Malignant meningioma: An indication for initial aggressive surgery and adjuvant radiotherapy

被引:202
作者
Dziuk, TW
Woo, S
Butler, EB
Thornby, J
Grossman, R
Dennis, WS
Lu, H
Carpenter, LS
Chiu, JK
机构
[1] Texas Oncol PA, Dallas, TX USA
[2] Baylor Coll Med, Houston, TX 77030 USA
关键词
malignant meningioma; surgery; radiotherapy; local recurrence; survival;
D O I
10.1023/A:1005853720926
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for postsurgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed. Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p = 0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p = NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p = 0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p = 0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy and recurrence status are independent prognostic factors. Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control.
引用
收藏
页码:177 / 188
页数:12
相关论文
共 37 条
[1]   THE RECURRENCE OF INTRACRANIAL MENINGIOMAS AFTER SURGICAL-TREATMENT [J].
ADEGBITE, AB ;
KHAN, MI ;
PAINE, KWE ;
TAN, LK .
JOURNAL OF NEUROSURGERY, 1983, 58 (01) :51-56
[2]   MALIGNANT AND ATYPICAL MENINGIOMAS - A REAPPRAISAL OF CLINICAL, HISTOLOGICAL, AND COMPUTED TOMOGRAPHIC FEATURES [J].
ALVAREZ, F ;
RODA, JM ;
ROMERO, MP ;
MORALES, C ;
SARMIENTO, MA ;
BLAZQUEZ, MG .
NEUROSURGERY, 1987, 20 (05) :688-694
[3]   THE RECURRENCE OF SUPRATENTORIAL MENINGIOMAS AFTER SURGERY [J].
BEKS, JWF ;
DEWINDT, HL .
ACTA NEUROCHIRURGICA, 1988, 95 (1-2) :3-5
[4]   RECURRENCE OF INTRACRANIAL MENINGIOMAS - THE ROLE PLAYED BY REGIONAL MULTICENTRICITY .2. CLINICAL AND RADIOLOGICAL ASPECTS [J].
BOROVICH, B ;
DORON, Y ;
BRAUN, J ;
GUILBURD, JN ;
ZAAROOR, M ;
GOLDSHER, D ;
LEMBERGER, A ;
GRUSZKIEWICZ, J ;
FEINSOD, M .
JOURNAL OF NEUROSURGERY, 1986, 65 (02) :168-171
[5]   RECURRENCE OF INTRACRANIAL MENINGIOMAS - THE ROLE PLAYED BY REGIONAL MULTICENTRICITY [J].
BOROVICH, B ;
DORON, Y .
JOURNAL OF NEUROSURGERY, 1986, 64 (01) :58-63
[6]  
BOYLAN SE, 1988, CANCER, V61, P1447, DOI 10.1002/1097-0142(19880401)61:7<1447::AID-CNCR2820610728>3.0.CO
[7]  
2-S
[8]   11 TIMES RECURRENCES OF A PARASAGITTAL FALXMENINGIOMA [J].
BUSHE, KA ;
MEIXENSBERGER, J ;
NADJMI, M ;
KIRCHNER, T ;
DITTMANN, W .
ACTA NEUROCHIRURGICA, 1990, 107 (1-2) :65-69
[9]   ROLE OF RADIATION-THERAPY IN THE MANAGEMENT OF MENINGIOMA [J].
CARELLA, RJ ;
RANSOHOFF, J ;
NEWALL, J .
NEUROSURGERY, 1982, 10 (03) :332-339
[10]   MORBIDITY, MORTALITY, AND QUALITY OF LIFE FOLLOWING SURGERY FOR INTRACRANIAL MENINGIOMAS - A RETROSPECTIVE STUDY IN 257 CASES [J].
CHAN, RC ;
THOMPSON, GB .
JOURNAL OF NEUROSURGERY, 1984, 60 (01) :52-60