Early Postoperative Adjuvant Radiotherapy Versus Active Monitoring After Gross Total Resection for Atypical Meningiomas: Factors Associated with Early Recurrence.

Abstract

To investigate the predictors of recurrence after gross total resection (GTR) that require early adjuvant radiotherapy upfront rather than at initial recurrence of atypical meningiomas (AMs). A retrospective study of gross totally resected AMs was conducted in a tertiary care center within ten years. The clinical, radiological, and pathological parameters were analyzed statistically, and the factors associated with recurrence after GTR were determined with univariate analysis. Among 23 AMs with GTR, 34.8% showed recurrence in a median follow-up of 40 months after the surgery. Preoperative tumor volume, tumor location in the skull base or tentorium, and lack of progesterone expression were associated with the higher recurrence rate. AMs with a preoperative volume of 27.5 cm³ were the most significant risk factor for the recurrence (a 9.3-fold increase) than those with < 27.5 cm < sup > 3 < /sup > (66.7% vs. 14.3%, respectively). Patients diagnosed with larger AMs ( > 27.5 cm < sup > 3 < /sup > ) might have higher recurrence rates after GTR and, therefore, would benefit from early adjuvant radiotherapy without waiting for a recurrence. AMs located in the skull base or tentorium and AMs having no progesterone expression might also be potential predictors for recurrence.