scholarly journals Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity

2015 ◽  
Vol 39 (2) ◽  
pp. E8 ◽  
Author(s):  
Mohammed Abdulaziz ◽  
Grant W. Mallory ◽  
Mohamad Bydon ◽  
Rafael De la Garza Ramos ◽  
Jason A. Ellis ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Adjuvant Radiotherapy ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Myxopapillary Ependymoma ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
En Bloc

OBJECT While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. METHODS A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. RESULTS Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7–68 years). The median follow-up was 51.5 months (range 12–243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. CONCLUSIONS A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

2013 ◽  
Vol 19 (4) ◽  
pp. 471-476 ◽  
Author(s):  
William B. Feldman ◽  
Aaron J. Clark ◽  
Michael Safaee ◽  
Christopher P. Ames ◽  
Andrew T. Parsa
Keyword(s):  
Recurrence Rate ◽  
Adjuvant Radiotherapy ◽  
Pediatric Patients ◽  
Cauda Equina ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Tumor Control ◽  
Recurrence Rates ◽  
Total Resection ◽  
Who Grade

Object Myxopapillary ependymomas (MPEs) are rare WHO Grade I tumors found in the conus medullaris, cauda equina, and filum terminale. Treatment generally consists of resection with or without adjuvant radiotherapy. Evidence-based guidelines for surgical management are lacking due to the rarity of this tumor. Methods An English-language PubMed search was performed using the key words “myxopapillary” and “ependymoma.” Reports describing fewer than 3 patients or those lacking data on the extent of resection or radiotherapy were excluded. A total of 28 articles describing 475 patients met the authors' inclusion criteria. Patients were grouped by extent of resection and whether or not they underwent adjuvant radiotherapy. Differences in recurrence rates were assessed by chi-square test. Results The overall recurrence rate was 15.5% in patients treated by gross-total resection (GTR) and 32.6% in patients treated by subtotal resection (STR), irrespective of whether they underwent adjuvant therapy (p < 0.001). Regardless of the extent of resection, adjuvant radiotherapy was not associated with a decrease in recurrence rates. The overall recurrence rate was 15.6% in patients who underwent GTR and radiotherapy compared with 15.9% in patients who underwent GTR alone (p = 0.58), and it was 29.3% in patients who underwent STR and radiotherapy compared with 35.1% in those who underwent STR alone (p = 0.53). The difference between recurrence rates for patients who underwent GTR alone versus STR and radiotherapy was statistically significant (p = 0.02). Subgroup analysis demonstrated significantly higher recurrence rates in pediatric patients compared with adults (40.5% vs 23.4%, respectively; p = 0.02). Even in the setting of GTR alone, recurrence rates were higher in pediatric patients (65% vs 7.6%; p < 0.001). Conclusions Gross-total resection alone is associated with decreased recurrence rates compared with STR with or without radiotherapy. The authors' results suggest that treatment goals should include attempted GTR whenever possible. The observation that children benefitted from radiation therapy to a greater extent than did adults suggests that biological differences between tumors in these patient populations warrants more rigorous scientific studies.

scholarly journals Commercially Available Gene Expression Assays as Predictive Tools for Adjuvant Radiotherapy? A Critical Review

Breast Care ◽  
2020 ◽  
Vol 15 (2) ◽  
pp. 118-127 ◽  
Author(s):  
David Krug ◽  
René Baumann ◽  
Wilfried Budach ◽  
Marciana Nona Duma ◽  
Jürgen Dunst ◽  
...  
Keyword(s):  
Gene Expression ◽  
Decision Making ◽  
Predictive Value ◽  
Adjuvant Radiotherapy ◽  
Clinical Indication ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
Hormone Receptor Positive ◽  
Prospective Trials

