therapy

SEER:

Surveillance, Epidemiology, and End Results

SRS:

Stereotactic radiosurgery

STR:

Subtotal resection

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA

    Suresh K. Balasubramanian, Glen H. Stevens, Gene H. Barnett, Richard A. Prayson, John H. Suh, Erin S. Murphy & Samuel T. Chao

  2. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk T28, Cleveland, OH, 44195, USA

    John H. Suh, Erin S. Murphy & Samuel T. Chao

  3. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Suresh K. Balasubramanian, Mayur Sharma, Danilo Silva, Glen H. Stevens, Gene H. Barnett, John H. Suh, Erin S. Murphy & Samuel T. Chao

  4. Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Samuel T. Chao

  5. Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Mayur Sharma, Danilo Silva & Gene H. Barnett

  6. Fairview Hospital, Cleveland, OH, USA

    Vidhya Karivedu

  7. Clinical Research Volunteer, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Philipp Schmitt

  8. Department of Neuropathology, Cleveland Clinic, Cleveland, OH, USA

    Richard A. Prayson

  9. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Paul Elson

Authors
  1. Suresh K. Balasubramanian
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  2. Mayur Sharma
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  3. Danilo Silva
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  9. Paul Elson
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  10. John H. Suh
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Correspondence to Samuel T. Chao.

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Balasubramanian, S.K., Sharma, M., Silva, D. et al. Longitudinal experience with WHO Grade III (anaplastic) meningiomas at a single institution. J Neurooncol 131, 555–563 (2017). https://doi.org/10.1007/s11060-016-2321-8

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  • DOI: https://doi.org/10.1007/s11060-016-2321-8

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