Brain Tumor Res Treat.  2013 Oct;1(2):85-90. 10.14791/btrt.2013.1.2.85.

Long Term Clinical Outcomes of Malignant Meningiomas

• Lim YS
• Kim MK
• Park BJ
• Kim TS
• Lim YJ

• KMID: 2048480
• DOI: http://doi.org/10.14791/btrt.2013.1.2.85

Abstract

OBJECTIVE
Malignant meningiomas are rare and have worse prognosis than benign meningiomas. We report our experience of a malignant meningioma and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors.
METHODS
Fifteen patients underwent surgical treatment for intracranial malignant meningiomas between year 1990 and 2012 in our institution. Anaplastic meningiomas were diagnosed in thirteen cases and papillary meningiomas in two. Fourteen patients (93.3%) received radiotherapy after surgical resection. All patients were followed regularly including clinical-neurological follow-up as well as magnetic resonance imaging. Progression was determined radiographically when there was more than 10% of mass volume increase or when there were onset or worsening of neurological symptoms not attributable to other causes.
RESULTS
Six patients were male and nine were women, and their mean age was 56.9 years (range 36-78). The median follow-up was 54 months (range 3-246). According to our study result, the 5-year progression free survival rate of malignant meningiomas was 53.6%. There were 2 cases (13.3%) of postoperative complications. Recurrences were confirmed in 4 patients (26.7%) during follow-up, the median recurrence time was 35 months (range 12-61), and further procedures were performed. Two of the recurred patients were treated with radiosurgery after secondary tumor resection, and other two patients were treated with radiosurgery alone. There was no more recurred disease patients in the follow-up period after then.
CONCLUSION
We report the outcomes of the aggressive surgery with radiation of malignant meningiomas. Although the data is limited, we found that radiosurgery treatment had favorable tumor control on recurred patients from our experience.

Keyword

Malignant meningioma; Radiotherapy; Radiosurgery

MeSH Terms

Disease-Free Survival
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Meningioma*
Postoperative Complications
Prognosis
Radiosurgery
Radiotherapy
Recurrence

Figure

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  Fig. 1 Kaplan-Meier plot of 5-year progression free survival. PFS: progression free survival.

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  Fig. 2 Enhanced coronal magnetic resonance imaging (MRI) series in a 45-year-old man (Case 11). A: Preoperative MRI showing a homogenously enhanced mass around right frontal convexity. B: MR imaging obtained 24 months after surgery and conventional radiotherapy revealing the recurrence of meningioma at previously surgical site with two separated enhancing mass. C: Thirty-seven months after operation with radiosurgery, a coronal MRI with gadolinium enhancement demonstrating disappearance of the meningioma.

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  Fig. 3 A: Preoperative magnetic resonance imaging with gadolinium enhancement showing homogenously enhancing mass which bases upon falcotentorium (Case 8). B: MR imaging obtained 3 month after surgery and conventional radiation therapy revealing diffuse enhancement on leptomeninges which are consistent with leptomeningeal seeding. The patient exhibited status epilepticus and expired.

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