Introduction: Atypical and malignant meningiomas account for 20-35% of all intracranial meningiomas with recurrence rates between 9-50% after gross total resection (GTR) and 36-83% after subtotal resection (STR). Treatment decision for recurrent atypical/malignant meningiomas is complicated because they are both surgery and radiation (RT) refractory. The goal of the current study was to evaluate treatment specific outcomes in patients with recurrent atypical/malignant meningiomas at a major cancer hospital.
Methods: Clinical data was reviewed for all patients treated for recurrent atypical/malignant meningiomas between January 1985 and July 2014 at Memorial Sloan-Kettering Cancer Center. Pathology was reviewed on all cases to confirm adherence to the 2007 WHO guidelines. Predictors of second recurrence were analyzed using Cox-Regression.
Results: A total of 918 patients were screened of which 60 (36 females) had recurrent disease with atypical/malignant histology. Median age and tumor volume at diagnosis were 58 (range 21-83) years and 27 (4-164) cm3, respectively with a median followup of 71 (4-451) months. Median recurrence and surgeries per patient was 2 (1-5) and 2 (1-4) respectively. Median time to first and second recurrences was 25(3-156) and 10(1-163) months, respectively. Progression free survival after treatment for 1st recurrence was 4.8months (surgery), 22 months (surgery+RT) and 17 months (RT alone). Surgery alone appeared to increase the hazard of a second recurrence when compared to radiation (p=0.1). Surgery also marginally increased the hazard of recurrence when compared to surgery+RT (p=0.07). There was no effect on overall survival.
Conclusions: Treatment of atypical/malignant meningiomas at recurrence remains a challenge. Our data indicates better tumor control with radiation than with surgery. Multicenter effort is needed to confirm these findings and propose treatment guidelines.
Patient Care: Treatment options for previously resected, recurrent meningiomas include re-resection followed by radiation or brachytherapy or adjuvant chemotherapy. The National Comprehensive Cancer Network guidelines recommend surgical treatment when feasible followed by radiation for recurrent atypical meningiomas, though the level of evidence is limited. Our data indicates better tumor control with radiation than with surgery. Multicenter effort is needed to confirm these findings and propose treatment guidelines.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Understand the aggressive clinical nature of atypical/malignant meningiomas
2. Discuss various treatment options available to treat recurrent atypical/malignant meningiomas
3. Describe treatment outcome data of atypical/malignant meningiomas from a major cancer center