Abstract：
OBJECTIVE: WHO Grade 3 (G3) meningiomas are rare tumours with limited data to guide management. This retrospective study documents UK management approaches across 14 centres over 11 years.
METHODS: Patients with WHO G3 meningioma between 01/01/2008 and 31/12/2018 were identified. Data were collected on demographics, management strategy, adjuvant radiotherapy, approach in recurrence setting and survival.
RESULTS: 84 patients were identified. 21.4% transformed from lower-grade disease. 96.4% underwent primary surgical resection, with 20.8% having evidence of residual disease on their post-op MRI. 59.3% of patients underwent adjuvant radiotherapy (RT) following surgical resection. Overall median PFS and OS were 12.6 months and 28.2 months, respectively. Median OS in the group who underwent complete surgical resection was 34.9 months, compared to 27.5 months for those who had incomplete resection (HR 0.58, 95% CI 0.27-1.23, p = 0.15). Median OS was 33.1 months for those who underwent adjuvant RT and 14.0 months for those who did not (HR 0.48, 95% CI 0.27-0.84, p = 0.004). Median adjuvant RT dose delivered was 60Gy (range 12Gy-60Gy), 45.8% of adjuvant RT was delivered using IMRT. At disease relapse, 31% underwent salvage surgery and 29.3% underwent salvage RT. Of those treated with salvage RT, 64.7% were re-treats and all were treated with hypofractionated RT.
CONCLUSIONS: Surgery continues to be the preferred primary management strategy. Post-operative MRI within 48 hours is indicated to assess presence of residual disease and guide further surgical options. Adjuvant radiotherapy plays an important part of the management paradigm in these patients with the data supporting an attached survival advantage. Further surgery and re-irradiation is an option in the disease recurrence setting with radiosurgery frequently utilised in this context.
METHODS: Patients with WHO G3 meningioma between 01/01/2008 and 31/12/2018 were identified. Data were collected on demographics, management strategy, adjuvant radiotherapy, approach in recurrence setting and survival.
RESULTS: 84 patients were identified. 21.4% transformed from lower-grade disease. 96.4% underwent primary surgical resection, with 20.8% having evidence of residual disease on their post-op MRI. 59.3% of patients underwent adjuvant radiotherapy (RT) following surgical resection. Overall median PFS and OS were 12.6 months and 28.2 months, respectively. Median OS in the group who underwent complete surgical resection was 34.9 months, compared to 27.5 months for those who had incomplete resection (HR 0.58, 95% CI 0.27-1.23, p = 0.15). Median OS was 33.1 months for those who underwent adjuvant RT and 14.0 months for those who did not (HR 0.48, 95% CI 0.27-0.84, p = 0.004). Median adjuvant RT dose delivered was 60Gy (range 12Gy-60Gy), 45.8% of adjuvant RT was delivered using IMRT. At disease relapse, 31% underwent salvage surgery and 29.3% underwent salvage RT. Of those treated with salvage RT, 64.7% were re-treats and all were treated with hypofractionated RT.
CONCLUSIONS: Surgery continues to be the preferred primary management strategy. Post-operative MRI within 48 hours is indicated to assess presence of residual disease and guide further surgical options. Adjuvant radiotherapy plays an important part of the management paradigm in these patients with the data supporting an attached survival advantage. Further surgery and re-irradiation is an option in the disease recurrence setting with radiosurgery frequently utilised in this context.
摘要：
目的：WHO3级（G3）脑膜瘤是罕见的肿瘤，指导治疗的数据有限。这项回顾性研究记录了超过11年的14个中心的英国管理方法。
方法：确定了2008年1月1日至2018年12月31日之间的WHOG3脑膜瘤患者。收集了人口统计数据，管理策略，辅助放疗,复发设置和生存的方法。
结果：确认84例患者。21.4%由低级疾病转化。96.4%接受了一期手术切除，20.8％的患者在术后MRI上有残留疾病的证据。59.3％的患者在手术切除后接受了辅助放疗（RT）。总体中位PFS和OS分别为12.6个月和28.2个月，分别。接受完全手术切除组的中位OS为34.9个月，与不完全切除者的27.5个月相比(HR0.58,95%CI0.27-1.23,p=0.15).接受辅助RT的患者的中位OS为33.1个月，未接受辅助RT的患者为14.0个月（HR0.48，95％CI0.27-0.84，p=0.004）。提供的辅助RT剂量中位数为60Gy（范围12Gy-60Gy），45.8%的佐剂RT使用IMRT递送。在疾病复发时，31%接受了抢救手术，29.3%接受了抢救RT。在接受救助RT治疗的人中，64.7％的患者进行了再治疗，所有患者均进行了低分割RT治疗。
结论：手术仍然是首选的主要管理策略。术后48小时内进行MRI检查以评估残留疾病的存在并指导进一步的手术选择。辅助放疗在这些患者的管理范式中起着重要的作用，数据支持附加的生存优势。在疾病复发的情况下，进一步的手术和重新照射是一种选择，在这种情况下经常使用放射外科。
方法：确定了2008年1月1日至2018年12月31日之间的WHOG3脑膜瘤患者。收集了人口统计数据，管理策略，辅助放疗,复发设置和生存的方法。
结果：确认84例患者。21.4%由低级疾病转化。96.4%接受了一期手术切除，20.8％的患者在术后MRI上有残留疾病的证据。59.3％的患者在手术切除后接受了辅助放疗（RT）。总体中位PFS和OS分别为12.6个月和28.2个月，分别。接受完全手术切除组的中位OS为34.9个月，与不完全切除者的27.5个月相比(HR0.58,95%CI0.27-1.23,p=0.15).接受辅助RT的患者的中位OS为33.1个月，未接受辅助RT的患者为14.0个月（HR0.48，95％CI0.27-0.84，p=0.004）。提供的辅助RT剂量中位数为60Gy（范围12Gy-60Gy），45.8%的佐剂RT使用IMRT递送。在疾病复发时，31%接受了抢救手术，29.3%接受了抢救RT。在接受救助RT治疗的人中，64.7％的患者进行了再治疗，所有患者均进行了低分割RT治疗。
结论：手术仍然是首选的主要管理策略。术后48小时内进行MRI检查以评估残留疾病的存在并指导进一步的手术选择。辅助放疗在这些患者的管理范式中起着重要的作用，数据支持附加的生存优势。在疾病复发的情况下，进一步的手术和重新照射是一种选择，在这种情况下经常使用放射外科。
