title: Clinicopathologic features of aggressive meningioma emphasizing the role of radiotherapy in treatment.
abstract: OBJECTIVE
  Although meningiomas are typically benign, they occasionally behave in an aggressive fashion and carry a less favorable prognosis. The aim of this study was to review the clinical, radiologic and histopathologic features of these aggressive variants as well as the outcome after multimodality therapy.
  
  
  METHODS
  16 patients with atypical meningiomas (n = 11) and anaplastic meningiomas (n = 5) were treated in the Departments of Neurosurgery and Radiation Oncology at the University Hospital of Philipps University Marburg, Germany, between 1997 and 2003. Tumor grading was based on new WHO criteria. There were eleven men and five women with a mean age of 54 years. The median follow-up period was 34 months.
  
  
  RESULTS
  A total of 24 surgical procedures were performed for these 16 patients. Only seven patients underwent postoperative fractionated stereotactic radiotherapy. Patients with atypical meningioma received radiotherapy only for the recurrent disease. Six patients (37.5%) experienced tumor recurrence after a mean period of 27.2 months in spite of gross total resection. Radiographic findings suggestive of aggressiveness were observed mostly with WHO grade III meningiomas. By comparing the proliferation rate in four cases with atypical meningioma operated twice, the recurrent tumor had a higher proliferation rate than the first tumor in three cases. A special proliferation pattern was noticed in MIB-1 with anaplastic meningiomas. The mean overall survival period was 66.5 months. There was no mortality among patients with atypical meningioma, while four out of five patients with anaplastic meningioma died during follow-up.
  
  
  CONCLUSIONS
  Considering the higher rate of recurrence in aggressive meningiomas even after radical surgical excision and the possibility that the recurrent tumor is more aggressive than the original one, surgery should be combined with postoperative fractionated radiotherapy to improve local tumor control. The peculiar focal expression patterns of anaplastic meningioma in MIB-1 might be a marker of such malignant development.
authors.affiliation: Department of Radiotherapy and Radiooncology, Philipps University, Baldingerstrasse, 35033 Marburg, Germany. engenhar@med.uni-marburg.de
authors.forename: Rita
authors.initials: R
authors.lastname: Engenhart-Cabillic
authors.forename: Ahmed
authors.initials: A
authors.lastname: Farhoud
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: Stefan
authors.initials: S
authors.lastname: Heinze
authors.forename: Martin
authors.initials: M
authors.lastname: Henzel
authors.forename: Hans-Dieter
authors.initials: HD
authors.lastname: Mennel
authors.forename: Helmut
authors.initials: H
authors.lastname: Bertalanffy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008577:Meningeal Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008578:Meninges / Q000473:pathology; D008579:Meningioma / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011879:Radiotherapy Dosage; D012737:Sex Factors; D013238:Stereotaxic Techniques; D016019:Survival Analysis; D013997:Time Factors; D014944:World Health Organization
chemical_list: D015415:Biomarkers; D019394:Ki-67 Antigen