Introduction: Atypical and anaplastic/malignant meningiomas (WHO Grades II-III) are aggressive tumors that recur despite resection and radiation, and do not respond well to chemotherapeutics. Thus, implantation of 125-I brachytherapy seeds into the resection cavity has been used to augment surgical treatment. Here, we report the results of patients treated at our institution over a 25-year period.
Methods: Charts of patients treated at the University of California, San Francisco who underwent surgical resection and interstitial placement of 125-I brachytherapy sources for atypical and malignant meningioma between 1988-2013 were reviewed to determine progression free survival, survival after brachytherapy and overall survival. Kaplan-Meier actuarial method was used to calculate progression free and overall survival. Log-rank comparisons between curves were performed.
Results: Forty-two patients with high grade meningioma underwent surgical resections with 125-I brachytherapy. All patients had prior resections and 35 had prior radiation. At the time of brachytherapy, 13 patients had gross total resection, while 28 had subtotal resection. Median time to progression after resection with 125-I brachytherapy was 8.9 months for atypical meningioma, 9.0 months for malignant meningioma (p = 0.69), and 8.95 months for the combined groups. Median survival after 125-I brachytherapy was 3.5 years for subjects with atypical meningioma, 2.4 years for subjects with malignant meningioma (p = 0.78), and 3.3 years for all subjects. Median overall survival after diagnosis was 11.5 years for subjects with atypical meningioma, 8.0 years for subjects with malignant meningioma (p = 0.27), and 9.4 years for all subjects. Complications included radiation necrosis (8), wound breakdown (6), hydrocephalus (4), infection (3), and a meningocele (1).
Conclusions: These results are the largest case series of local brachytherapy with radioactive iodine sources as an adjuvant to resection for patients with high grade meningiomas. The favorable outcomes support the use of adjuvant brachytherapy in treating these aggressive tumors.
Patient Care: It provides outcomes information on using 125-Iodine brachytherapy as an adjuvent for resection of high grade meningioma, which informs patients and physicians in their treatment selection for these high-grade tumors.
Learning Objectives: By conclusion of this session, participants should understand options for treating high-grade meningioma, general survival for high-grade meningioma, how adjuvant brachytherapy works, and survival after adjuvant therapy is used as an option for high-grade meningioma