Brain Tumor Res Treat.  2017 Oct;5(2):54-63. 10.14791/btrt.2017.5.2.54.

Recurred Intracranial Meningioma: A Retrospective Analysis for Treatment Outcome and Prognostic Factor

• Ryu HS
• Moon KS
• Lee KH
• Jang WY
• Jung TY
• Kim IY
• Jung S

• KMID: 2396448
• DOI: http://doi.org/10.14791/btrt.2017.5.2.54

Abstract

BACKGROUND
In this study, we aimed to compare repeated resection and radiation treatment, such as Gamma knife radiosurgery (GKRS) or conventional radiotherapy (RT), and investigate the factors influencing treatment outcome, including overall survival (OS), progression-free survival (PFS), and complication rates.
METHODS
We retrospectively reviewed 67 cases of recurred intracranial meningiomas (repeated resection: 36 cases, radiation treatment: 31 cases) with 56 months of the median follow-up duration (range, 13-294 months).
RESULTS
The incidence of death rate was 29.9% over follow-up period after treatment for recurred meningiomas (20/67). As independent predictable factors for OS, benign pathology [hazard ratio (HR) 0.132, 95% confidence interval (CI) 0.048-0.362, p<0.001] and tumor size <3 cm (HR 0.167, 95% CI 0.061-0.452, p<0.001) were significantly associated with a longer OS. The incidence of progression rate was 23.9% (16/67). Only treatment modality was important for PFS as an independent predictable factor (GKRS/RT vs. open resection; HR 0.117, 95% CI 0.027-0.518, p<0.005). The complication rate was 14.9% in our study (10/67). Larger tumor size (≥3 cm, HR 0.060, 95% CI 0.007-0.509, p=0.010) was significant as an independent prognostic factor for development of complications. Although treatment modality was not included for multivariate analysis, it should be considered as a predictable factor for complications (p=0.001 in univariate analysis).
CONCLUSION
The role of repeated resection is questionable for recurred intracranial meningiomas, considering high progression and complication rates. Frequent and regular imaging follow-up is required to detect recurred tumor sized as small as possible, and radiation treatment can be a preferred treatment.

Keyword

Intracranial meningioma; Radiosurgery; Recurrent brain tumor; Reoperation; Treatment outcome

MeSH Terms

Brain Neoplasms
Disease-Free Survival
Follow-Up Studies
Incidence
Meningioma*
Mortality
Multivariate Analysis
Pathology
Radiosurgery
Radiotherapy
Reoperation
Retrospective Studies*
Treatment Outcome*

Figure

• 

  Fig. 1 Kaplan-Meier curves showing OS of 67 study patients based on different predictors (overall comparison was estimated using a log-rank test). The number on right lower in each curve represents the p-value. A: Entire patients. B: WHO grade. C: Location. D: Size of tumor. E: Treatment modality for recurrence. F: Postoperative complication. OS, overall survival; GKRS, Gamma knife radiosurgery; RT, radiotherapy.

• 

  Fig. 2 Kaplan-Meier curves showing PFS of 67 study patients based on different predictors (overall comparison was estimated using a log-rank test). The number on right lower in each curve represents the p-value. A: Entire patients. B: Treatment modality for recurrence. PFS, progression-free survival; GKRS, Gamma knife radiosurgery; RT, radiotherapy.

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