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Primary management of atypical meningioma: treatment patterns and survival outcomes by patient age

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The initial management of atypical meningiomas poses a distinct clinical challenge in that treatment protocols have not been fully established, and outcomes, especially differences by patient age, have not been broadly measured. The National Cancer Database (NCDB) allows for analysis of a large, diverse patient population to determine clinical parameters and survival outcomes based on the initial treatment of patients with atypical meningiomas.

Methods

Analysis of the NCDB yielded 3611 atypical meningioma patients treated between 2008 and 2012. Principal treatment paradigms included surgery with or without radiation. Survival estimates were calculated using Kaplan–Meier curves stratified by age at diagnosis for each treatment paradigm. Subset analysis was performed for socio-economic factors.

Results

Overall 5-year survival rate was 77.6% and declined with increasing patient age (p < 0.0001). Five-year survival for patients ≤ 45 years undergoing surgery alone was 89.3 vs. 44.4% for those > 75 years (p < 0.0001). For patients undergoing surgery with adjuvant radiation, 5-year survival was 93.7% in those ≤ 45 years and 54.1% in those > 75 years (p < 0.0001). Use of adjuvant radiation was stable over time. Private-insured patients were more likely to receive adjuvant radiation (p = 0.0001).

Conclusions

Patients treated for atypical meningioma have high rates of 5-year survival. A marginal survival benefit of adjuvant radiation was observed for patients < 55 and > 75 years, while patients between 55 and 75 years tended to have slightly improved survival with surgery alone. Though surgery remains the standard of care in the primary treatment of atypical meningioma, the decision to administer radiation post-operatively has remained controversial.

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Abbreviations

NCDB:

National Cancer Database

WHO:

World Health Organization

RT:

Radiation therapy

ICDO:

International Classification of Diseases for Oncology

IMRT:

Intensity-modulated radiation therapy

References

  • Aghi MK, Carter BS, Cosgrove GR et al (2009) Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 64(1):56–60

    Article  PubMed  Google Scholar 

  • American College of Surgeons (2017) About the National Cancer Database. http://www.facs.org/quality-programs/cancer/ncdb/about. Accessed 16 Jun 2017

  • Andric M, Dixit S, Dubey A, Jessup P, Hunn A (2012) Atypical meningiomas—a case series. Clin Neurol Neurosurg 114(6):699–702

    Article  PubMed  Google Scholar 

  • Boffa DJ, Rosen JE, Mallin K et al (2017) Using the National Cancer Database for outcomes research: a review. JAMA Oncol 3(12):1722–1728

    Article  PubMed  Google Scholar 

  • Cain SA, Smoll NR, Van Heerden J, Tsui A, Drummond KJ (2015) Atypical and malignant meningiomas: considerations for treatment and efficacy of radiotherapy. J Clin Neurosci 22(11):1742–1748

    Article  PubMed  Google Scholar 

  • Combs SE, Schulz-Ertner D, Debus J, von Deimling A, Hartmann C (2011) Improved correlation of the neuropathologic classification according to adapted world health organization classification and outcome after radiotherapy in patients with atypical and anaplastic meningiomas. Int J Radiat Oncol Biol Phys 81(5):1415–1421

    Article  PubMed  Google Scholar 

  • Curry WT Jr, Barker FG 2nd (2009) Racial, ethnic and socioeconomic disparities in the treatment of brain tumors. J Neurooncol 93(1):25–39

    Article  PubMed  Google Scholar 

  • Detti B, Scoccianti S, Di Cataldo V et al (2013) Atypical and malignant meningioma: outcome and prognostic factors in 68 irradiated patients. J Neurooncol 115(3):421–427

    Article  CAS  PubMed  Google Scholar 

  • Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  CAS  PubMed  Google Scholar 

  • Farina P, Lombardi G, Bergo E, Roma A, Zagonel V (2014) Treatment of malignant gliomas in elderly patients: a concise overview of the literature. Biomed Res Int 2014:734281

    Article  PubMed  PubMed Central  Google Scholar 

  • Garzon-Muvdi T, Yang W, Lim M, Brem H, Huang J (2017) Atypical and anaplastic meningioma: outcomes in a population based study. J Neurooncol 133(2):321–330

    Article  CAS  PubMed  Google Scholar 

  • Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH (2000) Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46(1):57–61

    Article  CAS  PubMed  Google Scholar 

  • Hammouche S, Clark S, Wong AHL, Eldridge P, Farah JO (2014) Long-term survival analysis of atypical meningiomas: survival rates, prognostic factors, operative and radiotherapy treatment. Acta Neurochir 156(8):1475–1481

    Article  PubMed  Google Scholar 

  • Hasan S, Young M, Albert T et al (2015) The role of adjuvant radiotherapy after gross total resection of atypical meningiomas. World Neurosurg 83(5):808–815

    Article  PubMed  Google Scholar 

  • Jagsi R, Bekelman JE, Chen A et al (2014) Considerations for observational research using large data sets in radiation oncology. Int J Radiat Oncol Biol Phys 90(1):11–24

    Article  PubMed  PubMed Central  Google Scholar 

  • Jo K, Park HJ, Nam DH et al (2010) Treatment of atypical meningioma. J Clin Neurosci 17(11):1362–1366

