title: Survival and failure patterns in atypical and anaplastic meningiomas: A single-center experience of surgery and postoperative radiotherapy.
abstract: BACKGROUND
  Intracranial meningiomas are the second most common tumor of the CNS. The high-grade tumors are atypical and malignant meningioma comprising 5-7% and 1-3% of all meningiomas. The high-grade meningioma have an aggressive histopathological and clinical behavior.
  
  
  METHODS
  We retrospectively reviewed 37 patients of high-grade meningioma treated in our institute from 2002 to 2011. Clinical characteristics and treatment modality in form of surgery and radiotherapy (RT) were noted. Statistical analysis was done with regards to progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis.
  
  
  RESULTS
  The median age of the patients was 45.0 years. The median duration of symptoms was 6 months. Headache was the most common presenting symptom. Fourteen patients underwent complete excision, while 23 had subtotal excision. Twenty-two patients had World Health Organization (WHO) grade II histology tumors and 15 patients had grade III histology. Median RT dose delivered was 50 Gy for grade II tumors and 54 Gy for grade III tumors. Five-year PFS for grade II and III tumors was 58 and 20%, respectively. Five-year OS for grade II and III tumors was 83 and 23%, respectively.
  
  
  CONCLUSIONS
  High-grade meningiomas represent a rare and aggressive neoplasm. The mainstay of therapy is gross total resection (GTR) at the initial surgery. Postoperative adjuvant RT should be offered to all patients, regardless of the degree of resection achieved. Long-term follow-up is important as local recurrences and progression can develop years after the initial treatment.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Divya
authors.initials: D
authors.lastname: Khosla
authors.forename: Pravin S
authors.initials: PS
authors.lastname: Salunke
authors.forename: S K
authors.initials: SK
authors.lastname: Gupta
authors.forename: B D
authors.initials: BD
authors.lastname: Radotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D008579:Meningioma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D011182:Postoperative Care; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure; D055815:Young Adult