title: Interinstitutional variance of postoperative radiotherapy and follow up for meningiomas in Germany: impact of changes of the WHO classification.
abstract: OBJECTIVE
  To document and critically analyse the impact of the revised WHO 2000 histological classification for meningiomas on postoperative radiotherapy/radiosurgery indications and MRI follow up protocols.
  
  
  METHODS
  The current (2000) WHO classification was used to grade 57 meningiomas treated surgically at one institution. These had been reviewed previously in 1999. All German neurosurgical departments carrying out intracranial microsurgery were asked to detail their guidelines for radiation therapy and follow up for meningiomas of different WHO grades.
  
  
  RESULTS
  Use of the current criteria downgraded seven of 15 atypical meningiomas (WHO grade II, MII) to grade I (MI), and four of six anaplastic tumours (WHO grade III, MIII) to grade II. Indications for radiotherapy/radiosurgery and MRI follow up protocols varied substantially with the histological grade and between institutions--for example, after an incomplete resection, radiotherapy/radiosurgery recommendations differed between MI and MII in 30 of 58 units (52%), and between MII and MIII in 34 of 56 units (61%).
  
  
  CONCLUSIONS
  Correlative studies combining treatment and outcome data with a standardised histopathological analysis are warranted to define properly the indications for radiotherapy/radiosurgery and follow up protocols after surgery for meningiomas of different histological grades. The use of changing grading paradigms during recent years renders decision making based on local and published experience difficult. The relatively large number of meningiomas classified as atypical/WHO grade II in current practice would argue against an uncritically aggressive approach to these tumours.
authors.affiliation: Neurochirurgische Universitätsklinik, Sigmund-Freud-Str 25, 53105 Bonn. Matthias.Simon@ukb.uni-bonn.de
authors.forename: M
authors.initials: M
authors.lastname: Simon
authors.forename: J
authors.initials: J
authors.lastname: Boström
authors.forename: P
authors.initials: P
authors.lastname: Koch
authors.forename: J
authors.initials: J
authors.lastname: Schramm
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000145:classification / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008579:Meningioma / Q000145:classification / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014944:World Health Organization