    Article  PubMed  Google Scholar 

  • Kaur G, Sayegh ET, Larson A et al (2014) Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro Oncol 16(5):628–636

    Article  PubMed  PubMed Central  Google Scholar 

  • Killelea BK, Yang VQ, Mougalian S et al (2015) Neoadjuvant chemotherapy for breast cancer increases the rate of breast conservation: results from the National Cancer Database. J Am Coll Surg 220(6):1063–1069

    Article  PubMed  Google Scholar 

  • Klinger DR, Flores BC, Lewis JJ et al (2015) Atypical meningiomas: recurrence, reoperation, and radiotherapy. World Neurosurg 84(3):839–845

    Article  PubMed  Google Scholar 

  • Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131(6):803–820

    Article  PubMed  Google Scholar 

  • McCarthy BJ, Davis FG, Freels S et al (1998) Factors associated with survival in patients with meningioma. J Neurosurg 88(5):831–839

    Article  CAS  PubMed  Google Scholar 

  • McClelland S, Page BR, Jaboin JJ, Chapman CH, Deville C, Thomas CR (2017) The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol 2(4):523

    Article  PubMed  PubMed Central  Google Scholar 

  • Minniti G, Filippi AR, Osti MF, Ricardi U (2017) Radiation therapy for older patients with brain tumors. Radiat Oncol 12(1):101

    Article  PubMed  PubMed Central  Google Scholar 

  • Moraes FY, Chung C (2017) Radiation for skull base meningiomas: review of the literature on the approach to radiotherapy. Chin Clin Oncol 6(1):S3

    Article  PubMed  Google Scholar 

  • Orton A, Frandsen J, Jensen R, Shrieve DC, Suneja G (2017) Anaplastic meningioma: an analysis of the National Cancer Database from 2004 to 2012. J Neurosurg 21:1–6

    Article  Google Scholar 

  • Ostrom QT, Gittleman H, Xu J et al (2016) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro Oncol 18(suppl_5):v1–v75

    Article  PubMed  Google Scholar 

  • Palma L, Celli P, Franco C, Cervoni L, Cantore G (1997) Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 86(5):793–800

    Article  CAS  PubMed  Google Scholar 

  • Pasquier D, Bijmolt S, Veninga T et al (2008) Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network. Int J Radiat Oncol Biol Phys 71(5):1388–1393

    Article  PubMed  Google Scholar 

  • Pollock BE (2014) Defining the best management for patients with intracranial World Health Organization grade II meningiomas. World Neurosurg 81(5–6):712–713

    Article  PubMed  Google Scholar 

  • Rogers L, Gilbert M, Vogelbaum MA (2010) Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 99(3):393–405

    Article  PubMed  Google Scholar 

  • Sun SQ, Hawasli AH, Huang J, Chicoine MR, Kim AH (2015) An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas. Neurosurg Focus 38(3):E3

    Article  PubMed  Google Scholar 

  • Wang YC, Chuang CC, Wei KC et al (2016) Long term surgical outcome and prognostic factors of atypical and malignant meningiomas. Sci Rep 6:35743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wang C, Kaprealian TB, Suh JH et al (2017) Overall survival benefit associated with adjuvant radiotherapy in WHO grade II meningioma. Neuro Oncol 19(9):1263–1270

    Article  PubMed  Google Scholar 

  • Zaher A, Abdelbari Mattar M, Zayed DH, Ellatif RA, Ashamallah SA (2013) Atypical meningioma: a study of prognostic factors. World Neurosurg 80(5):549–553

    Article  PubMed  Google Scholar 

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Funding

The authors received no financial or material support in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Ernest Barthélemy, Joshua Loewenstern, Margaret Pain, Jordan Hall, Joshua Bederson & Raj K. Shrivastava

  2. Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Neeraja Konuthula, Satish Govindaraj & Raj K. Shrivastava

  3. Annenberg Building Floor 8 Room 35; 1468 Madison Avenue, New York, NY, 10029, USA

    Raj K. Shrivastava

Authors
  1. Ernest Barthélemy
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  2. Joshua Loewenstern
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  3. Neeraja Konuthula
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  4. Margaret Pain
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  5. Jordan Hall
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  6. Satish Govindaraj
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  7. Joshua Bederson
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  8. Raj K. Shrivastava
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Correspondence to Raj K. Shrivastava.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Ernest Barthélemy declares that he has no conflict of interest. Joshua Loewenstern declares that he has no conflict of interest. Neeraja Konuthula declares that she has no conflict of interest. Margaret Pain declares that she has no conflict of interest. Jordan Hall declares that he has no conflict of interest. Satish Govindaraj declares that he has no conflict of interest. Joshua Bederson declares that he has no conflict of interest. Raj K. Shrivastava declares that he has no conflict of interest.

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This article does not contain any studies with human participants performed by any other authors. Data were downloaded from a publicly available de-identified dataset.

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Barthélemy, E., Loewenstern, J., Konuthula, N. et al. Primary management of atypical meningioma: treatment patterns and survival outcomes by patient age. J Cancer Res Clin Oncol 144, 969–978 (2018). https://doi.org/10.1007/s00432-018-2618-4

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  • DOI: https://doi.org/10.1007/s00432-018-2618-4

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