Article
Primary and secondary anaplastic meningioma; different entities?
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Authors
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Konstantinos Gousias
- Neurochirurgische Universitätsklinik Bonn
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Christel Herold-Mende
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg
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Ralf Ketter
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes
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Katrin Lamszus
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
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Mario Löhr
- Neurochirurgische Klinik, Universitätsklinikum Würzburg
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Matthias Simon for the FORAMEN study group
- Neurochirurgische Universitätsklinik Bonn
| Published: | June 2, 2015 |
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Outline
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Objective: Patients with anaplastic meningiomas WHO grade III (MIII) have a poor prognosis. Some patients are diagnosed with a MIII already at their first surgery (primary MIII, pMIII), whereas in others malignant degeneration of a lower grade meningioma is observed at the time of recurrence (secondary MIII, sMIII). Our study group aims at recruiting a large number of patients with these rare aggressive tumors in order to investigate their clinical course and biological background. Here we present a preliminary clinical analysis of our cases.
Method: We retrospectively analyzed pertinent demographic and clinical data of patients with MIII referred to five German neurosurgical departments. Progression free survival (PFS) was defined as the time between first surgery for a MIII and therapy for first tumor recurrence.
Results: The overall series comprised 64 patients (54.6% male) including only 36 cases with a pMIII. Median follow-up after first surgery was 51 months. Complete (i.e Simpson’s grade I-III) MIII resections were performed in 87% of cases. Median preoperative and postoperative KPS was 80%. Overall, 74% of pM III and 95% of sM III had radiotherapy (p=n.s.). 43% of sMIII patients underwent radiotherapy already for a lower grade meningioma, 59% for their MIII, and 5% had more than one course of radiation therapy. Median PFS after the MIII diagnosis was only 23 months. Patients with pMIII had a longer PFS (median PFS, pMIII: 28 vs. sMIII: 20 months; Kaplan Meier estimates, log rank test: p=0.094) and significantly reduced rates of tumor related death (pMIII: 39% vs. sMIII: 61%, p=0.006). Patients with sM III were younger when compared to patients with pM III (median age at first MIII surgery: 54 vs. 67 yrs., student T test, p=0.026). Skull base tumors were seen in 17% of pM III and 33% of sM III (p=n.s).
Conclusions: The present study confirms the relatively adverse prognosis of patients with MIII. In addition, we provide some evidence to suggest that pMIII and sMIII are different entities, and that pMIII have a better prognosis.
