title: Atypical and malignant meningioma: outcome and prognostic factors in 119 irradiated patients. A multicenter, retrospective study of the Rare Cancer Network.
abstract: OBJECTIVE
  To retrospectively analyze and assess the outcomes and prognostic factors in a large number of patients with atypical and malignant meningiomas.
  
  
  METHODS
  Ten academic medical centers participating in this Rare Cancer Network contributed 119 cases of patients with atypical or malignant meningiomas treated with external beam radiotherapy (EBRT) after surgery or for recurrence. Eligibility criteria were histologically proven atypical or anaplastic (malignant) meningioma (World Health Organization Grade 2 and 3) treated with fractionated EBRT after initial resection or for recurrence, and age >18 years. Sex ratio (male/female) was 1.3, and mean (+/-SD) age was 57.6 +/- 12 years. Surgery was macroscopically complete (Simpson Grades 1-3) in 71% of patients; histology was atypical and malignant in 69% and 31%, respectively. Mean dose of EBRT was 54.6 +/- 5.1 Gy (range, 40-66 Gy). Median follow-up was 4.1 years.
  
  
  RESULTS
  The 5- and 10-year actuarial overall survival rates were 65% and 51%, respectively, and were significantly influenced by age >60 years (p = 0.005), Karnofsky performance status (KPS) (p = 0.01), and high mitotic rate (p = 0.047) on univariate analysis. On multivariate analysis age >60 years (p = 0.001) and high mitotic rate (p = 0.02) remained significant adverse prognostic factors. The 5- and 10-year disease-free survival rates were 58% and 48%, respectively, and were significantly influenced by KPS (p = 0.04) and high mitotic rate (p = 0.003) on univariate analysis. On multivariate analysis only high mitotic rate (p = 0.003) remained a significant prognostic factor.
  
  
  CONCLUSIONS
  In this multicenter retrospective study, age, KPS, and mitotic rate influenced outcome. Multicenter prospective studies are necessary to clarify the management and prognostic factors of such a rare disease.
authors.affiliation: Department of Radiation Oncology, Centre O. Lambret and University Lille II, 3 rue F. Combemale, Lille, France. d-pasquier@o-lambret.fr
authors.forename: David
authors.initials: D
authors.lastname: Pasquier
authors.forename: Stefan
authors.initials: S
authors.lastname: Bijmolt
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rezvoy
authors.forename: Salvador
authors.initials: S
authors.lastname: Villa
authors.forename: Marco
authors.initials: M
authors.lastname: Krengli
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.forename: Brigitta G
authors.initials: BG
authors.lastname: Baumert
authors.forename: Emine
authors.initials: E
authors.lastname: Canyilmaz
authors.forename: Deniz
authors.initials: D
authors.lastname: Yalman
authors.forename: Ewa
authors.initials: E
authors.lastname: Szutowicz
authors.forename: Tzahala
authors.initials: T
authors.lastname: Tzuk-Shina
authors.forename: René O
authors.initials: RO
authors.lastname: Mirimanoff
mesh_terms: D000704:Analysis of Variance; D005260:Female; 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 / Q000401:mortality / Q000532:radiotherapy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome