title: Local control and overall survival in atypical meningioma: a retrospective study.
abstract: OBJECTIVE
  To evaluate local control and overall survival after primary surgery for patients with atypical meningiomas.
  
  
  METHODS
  From the Department of Pathology database, we identified 491 cases of meningioma treated at the Cleveland Clinic Foundation from 1979 through 1995. Thirty-three were diagnosed with atypical meningioma. Eleven of the excluded patients had incomplete records, were lost to follow-up, or received treatment elsewhere. Of the 22 evaluable patients, 15 underwent gross total resection (GTR), 4 had a subtotal resection (STR), and 3 had a resection of unknown extent. Eight patients received radiation therapy (2 after initial resection and 6 after at least one recurrence). The median radiation dose was 5,400 cGy (range 3,500-5,940). The median age at presentation was 55.5 years, the male:female ratio was 14:8, and 19/22 patients had a Karnofsky performance score (KPS) > or =80. The independent variables analyzed for overall survival and local control were gender, KPS (> or =80 vs. < 80), extent of surgery (GTR vs. STR or unknown extent of surgery), and postoperative radiation therapy.
  
  
  RESULTS
  Median survival was 10.6 years, with a median follow-up of 5.5 years (range 1.5-14.8). Eight of the 22 patients had local recurrence, including 2/15 with GTR, 3/4 with STR, and all 3 patients who underwent resection of unknown extent. At 10 years, patients with GTR had a higher local control rate than those who had either a STR or a resection of unknown extent (87% vs. 17%; p = 0.02). The 5- and 10-year overall survival rates for the entire group were 91% and 76%, respectively. Patients who had GTR had 5- and 10-year overall survival of 87% and 87%, respectively. Patients with STR or resection of unknown extent had 5- and 10-year overall survival rates of 100% and 75%, respectively.
  
  
  CONCLUSIONS
  In patients with atypical meningiomas, gross total resection is associated with a lower recurrence rate than in subtotal resection.
authors.affiliation: Department of Radiation Oncology, The Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: L K
authors.initials: LK
authors.lastname: Goyal
authors.forename: J H
authors.initials: JH
authors.lastname: Suh
authors.forename: D S
authors.initials: DS
authors.lastname: Mohan
authors.forename: R A
authors.initials: RA
authors.lastname: Prayson
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: G H
authors.initials: GH
authors.lastname: Barnett
mesh_terms: D000704:Analysis of Variance; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D008579:Meningioma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome