Abstract
BackgroundVarious prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. However, assessability of brain or bone involvement is often limited or varies between histopathologic, operative and imaging reports. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches.MethodsA cohort of 111 patients was treated with primary, adjuvant or salvage irradiation between 2008 and 2017 using intensity-modulated radiotherapy. Positron-emission tomography (PET) was available for treatment planning in 81% of patients. Clinical data were extracted from the medical reports. Brain and bone involvement were stratified separately according to histopathologic, operative and imaging reports as well as judged in synopsis.ResultsWHO grade I tumours, lower estimated proliferation index, primary versus recurrence treatment and localization (i.e. skull base, optic nerve sheath) were beneficial prognostic factors for local control. Judgement of brain and bone invasion partly differed between diagnostic modalities. In synopsis, brain or bone invasion did not show a significant influence on local control rates.ConclusionsSeveral previously described prognostic factors could be reproduced. However, partly divergent histopathological, surgical and image-based judgements could be found in regard to brain and bone invasion and all methods imply limitations. Therefore, we suggest a particular, complemental synopsis judgement. In synopsis, brain or bone involvement did not coherently impair local control in our irradiated patients. This might be explained by elaborate radiation techniques and PET-based treatment planning.
Highlights
Various prognostic factors have been suggested in meningioma patients including World Health Organization (WHO) grading, brain invasion and bone involvement, for instance
Described risk factors for recurrence imply incomplete resection [2], higher histopathological grading according to the World Health Organization (WHO) classification [3], increased proliferation activity (e.g. Molecular Immunology Borstel (MIB-1) immunohistochemistry) [4], bone involvement [5] and brain invasion [6]
In our single-centre cohort of meningioma patients, we retrospectively screened for patients treated with intensity-modulated radiotherapy (IMRT) with or without prior surgery between 2008 and 2017
Summary
Various prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches. Described risk factors for recurrence imply incomplete resection [2], higher histopathological grading according to the World Health Organization (WHO) classification [3], increased proliferation activity (e.g. Molecular Immunology Borstel (MIB-1) immunohistochemistry) [4], bone involvement [5] and brain invasion [6]. Even in surgically treated patients, the stand-alone impact of brain invasion on prognosis has been critically addressed, recently [8,9,10]. Judgement of bone involvement is sometimes ambiguous, even though it has considerable implications on target volume definition in radiation treatment planning [11]
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