Background: Gene expression assays are increasingly used for decision-making regarding adjuvant chemotherapy in patients with hormone receptor-positive, HER2-negative breast cancer. There are some clinical situations in which there is also a need for better prognostic and predictive markers to better estimate the amount of benefit from adjuvant radiotherapy. The rising availability of gene expression analyses prompts the question whether their results can also be used to guide clinical decisions regarding adjuvant radiation. Summary: Multiple studies suggest a correlation between results from gene expression assays and locoregional recurrence rates. Only few publications addressed the predictive value of results from gene expression analysis for the role of adjuvant radiotherapy in different settings. Key Messages: To date, the available evidence on the possible predictive value of gene expression assays for radiotherapy does not support their inclusion into the decision-making process for adjuvant radiation. This is due to methodological weaknesses and limitations regarding patient selection, the nonrandomized design of all studies in terms of radiotherapy use, and limited availability of tissue from prospective trials. Thus, utilization of the present knowledge for clinical indication of radiotherapy should be very cautious.

scholarly journals Outcomes After Surgery and Radiotherapy for Spinal Myxopapillary Ependymoma

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 205-214 ◽  
Author(s):  
Chiaojung Jillian Tsai ◽  
Yucai Wang ◽  
Pamela K. Allen ◽  
Anita Mahajan ◽  
Ian E. McCutcheon ◽  
...  
Keyword(s):  
Cox Regression ◽  
Postoperative Radiotherapy ◽  
Gross Total Resection ◽  
Entire Group ◽  
Subtotal Resection ◽  
Myxopapillary Ependymoma ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
Cox Regression Analysis

Abstract BACKGROUND: The role of radiotherapy after surgery for myxopapillary ependymoma (MPE) is unclear. OBJECTIVE: To review long-term outcomes after surgery, with or without radiation, for spinal MPE. METHODS: Fifty-one patients with spinal MPE treated from 1968 to 2007 were included. Associations between clinical variables and overall survival (OS), progression-free survival (PFS), and local control (LC) were tested with Cox regression analysis. RESULTS: The median age at diagnosis was 35 years (range, 8-63 years). Twenty patients (39%) had surgery alone, 30 (59%) had surgery plus radiotherapy (RT), and 1 (2%) had RT only. At a median follow-up of 11 years (range, 0.2-37 years), 10-year OS, PFS, and LC for the entire group were 93%, 63%, and 67%, respectively. Nineteen patients (37%) had disease recurrence, and the recurrence was mostly local (79%). Twenty-eight of 50 patients who had surgery (56%) had gross total resection; 10-year LC was 56% after surgery vs 92% after surgery and RT (log-rank P = .14); the median time of LC was 10.5 years for patients receiving gross total resection plus RT, and 4.75 years for gross total resection only (P = .03). Among 16 patients with subtotal resection and follow-up data, 10-year LC was 0% after surgery vs 65% for surgery plus RT (log-rank P = .008). On multivariate analyses adjusting for resection type, age older that 35 years at diagnosis and receipt of adjuvant radiation were associated with improved PFS (hazard ratio [HR]: 0.14, P = .003 and HR: 0.45, P = .009) and LC (HR: 0.22, P = .02 and HR: 0.45, P = .009). CONCLUSION: Postoperative radiotherapy after resection of MPE was associated with improved PFS and LC.

scholarly journals Predictors of Treatment Response and Survival Outcomes in Meningioma Recurrence with Atypical or Anaplastic Histology

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 824-832 ◽  
Author(s):  
Muhammad O Chohan ◽  
Christopher T Ryan ◽  
Ranjodh Singh ◽  
Ryan M Lanning ◽  
Anne S Reiner ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Extent Of Resection ◽  
Cancer Center ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Recurrence Rates ◽  
Risk Of Progression ◽  
Anaplastic Histology ◽  
First Recurrence

