The surgical role for the treatment of atypical meningiomas and predictive parameters of recurrence and overall Survival
EANS Academy. Marini A. 09/25/19; 275752; EP04004
Dr. Alessandra Marini
Dr. Alessandra Marini

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Background: The atypical meningiomas (AMs, WHO grade II) shows invasive characteristics and rapid progression.
The main treatment is the surgical one, a gross total removal (GTR) is one of the best positive predictive parameters for the clinical outcome. The role of radiotherapy as adjuvant therapy is still unclear.
Methods: From 2007 to 2017, 39 patients with atypical meningioma underwent neurosurgical intervention.
The follow-up was on average 52 (13- 108) months. Data (age, gender, comorbidity, pre-operative symptoms, localization, size, post-operative complications, the re-operation, Simpson grade) were analyzed. Radiotherapy and complications were evaluated. Karnofsky performance status (KPS) in pre-operative and in post-operative follow up (FU) and recurrence and time of recurrence, overall survival (OS) were analyzed too.
Results: Our study showed that GTR was achieved in 82% of patients. The 71.8% of patients who received GTR did not relapse, while over 85 percent of patients with near total relapsed (85,7%). Recurrence free survival(RFS) is statistically influenced by the extent of the resection (EOR, p=0,029). MIB 1 > 8 and brain invasion were negative predictive factors for recurrence (p=0,006 and p=0,014). The complications didn't change OS (p=0,566). The complications of second intervention were a negative predictive parameter for OS.
Radiotherapy correlated statistically with occurrence of recurrence (p=0,016). The RFS was 97,4 % at one Year, 75% at three years, 71.4% at five years FU. Mortality was 17%. At 3 years after surgery OS was 89, 2%, at 5 years it was 85.7%.
A good clinical outcome (KPS > 70) in the FU, was positive predictive parameter for survival.
Conclusions: EOR was correlated to RFS, MIB 1 >8 and brain invasion were associated with recurrence. Complications of surgery for recurrence were negative predictive parameter for OS. Good clinical outcome (KPS > 70 in the FU) was a predictive parameter for the OS.
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