Advertisement

Risk group-adapted adjuvant radiotherapy for WHO grade I and II skull base meningioma

  • Sangjoon Park
  • Yoon Jin Cha
  • Sang Hyun Suh
  • Ik Jae Lee
  • Kyu-Sung Lee
  • Chang-Ki HongEmail author
  • Jun Won KimEmail author
Original Article – Clinical Oncology

Abstract

Purpose

Salvage treatment including surgery and radiotherapy (RT) for recurrent or progressive meningioma is not an easy task, especially for the skull base location. And yet, criteria for adjuvant radiotherapy after initial surgery are not clearly defined for WHO grade I/II meningioma. We determined prognostic factors for recurrence and evaluated the benefit of risk group-adapted adjuvant RT for WHO grade I/II meningioma in the skull base.

Methods

We reviewed 272 patients who underwent surgery and were pathologically confirmed with WHO grade I or II skull base meningioma between January 2000 and July 2017. Subgroup analyses were performed for WHO grade I (259 patients) and WHO grade II (13 patients) meningiomas to evaluate the benefit of RT in each subgroup.

Results

Patients with WHO grade II meningiomas tended to present more neurologic symptoms and to receive RT more frequently. In prognostic factor analysis, tumor size (p = 0.039), surgical extent (p < 0.001), and RT (p = 0.005) were associated with recurrence-free survival (RFS). In subgroup analysis of WHO grade I, RFS was significantly better in RT group after matching other variables. The risk stratification was performed using three risk factors (petroclival location, tumor size, Simpson grade) in WHO grade I patients, and significantly different RFS was observed according to the risk group in non-RT patients.

Conclusions

Tumor size, Simpson grade, and adjuvant RT were prognostic factors. The risk group-adapted approach can facilitate the selection of patients who may benefit from adjuvant RT for WHO grade I/II skull base meningiomas.

Keywords

Meningioma WHO grade I/II Skull base neoplasm Adjuvant radiotherapy Surgical extent Risk factors 

Notes

Funding

Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education, Republic of Korea, Grant/Award Number: (2017R1D1A1B03035047); Korean Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea, Grant/Award Number: (HI15C0638).

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods in this study or the findings specified in this paper.

Supplementary material

432_2019_2891_MOESM1_ESM.doc (68 kb)
Supplementary material 1 (DOC 66 KB)