Abstract BACKGROUND Recurrence rates for atypical and anaplastic meningiomas range between 9% and 50% after gross total resection and between 36% and 83% after subtotal resection. Optimal treatment of recurrent meningiomas exhibiting atypical/anaplastic histology is complicated because they are often refractory to both surgery and radiation. OBJECTIVE To evaluate clinical determinants of recurrence and treatment-specific outcomes in patients with recurrent meningiomas exhibiting atypical/anaplastic histology at our institution. METHODS A cohort study was conducted using clinical data of all patients treated for meningiomas with atypical/anaplastic histology at first recurrence between January 1985 and July 2014 at a tertiary cancer center. Predictors of second recurrence were analyzed using competing risks regression models. RESULTS Nine hundred eighteen patients with meningioma were screened, of whom 60 (55% female) had recurrent disease with atypical/anaplastic histology at a median age of 58.1 yr at diagnosis. The median follow-up from the time of first recurrence was 36.7 mo, with 32 (53%) patients alive at last follow-up. There was no effect of extent of resection at first recurrence on time to a subsequent recurrence. Inclusion of radiation as primary or adjuvant therapy at first recurrence reduced the risk of progression or subsequent recurrence compared to surgery alone (P = .07). CONCLUSION Treatment of recurrent meningiomas with atypical/anaplastic histology remains challenging. Our data, from one of the largest cohorts, suggest better tumor control with the addition of radiation and challenges the importance of extent of resection at first recurrence. A multicenter effort is needed to confirm these findings and propose treatment guidelines.

Prognostic factors and outcome of atypical and anaplastic meningioma with and without radiation.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2083-2083
Author(s):  
Hannah Yoon ◽  
Irene B. Helenowski ◽  
Karthikeyan Perumal ◽  
MaryAnne H. Marymont ◽  
James Chandler ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
External Beam Radiation ◽  
Subtotal Resection ◽  
Beam Radiation ◽  
Brain Invasion ◽  
Simpson Grade

2083 Background: We evaluated outcome and prognostic factors for high grade meningioma (G2-3) and the role of early post-operative radiotherapy (RT). Methods: From 2000 to 2010, 136 patients were diagnosed with G2-3 meningioma at Northwestern: 124 with atypical (G2) and 12 with anaplastic (G3) meningioma. All were treated with or without RT after initial or subsequent resection. The primary endpoint was progression-free survival (PFS). Results: 21 patients received adjuvant RT, and 115 did not. Median PFS for G2 with and without RT was 68 vs.89 mos. Median PFS for G3 with and without RT was not reached=nr (mean 5) vs.60 mos (mean 35). Median PFS for Simpson G1-3 with and without RT was 18 vs.96 mos. Median PFS for Simpson G4 with and without RT was nr (mean 55) vs.59 mos (mean 44). For median follow-up of 33 mos for Simpson G1-3 and 29 mos for G4, recurrence rate for Simpson G1-3 with and without RT was 40 vs.6%, and for Simpson G4 with and without RT, 9 vs.31%. 3-yr OS for G2 with and without RT was 93 vs.94%. 3-yr OS for G3 with and without RT was 80 vs.80%. In multivariate analysis, G3 histology and Simpson grade were predictive for relapse, while brain invasion, mitoses, adjuvant RT, and location of tumor were not. For those who received adjuvant RT, mean dose of external beam radiation (EBRT) in 2 patients was 58 Gy, while mean dose of stereotactic radiosurgery (SRS) in 15 patients was 15 Gy. 51% EBRT patients recurred, while 22% SRS patients recurred (p = 0.45). Median PFS with EBRT was 43 vs.51 mos for SRS (p = 0.34). Patients were maldistributed between the with and without RT arms in terms of brain invasion, extent of resection, and G3 histology. Conclusions: Patients who received RT had lower PFS compared to those who did not; survival was comparable. This may be due to inherent selection bias for patients with more aggressive disease getting adjuvant RT. Our study may be underpowered to determine the true role of RT in G2-3 meningioma. Patients with subtotal resection, Simpson G4, who received RT had fewer recurrences and higher PFS compared to those who did not. 3-yr OS was equivalent in both G2 and G3 tumors with and without RT. G3 histology and Simpson grade were predictive for relapse while brain invasion, mitoses, adjuvant RT, and location of tumor were not.

