title: Management of atypical cranial meningiomas, part 2: predictors of progression and the role of adjuvant radiation after subtotal resection.
abstract: BACKGROUND
  The efficacies of adjuvant stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) for atypical meningiomas (AMs) after subtotal resection (STR) remain unclear.
  
  
  OBJECTIVE
  To analyze the clinical, histopathological, and radiographic features associated with progression in AM patients after STR.
  
  
  METHODS
  Fifty-nine primary AMs after STR were examined for predictors of progression, including the impact of SRS and EBRT, in a retrospective cohort study.
  
  
  RESULTS
  Twenty-seven patients (46%) progressed after STR (median, 30 months). On univariate analysis, spontaneous necrosis positively (hazard ratio = 5.2; P = .006) and adjuvant radiation negatively (hazard ratio = 0.3; P = .009) correlated with progression; on multivariate analysis, only adjuvant radiation remained independently significant (hazard ratio = 0.3; P = .006). SRS and EBRT were associated with greater local control (LC; P = .02) and progression-free survival (P = .007). The 2-, 5-, and 10-year actuarial LC rates after STR vs STR/EBRT were 60%, 34%, and 34% vs 96%, 65%, and 45%. The 2-, 5-, and 10-year actuarial progression-free survival rates after STR vs STR/EBRT were 60%, 30%, and 26% vs 96%, 65%, and 45%. Compared with STR alone, adjuvant radiation therapy significantly improved LC in AMs that lack spontaneous necrosis (P = .003) but did not improve LC in AMs with spontaneous necrosis (P = .6).
  
  
  CONCLUSIONS
  Adjuvant SRS or EBRT improved LC of AMs after STR but only for tumors without spontaneous necrosis. Spontaneous necrosis may aid in decisions to administer adjuvant SRS or EBRT after STR of AMs.
authors.affiliation: *Washington University School of Medicine, St. Louis, Missouri ‡Departments of Pathology and Immunology, §Neurosurgery, and ¶Radiation Oncology, Washington University, St. Louis, Missouri.
authors.forename: Sam Q
authors.initials: SQ
authors.lastname: Sun
authors.forename: Chunyu
authors.initials: C
authors.lastname: Cai
authors.forename: Rory K J
authors.initials: RK
authors.lastname: Murphy
authors.forename: Todd
authors.initials: T
authors.lastname: DeWees
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Dacey
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.forename: Keith M
authors.initials: KM
authors.lastname: Rich
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Dowling
authors.forename: Eric C
authors.initials: EC
authors.lastname: Leuthardt
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
authors.forename: John
authors.initials: J
authors.lastname: Evans
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Simpson
authors.forename: Clifford G
authors.initials: CG
authors.lastname: Robinson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Perrin
authors.forename: Jiayi
authors.initials: J
authors.lastname: Huang
authors.forename: Michael R
authors.initials: MR
authors.lastname: Chicoine
authors.forename: Albert H
authors.initials: AH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D008579:Meningioma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D016634:Radiosurgery / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies