Artikel
Retrospective analysis of recurrence rate in primary intracranial atypical meningiomas
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Current guidelines for the treatment of atypical meningiomas recommend radiotherapy following tumor resection to prevent tumor recurrence. The indication for radiotherapy is however still controversial as this treatment may be associated with significant side effects and may induce malignant progression or secondary malignancy. The aim of this work was to evaluate the rate of recurrence in atypical meningiomas with and without radiotherapy after surgery.
Method: We performed a retrospective analysis of intracranial meningiomas, treated in our department from 2003 to 2014. For this analysis, only primary WHO Grade II meningiomas diagnosed at first surgery were selected. We graded the removal of meningeomas according to Simpson grading system. Cases with insufficient follow-up of less than 6 months were excluded. Tumor recurrence rate was compared in the patients with and without postoperative adjuvant radiotherapy. Statistical analysis was performed using two-sided Fisher exact test.
Results: In total, 102 patients with atypical meningiomas were identified. 52 matched our inclusion criteria. Median age at the time of diagnosis was 60 years (Range 12-81 years, male/female ratio 0.7). Median follow-up was 3 years (range 0.5-8 years). In 45 patients (87%), Simpson Grade I and II tumor removal could be achieved. 17 patients (31%) received postoperative radiotherapy and 13 patients (24%) were diagnosed with tumor recurrence. There was a disproportionally larger rate of tumor recurrence in patients after radiotherapy in comparison to conservative observational treatment, 41% and 17%, respectively, however this did not reach statistical significance (p=0.09). This rate did not change markedly after eliminating Simpson grade ≥ 3 tumors, 31% and 13%, respectively, (p=0.21).
Conclusions: We observed a trend to higher recurrence rate in atypical meningiomas after radiation vs. observational clinical and imaging follow-up in primary intracranial atypical meningiomas. The indication for radiation at least for completely resected atypical meningiomas should be considered carefully.