scholarly journals Multidisciplinary management of spinal aneurysmal bone cysts: A single-center experience

2019 ◽  
Vol 25 (5) ◽  
pp. 564-569 ◽  
Author(s):  
Sudhen B Desai ◽  
Cormac O’Brien ◽  
Raja Shaikh ◽  
Daniel Hedequist ◽  
Mark Proctor ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Surgical Intervention ◽  
Spinal Column ◽  
Axial Skeleton ◽  
Qualitative Assessment ◽  
Subtotal Resection ◽  
Bone Cysts ◽  
En Bloc ◽  
Aneurysmal Bone Cysts

Objective The management of spinal aneurysmal bone cysts (ABCs) is complex and often requires multimodality therapy, including surgical intervention to stabilize the axial skeleton, and avoid neurologic injury or death. With en bloc resection, ABCs have a recurrence rate of 12%, which increases to >50% with subtotal resection. The use of doxycycline sclerotherapy has been reported to reduce the recurrence rate of non-spinal ABCs to 5% at >24 month follow-up. We retrospectively reviewed our institutional results for sodium tetradecyl sulfate (STS)/doxycycline sclerotherapy and surgical intervention for spinal ABCs, to assess our treatment paradigm for these tumors and inform our future approach to these lesions. Methods Three cervical, two thoracic and two lumbar spine ABCs were treated in seven patients with spine-exclusive disease at our institution from 2011 to the present. The most common presenting complaint was pain. Each patient was retrospectively reviewed for clinical symptomology, number of treatments, technique and clinical follow-up. Qualitative assessment of improvement was based on the most recent clinical evaluation. Results The cohort underwent a mean of three treatment sessions (range 2–15). All were treated with STS and/or doxycycline. Five patients underwent surgical intervention at some point, either before or following sclerotherapy. After the last sclerotherapy session, four patients reported stable or improved pain symptoms, while two reported progressive pain that required surgical intervention for that indication. One patient, who underwent both multiple rounds of sclerotherapy and surgical resection, died due to acute on chronic cervical spine collapse with cord compression and inability to control disease. Conclusion We report our experience in the treatment of spinal column ABCs. Stabilization or improvement in pain was seen in four patients, while the remainder had progressive disease. Our multidisciplinary approach allows patients to receive the most appropriate treatment at presentation and thereafter, for symptom amelioration or spinal stability. Important future goals are to quantitatively assess changes in symptoms over time and to incorporate a reproducible radiographic endpoint for the assessment of treatment efficacy.

scholarly journals Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

2019 ◽  
Vol 46 (6) ◽  
pp. E3 ◽  
Author(s):  
Abhinav K. Reddy ◽  
James S. Ryoo ◽  
Steven Denyer ◽  
Laura S. McGuire ◽  
Ankit I. Mehta
Keyword(s):  
Adjuvant Radiotherapy ◽  
Survival Benefit ◽  
Atypical Meningioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
Cause Specific Survival ◽  
End Results

OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.

Cauda equina ependymomas: surgical treatment and long-term outcomes in a series of 125 patients

2021 ◽  
pp. 1-12
Author(s):  
Nicolò Marchesini ◽  
Nicola Tommasi ◽  
Franco Faccioli ◽  
Giampietro Pinna ◽  
Francesco Sala
Keyword(s):  
General Population ◽  
Tumor Size ◽  
Cauda Equina ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Control Group ◽  
Myxopapillary Ependymoma ◽  
En Bloc ◽  
Neurological Outcomes

