title: Impaired survival and long-term neurological problems in benign meningioma.
abstract: OBJECTIVE
  To assess long-term functional outcome and survival among patients with meningioma World Health Organization (WHO) grade I.
  
  
  METHODS
  Retrospective analysis of 205 patients after resection of WHO grade I intracranial meningioma from 1985 through 2003. Expected age- and sex-specific survival was calculated by applying Dutch life-table statistics to each patient for the individual duration of follow-up. Long-term functional outcome was assessed using a mailed questionnaire to the general practitioner.
  
  
  RESULTS
  The mean duration of follow-up was 11.5 years. Survival at 5, 10, 15, and 20 years was 92%, 81%, 63%, and 53%, respectively, which is significantly lower than the expected survival (94%, 86%, 78%, and 66%, respectively). Survival was worse with higher age (P < .001). Survival among patients younger than 45 years and older than 65 years was comparable to the expected survival but significantly worse among patients aged 45-65 years. Analysis of the cause of death suggests an excess mortality associated with both brain tumor death and stroke (P = .07). Recurrence rates at 5, 10, and 15 years were 18%, 26%, and 32%, respectively. Higher Simpson grade (P < .001) and lower age (P = .02) were associated with a higher recurrence rate. In 29 patients (14%) receiving radiotherapy, the 5-year recurrence rate was 18% and the 5-year survival was only 58%. Long-term functioning (≥ 5 years after last treatment) could be assessed in 89 long-term survivors: 29 patients (33%) showed no deficits, and 60 (67%) showed at least 1 neurological symptom, of whom 24 (27%) were unable to perform normal daily activities.
  
  
  CONCLUSIONS
  Long-term survival in WHO grade I meningioma is challenged in patients more than 45 years of age. Excess mortality seems to be associated with both tumor recurrence and stroke. The majority of patients have long-term neurological problems.
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Radiation Oncology, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hanna
authors.initials: H
authors.lastname: van Alkemade
authors.forename: Michelle
authors.initials: M
authors.lastname: de Leau
authors.forename: Edith M T
authors.initials: EM
authors.lastname: Dieleman
authors.forename: Jan W P F
authors.initials: JW
authors.lastname: Kardaun
authors.forename: Rob
authors.initials: R
authors.lastname: van Os
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
authors.forename: Wouter R
authors.initials: WR
authors.lastname: van Furth
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008579:Meningioma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D060787:Neoplasm Grading; D009422:Nervous System Diseases / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult