Recurrent Atypical Meningiomas: Combining Surgery and Radiosurgery in One Effective Multimodal Treatment.
OBJECTIVE
Owing to their rarity and proteiform pathologic features, the clinical behavior of atypical meningiomas is not yet well characterized. Though the extent of resection is believed to be a key determinant of prognosis, limited data exist regarding optimal management of patients with recurrent disease.


METHODS
In this 20-year retrospective case series, we reviewed the medical records of 46 patients with recurrent atypical meningiomas (185 lesions, 89 of which were local, 78 marginal, and 18 distant recurrences); treatment was radiosurgery (n = 60), surgery (n = 56), or both (n = 8). The median follow-up period was 53 months. Outcome measures were length of overall survival and disease-free intervals and prognostic factors for survival.


RESULTS
Overall, the median progression-free survival was 26 months at the first recurrence and 100 months thereafter (the sum of the later intervals). Multivariate analysis showed that no treatment-related factors influenced prognosis, whereas recurrence at the skull base was a significant tumor-related factor limiting further treatment. Irrespective of treatment type, the recurrence-free interval was increasingly shorter during the clinical course, with a higher occurrence of marginal and distant lesions migrating to the midline and to the skull base. In sporadic cases, disease-free intervals were longer after wide craniotomy, tumor and dural resection with tumor-free margin.


CONCLUSIONS
The disease-free interval was substantially similar after surgery and radiosurgery for treating recurrent disease in patients with atypical meningiomas. Surgery is the mainstay for prolonging survival, while radiosurgery can be an adjuvant strategy to gain time for clinical observation and planning aggressive surgical treatment.
Department of Neurological Science and Movement, University of Verona, Verona, Italy. Electronic address: andrea.talacchi@univr.it.
Andrea
A
Talacchi
Department of Neurological Science and Movement, University of Verona, Verona, Italy.
Francesco
F
Muggiolu
Department of Neurological Science and Movement, University of Verona, Verona, Italy.
Antonella
A
De Carlo
Department of Neurosciences, Section of Neurosurgery, Azienda Ospedeliera Universitaria Integrata, Verona, Italy.
Antonio
A
Nicolato
Department of Public Health and Community Medicine, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
Francesca
F
Locatelli
Department of Neurological Science and Movement, University of Verona, Verona, Italy.
Mario
M
Meglio
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
Meningiomas; Recurrence; Treatment; Tumor progression