Artikel
Impact of radiotherapy on recurrence of primary intracranial atypical meningiomas
Der Einfluss der Bestrahlung auf das Tumorrezidiv bei primären intrakraniellen atypischen Meningeomen
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Autoren
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Naureen Keric
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Darius Kalasauskas
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Christian F. Freyschlag
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Jens Gempt
- Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Martin Misch
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Alicia Poplawski
- Universitätsmedizin Mainz, Institut für Biomedizinische Informatik, Mainz, Deutschland
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Ali Ayyad
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Bernhard Meyer
- Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Atypical meningiomas (WHO °II) have an increased recurrence rate. However prognostic factors for tumor recurrence and data on postoperative radiotherapy are still conflicting. The aim of this study was to evaluate the influence of postoperative radiotherapy on the recurrence of primary intracranial atypical meningiomas.
Methods: The medical records of all patients who underwent surgery (2007–2017 in 4 neurosurgical departments) of histologically diagnosed primary atypical meningioma were reviewed. Demographic and clinical data were analyzed to assess progression-free survival (PFS).
Results: 258 patients with a median age of 60 years were included in this analysis; 141 were female (54.7%). The predominant tumor localizations were convexity and falx (60.9%) followed by skull base (37.2%). Gross total resection (Simpson grade I+II) was achieved in 184 patients (75.2%), subtotal resection (Simpson grade III+IV) in 53 patients (20.5%), in 11 patients (4.3%) it was not reported. Median follow-up was 30 months. Radiation was performed in 46 cases (17.8%) and tumor recurred in 54 cases (20.9%). Radiation was more often applied after incomplete resection (13.4% vs. 37.7%; Simpson I+II vs. III-V). A significantly shorter PFS was associated with Simpson grade III-V (HR=1.14, CI (95%) 1.05–1.24, p=0.002) and age >70 years (HR=4.33, CI (95%) 2.19–8.54, p<0.0001). Radiation showed a trend towards shorter PFS (p=0.053). A multivariate analysis of a subgroup with minimal follow-up of 36 months (101 patients including 14 radiation cases) revealed following factors significantly reducing PFS: Simpson grades III-V (HR=1.11, CI (95%) 1.03–1.24, p=0.043), radiation (HR=2.90, CI (95%) 1.09–7.67, p=0.031) and age >70 years (HR=4.78, CI (95%) 2.03–11.27, p=0.0001).
Conclusion: In the present study, postoperative radiotherapy did not improve PFS. There may be a selection bias by choosing patients with high risk of recurrence for radiation. The most important prognostic factors remain the extent of resection and age.
