world_health_organization_grade_2_meningioma

World health organization grade 2 meningioma

Chordoid meningioma

Clear Cell meningioma

Atypical meningioma

Extent of resection independently predicts progression-free and overall survivals in patients with World health organization grade 2 meningioma. In an era of increasing support for adjuvant treatment modalities in the management of meningiomas. Data support maximal safe resection as the primary goal in treatment of these patients 1).

see Atypical meningioma treatment.

A retrospective database review between 1995 and 2019. Kaplan-Meier analysis was used to compare overall and progression-free survivals between patients who underwent gross total resection (GTR) and those who underwent subtotal resection (STR). Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and mortality.

Results: Of 214 patients who underwent surgical resection for WHO grade II meningiomas (median follow-up 53.4 months), 158 had GTR and 56 had STR. In Kaplan-Meier analysis, patients who underwent GTR had significantly longer progression-free (p = 0.002) and overall (p = 0.006) survivals than those who underwent STR. In multivariable Cox proportional-hazards analysis, GTR independently predicted prolonged progression-free (HR 0.57, p = 0.038) and overall (HR 0.44, p = 0.017) survivals when controlling for age, tumor location, and adjuvant radiation.

Conclusions: Extent of resection independently predicts progression-free and overall survivals in patients with WHO grade II meningiomas. In an era of increasing support for adjuvant treatment modalities in the management of meningiomas, our data support maximal safe resection as the primary goal in treatment of these patients 2).


Poulen et al. retrospectively analyzed patients in the database with WHO grade II meningioma, operated on between 2007 and 2010 in the university hospitals of Montpellier and Bordeaux, France. Clinical and radiological data, treatments and survival were analyzed.

Eighty-eight patients were included. Five-year overall survival was 89.7%. Nineteen patients received radiotherapy during follow-up, without a significant impact on survival (p=0.27).

In WHO grade II meningioma, it is currently difficult to establish clear recommendations for radiotherapy. The present study is in accordance with the literature that early postoperative radiotherapy is not mandatory in grade II meningioma with macroscopically total resection 3).


Between January 2000 and August 2015, 178 cases of World Health Organisation (WHO) Grade II meningioma were operated.

This population underwent a total of 224 surgical resections and 36 patients received a radiotherapy. Median follow-up was 3.6 years, interquartile ranges (IQR)[1.5 - 6.2].

28 patients (16.1%) were re operated for a relapse of their grade II meningioma. The median time between the first and the second surgery was 4.2 years, IQR[1.4-5.3]. Surgical recurrence-free survival at 1, 2, 5 and 10 years were respectively: 96.9%, 95 %CI[94.2, 99.6]; 91.7%, 95 %CI[87.3, 96.3], 85%, 95 %CI[78.6, 92] and, 70.8%, 95 %CI[60.1,83.5].At the end of the study, 93 patients (57.8%) had no residual tumour on the last scan. Age at diagnosis (HR=0.17, 95 %CI[0.05,0.56], p-value<0.001), extent of resection (HR=0.22, 95 %CI[0.08,0.64], p-value=0.01), and Ki-67 index (HR=0.18, 95 %CI[0.06,0.56], p-value<0.001) were independent factors associated with the surgical recurrence-free survival.

Younger patients with a lower proliferation rate and gross total resection are less likely to undergo a reintervention for WHO grade II meningioma recurrence. Observation rather than systematic adjuvant radiotherapy may be preferred. If possible, a redo surgery may be considered in case of relapse or tumor residual progression, as radiotherapy may not decrease the surgical recurrence-free survival after complete or incomplete resection 4).


1) , 2)
Soni P, Davison MA, Shao J, Momin A, Lopez D, Angelov L, Barnett GH, Lee JH, Mohammadi AM, Kshettry VR, Recinos PF. Extent of resection and survival outcomes in World Health Organization grade II meningiomas. J Neurooncol. 2020 Nov 17. doi: 10.1007/s11060-020-03632-3. Epub ahead of print. PMID: 33205354.
3)
Poulen G, Vignes JR, Corre ML, Loiseau H, Bauchet L. WHO Grade II Meningioma: epidemiology, survival and interest of post-operative radiotherapy in a multicenter cohort of 88 patients. Neurochirurgie. 2020 Mar 4. pii: S0028-3770(20)30034-5. doi: 10.1016/j.neuchi.2019.12.008. [Epub ahead of print] PubMed PMID: 32145249.
4)
Champeaux C, Dunn L. World Health Organization grade II meningioma. A 10-year retrospective study for recurrence and prognostic factor assessment. World Neurosurg. 2016 Feb 2. pii: S1878-8750(16)00143-1. doi: 10.1016/j.wneu.2016.01.055. [Epub ahead of print] PubMed PMID: 26850975.
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