References

  1. Adeberg S et al (2012) Long-term outcome after radiotherapy in patients with atypical and malignant meningiomas—clinical results in 85 patients treated in a single institution leading to optimized guidelines for early radiation therapy. Int J Radiat Oncol Biol Phys 83:859–864.  https://doi.org/10.1016/j.ijrobp.2011.08.010 CrossRefGoogle Scholar
  2. Aghi MK et al (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64:56–60.  https://doi.org/10.1227/01.neu.0000330399.55586.63 (discussion 60) CrossRefGoogle Scholar
  3. Ayerbe J, Lobato RD, de la Cruz J, Alday R, Rivas JJ, Gómez PA, Cabrera A (1999) Risk factors predicting recurrence in patients operated on for intracranial meningioma. A multivariate analysis. Acta Neurochirur 141:921–932.  https://doi.org/10.1007/s007010050398 CrossRefGoogle Scholar
  4. Chang J, Chang J, Choi J, Park Y, Chung S (2003) Complications after gamma knife radiosurgery for benign meningiomas. J Neurol Neurosurg Psychiatry 74:226–230CrossRefGoogle Scholar
  5. Combs SE et al (2013) Skull base meningiomas: Long-term results and patient self-reported outcome in 507 patients treated with fractionated stereotactic radiotherapy (FSRT) or intensity modulated radiotherapy (IMRT) radiotherapy and oncology. J Eur Soc Therapeutic Radiol Oncol 106:186–191.  https://doi.org/10.1016/j.radonc.2012.07.008 CrossRefGoogle Scholar
  6. Combs SE, Farzin M, Boehmer J, Oehlke O, Molls M, Debus J, Grosu AL (2018) Clinical outcome after high-precision radiotherapy for skull base meningiomas: pooled data from three large German centers for radiation oncology. Radiother Oncol.  https://doi.org/10.1016/j.radonc.2018.03.006 Google Scholar
  7. Condra KS, Buatti JM, Mendenhall WM, Friedman WA, Marcus RB Jr, Rhoton AL (1997) Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 39:427–436CrossRefGoogle Scholar
  8. Cornelius JF, Slotty PJ, Steiger HJ, Hanggi D, Polivka M, George B (2013) Malignant potential of skull base versus non-skull base meningiomas: clinical series of 1,663 cases. Acta Neurochirur 155:407–413.  https://doi.org/10.1007/s00701-012-1611-y CrossRefGoogle Scholar
  9. Dziuk TW et al (1998) Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neuro-Oncol 37:177–188CrossRefGoogle Scholar
  10. Gorman L, Ruben J, Myers R, Dally M (2008) Role of hypofractionated stereotactic radiotherapy in treatment of skull base meningiomas. J Clin Neurosci 15:856–862.  https://doi.org/10.1016/j.jocn.2007.05.020 CrossRefGoogle Scholar
  11. Hamm K, Henzel M, Gross MW, Surber G, Kleinert G, Engenhart-Cabillic R (2008) Radiosurgery/stereotactic radiotherapy in the therapeutical concept for skull base meningiomas. Zentralbl Neurochir 69:14–21.  https://doi.org/10.1055/s-2007-992138 CrossRefGoogle Scholar
  12. Huffmann BC, Reinacher PC, Gilsbach JM (2005) Gamma knife surgery for atypical meningiomas. J Neurosurg 102:283–286CrossRefGoogle Scholar
  13. Hug EB et al (2000) Management of atypical and malignant meningiomas: role of High-dose, 3D-conformal radiation therapy. J Neuro-Oncol 48:151–160.  https://doi.org/10.1023/A:1006434124794 CrossRefGoogle Scholar
  14. Iwai Y, Yamanaka K, Ikeda H (2008) Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment. J Neurosurg 109:804–810.  https://doi.org/10.3171/jns/2008/109/11/0804 CrossRefGoogle Scholar
  15. Kane AJ et al (2011) Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 117:1272–1278.  https://doi.org/10.1002/cncr.25591 CrossRefGoogle Scholar
  16. Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G (2005) Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry 76:1425–1430  https://doi.org/10.1136/jnnp.2004.049213 CrossRefGoogle Scholar
  17. Mathiesen T, Lindquist C, Kihlstrom L, Karlsson B (1996) Recurrence of cranial base meningiomas. Neurosurgery 39:2–7 (discussion 8–9) CrossRefGoogle Scholar
  18. Milker-Zabel S, Zabel A, Schulz-Ertner D, Schlegel W, Wannenmacher M, Debus J (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61:809–816.  https://doi.org/10.1016/j.ijrobp.2004.07.669 CrossRefGoogle Scholar
  19. Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J (2007) Intensity-modulated radiotherapy for complex-shaped meningioma of the skull base: long-term experience of a single institution. Int J Radiat Oncol Biol Phys 68:858–863.  https://doi.org/10.1016/j.ijrobp.2006.12.073 CrossRefGoogle Scholar
  20. Ostrom QT et al (2013) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology 15:ii1–ii56.  https://doi.org/10.1093/neuonc/not151 CrossRefGoogle Scholar
  21. Park C-K, Jung H-W, Kim JE, Paek SH, Kim DG (2006) The selection of the optimal therapeutic strategy for petroclival meningiomas. Surg Neurol 66:160–165CrossRefGoogle Scholar
  22. Park HJ et al (2013) The role of adjuvant radiotherapy in atypical meningioma. J Neuro-Oncol 115:241–247.  https://doi.org/10.1007/s11060-013-1219-y CrossRefGoogle Scholar
  23. Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC (1999) “Malignancy” in meningiomas: a clinicopathologic study of 116 patients with grading implications. Cancer 85:2046–2056Google Scholar
  24. Pirzkall A, Debus J, Haering P, Rhein B, Grosser KH, Hoss A, Wannenmacher M (2003) Intensity modulated radiotherapy (IMRT) for recurrent, residual, or untreated skull-base meningiomas: preliminary clinical experience. Int J Radiat Oncol Biol Phys 55:362–372CrossRefGoogle Scholar
  25. Rogers L et al (2017) Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg.  https://doi.org/10.3171/2016.11.jns161170 Google Scholar
  26. Rosenberg LA et al (2009) Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution. Int J Rad Oncol Biol Phys 74:427–432.  https://doi.org/10.1016/j.ijrobp.2008.08.018 CrossRefGoogle Scholar
  27. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22CrossRefGoogle Scholar
  28. Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 113:1036–1042.  https://doi.org/10.3171/2010.3.jns091966 CrossRefGoogle Scholar
  29. Thoemmes F (2012) Propensity score matching in SPSS arXiv preprint arXiv:12016385Google Scholar
  30. Van Havenbergh T, Carvalho G, Tatagiba M, Plets C, Samii M (2003) Natural history of petroclival meningiomas. Neurosurgery 52:55–62 (discussion 62–54) Google Scholar
  31. Wayhs SY, Lepski GA, Frighetto L, Isolan GR (2017) Petroclival meningiomas: remaining controversies in light of minimally invasive approaches. Clin Neurol Neurosurg 152:68–75.  https://doi.org/10.1016/j.clineuro.2016.11.021 CrossRefGoogle Scholar
  32. Yamaguchi S et al (2014) Prognostic factors for survival in patients with high-grade meningioma and recurrence-risk stratification for application of radiotherapy. PLoS One 9:e97108.  https://doi.org/10.1371/journal.pone.0097108 CrossRefGoogle Scholar
  33. Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008) Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574–580.  https://doi.org/10.1136/jnnp.2007.121582 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Gangnam Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of PathologyYonsei University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyYonsei University College of MedicineSeoulSouth Korea
  4. 4.Department of Neurosurgery, Gangnam Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations