Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study

Matthew J Shepard; Zhiyuan Xu; Kathryn Kearns; Chelsea Li; Ajay Chatrath; Kimball Sheehan; Darrah Sheehan; Andrew Faramand; Ajay Niranjan; Hideyuki Kano; Jason Gurewitz; Kenneth Bernstein; Roman Liscak; Khumar Guseynova; Inga S Grills; Jacob S Parzen; Christopher P Cifarelli; Azeem A Rehman; Ahmet Atik; Joshua Bakhsheshian; Gabriel Zada; Eric Chang; Steven Giannotta; Herwin Speckter; Hsiu-Mei Wu; Douglas Kondziolka; John G Golfinos; David Mathieu; Cheng-Chia Lee; Ronald E Warnick; L Dade Lunsford; Jason P Sheehan

doi:10.1093/neuros/nyaa553

Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study

Neurosurgery. 2021 Apr 15;88(5):980-988. doi: 10.1093/neuros/nyaa553.

Authors

Matthew J Shepard^{1

2}, Zhiyuan Xu¹, Kathryn Kearns¹, Chelsea Li¹, Ajay Chatrath¹, Kimball Sheehan¹, Darrah Sheehan¹, Andrew Faramand³, Ajay Niranjan³, Hideyuki Kano³, Jason Gurewitz⁴, Kenneth Bernstein⁵, Roman Liscak⁶, Khumar Guseynova⁶, Inga S Grills⁷, Jacob S Parzen⁷, Christopher P Cifarelli⁸, Azeem A Rehman⁸, Ahmet Atik⁹, Joshua Bakhsheshian¹⁰, Gabriel Zada¹⁰, Eric Chang¹¹, Steven Giannotta¹⁰, Herwin Speckter¹², Hsiu-Mei Wu^{13

14}, Douglas Kondziolka⁴, John G Golfinos⁴, David Mathieu¹⁵, Cheng-Chia Lee^{16

14}, Ronald E Warnick¹⁷, L Dade Lunsford³, Jason P Sheehan¹

Affiliations

¹ Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia.
² MD Anderson Cancer Center, Houston, Texas.
³ Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
⁴ Departments of Neurosurgery and Medical Physics.
⁵ NYU Langone Health System, New York, New York.
⁶ Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
⁷ Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan.
⁸ Department of Neurologic Surgery, West Virginia University, Morgantown, West Virginia.
⁹ Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
¹⁰ Departments of Neurologic Surgery, University of Southern California, Los Angeles, California.
¹¹ Department of Radiation Oncology, University of Southern California, Los Angeles, California.
¹² Centro Gamma Knife Dominicano, CEDIMAT, Plaza de la Salud, Santo Domingo, Dominican Republic.
¹³ Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan.
¹⁴ National Yang-Ming University School of Medicine, Taipei, Taiwan.
¹⁵ Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada.
¹⁶ Department of Neurosurgery, Taipei Veteran General Hospital, Taipei, Taiwan.
¹⁷ Department of Neurologic Surgery, Mayfield Clinic, Cincinnati, Ohio.

PMID: 33469655
DOI: 10.1093/neuros/nyaa553

Abstract

Background: Atypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described.

Objective: To define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs.

Methods: An international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model.

Results: A total of 271 patients received SRS for AMs (n = 233, 85.9%) or MMs (n = 38, 14.0%). Single-fraction SRS was most commonly employed (n = 264, 97.4%) with a mean target dose of 14.8 Gy. SRS was used as adjuvant treatment (n = 85, 31.4%), salvage therapy (n = 182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR) = 1.01, P < .05) and a Ki-67 index > 15% (HR = 1.66, P < .03) negatively correlated with PFS. MMs (HR = 3.21, P < .05), increased age (HR = 1.04, P = .04), and reduced KPS (HR = 0.95, P = .04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR = 0.99, P = .02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively.

Conclusion: AM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.

Keywords: Anaplastic; Atypical; Gamma knife radiosurgery; Meningioma; Radiosurgery; Stereotactic.

Publication types

Multicenter Study

MeSH terms

Humans
Meningioma / mortality
Meningioma / surgery*
Postoperative Complications / epidemiology
Radiation Injuries / epidemiology
Radiosurgery* / adverse effects
Radiosurgery* / methods
Radiosurgery* / mortality
Reoperation / statistics & numerical data
Retrospective Studies