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Long-term outcomes of multimodality management for parasagittal meningiomas

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Abstract

Purpose

The aim of this study was to systematically analyze the clinical characteristics of a large cohort of parasagittal meningioma (PM) and to evaluate the patients’ outcomes and best treatment strategies based on tumor features.

Methods

To minimize selection bias we performed a single-institutional review of PM with restricted criteria. One hundred and ninety-two consecutive patients who met criteria for inclusion were reviewed from 2003 to 2011 in our general hospital.

Results

A total of 131 cases (68.2%) were with WHO grade I, while grade II and grade III PMs constituted 40 (20.8%) and 21 cases (10.9%). Higher histological grade was associated with loss of trimethylation of H3K27 (P = 0.000). For WHO grade I PMs, GTR was significantly associated with a better PFS (P = 0.023); however, adjuvant radiotherapy did not benefit patients with STR (P = 0.215). For de novo high-grade (WHO grade II and III) PMs (n = 37), adjuvant radiotherapy was associated with a significantly longer OS (P = 0.013), while no difference was observed between GTR and STR (P = 0.654). In recurrent high-grade PM patients (n = 24), GTR combined with adjuvant radiotherapy increased PFS (P = 0.005).

Conclusions

This study demonstrated that PMs were a heterogeneous group of tumors with a high proportion of high-grade tumors that often displayed aggressive clinical behaviors. Low-grade PM benefited from radical resection, whereas high-grade de novo PM did not. Adjuvant radiotherapy significantly prolonged OS for high-grade primary PM, but did not impact survival of patients with subtotally resected low-grade tumors. Long-term outcome of high-grade recurrent PMs was dismal. We thus show that extent of tumor resection, tumor grade and tumor recurrent status inform therapeutic decisions for PMs.

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Abbreviations

PM:

Parasagittal meningioma

PFS:

Progression free survival

OS:

Overall survival

CNS:

Central nervous system

WHO:

World Health Organization

KPS:

Karnofsky performance score

GTR:

Gross total resection

STR:

Subtotal resection

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Acknowledgements

This study was supported by grants from the National Key R&D Program of China (2018YFC1312600, 2018YFC1312604 to Y. Gong), National Natural Science Foundation of China (81772674 to Y. Gong) and the Science and Technology Commission of Shanghai Municipality (18140900200 to Y. Gong).

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Author notes

  1. Lingyang Hua and Daijun Wang are co-first authors.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China

    Lingyang Hua, Daijun Wang, Hongda Zhu, Jiaojiao Deng, Shihai Luan, Shuchen Sun, Hailiang Tang, Qing Xie & Ye Gong

  2. Department of Neuropathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

    Haixia Chen

  3. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Hiroaki Wakimoto

  4. Department of Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

    Ye Gong

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  1. Lingyang Hua
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Correspondence to Hiroaki Wakimoto or Ye Gong.

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11060_2020_3440_MOESM1_ESM.tif

Supplementary Fig. 1 Examples of meningiomas positive and negative for H3K27me3 staining. A, B & C, Coronal, sagittal and axial enhanced MR scanning of a 55-year-old female patient with a recurrent atypical meningioma showing negative of H3K27me3 staining. D, E & F, H&E, Ki-67 and H3K27me3 staining; G, H & I, Coronal, sagittal and axial enhanced MR scanning of a 42-year-old male patient with a de-novo meningethelial meningioma showing positive of H3K27me3 staining. J, K & L, H&E, Ki-67 and H3K27me3 staining. (TIF 1626 kb)

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Hua, L., Wang, D., Zhu, H. et al. Long-term outcomes of multimodality management for parasagittal meningiomas. J Neurooncol 147, 441–450 (2020). https://doi.org/10.1007/s11060-020-03440-9

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