OBJECTIVE Cauda equina ependymoma (CEE) is a rare tumor for which little information is available on the oncological and clinical outcomes of patients. In this study the authors aimed to address functional, oncological, and quality-of-life (QOL) outcomes in a large series of consecutive patients operated on at their institution during the past 20 years. METHODS The records of 125 patients who underwent surgery between January 1998 and September 2018 were reviewed. Analyzed variables included demographic, clinical, radiological, surgical, and histopathological features. Neurological outcomes were graded according to the McCormick and Kesselring scales. The QOL at follow-up was evaluated by administering the EQ-5DL questionnaire. RESULTS On admission, 84% of patients had a McCormick grade of I and 76.8% had a Kesselring score of 0. At follow-up (clinical 8.13 years; radiological 5.87 years) most scores were unchanged. Sacral level involvement (p = 0.029) and tumor size (p = 0.002) were predictors of poor functional outcome at discharge. Tumor size (p = 0.019) and repeated surgery (p < 0.001) were predictors of poor outcome. A preoperative McCormick grade ≥ III and Kesselring grade ≥ 2 were associated with worse outcomes (p = 0.035 and p = 0.002, respectively). Myxopapillary ependymoma (MPE) was more frequent than grade II ependymoma (EII). The overall rate of gross-total resection (GTR) was 91.2% and rates were significantly higher for patients with EII (98%) than for those with MPE (84%) (p = 0.0074). On multivariate analysis, the only factor associated with GTR was the presence of a capsule (p = 0.011). Seventeen patients (13.7%) had recurrences (13 MPE, 4 EII; 76.4% vs 23.6%; p = 0.032). The extent of resection was the only factor associated with recurrence (p = 0.0023) and number of surgeries (p = 0.006). Differences in progression-free survival (PFS) were seen depending on the extent of resection at first operation (p < 0.001), subarachnoid seeding (p = 0.041), piecemeal resection (p = 0.004), and number of spine levels involved (3 [p = 0.016], 4 [p = 0.011], or ≥ 5 [p = 0.013]). At follow-up a higher proportion of EII than MPE patients were disease free (94.7% vs 77.7%; p = 0.007). The QOL results were inferior in almost all areas compared to a control group of subjects from the Italian general population. A McCormick grade ≥ 3 and repeated surgeries were associated with a worse QOL (p = 0.006 and p = 0.017). CONCLUSIONS An early diagnosis of CEE is important because larger tumors are associated with recurrences and worse functional neurological outcomes. Surgery should be performed with the aim of achieving an en bloc GTR. The histological subtype was not directly associated with recurrences, but some of the features more commonly encountered in MPEs were. The outcomes are in most cases favorable, but the mean QOL perception is inferior to that of the general population.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

Adjuvant Radiotherapy in Grade II, Atypical Meningioma of the Skull Base

2021 ◽  
Author(s):  
David P. Bray ◽  
Bryan E. Buster ◽  
Joseph W. Quillin ◽  
Robert H. Press ◽  
Bree R. Eaton ◽  
...  
Keyword(s):  
Skull Base ◽  
Adjuvant Radiotherapy ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Grade Ii ◽  
Atypical Meningiomas ◽  
Mean Time ◽  
Two Populations ◽  
Initial Resection

Abstract Introduction Atypical meningiomas (AM) are meningiomas that are more aggressive than their grade-I counterparts and have a higher rate of recurrence. The effect of adjuvant radiotherapy (ART) on AM of the skull base is not defined. Methods A retrospective review of all AM's of the skull base primarily resected at our institution from 1996 to 2018 was completed. ART was defined as radiotherapy (RT) that occurred within 6 months of initial resection, regardless of Simpson's grade. Minimum time length of follow-up after resection was 2 years. Statistical analysis was performed using SAS. Results There were a total of 59 skull base–located (SBL) AMs resected at our institution from 1996 to 2018. The average age of our cohort was 53.2 years. Gross total resection, defined as Simpson's grades I to III resection, was achieved in 36 (61%) of cases. Thirty-five of 59 (59%) patients received ART. Recurrence was observed in 14 patients (24%), and mean time to recurrence was 63.8 months. Patients who received ART had a lower observed rate of recurrence (8 vs. 46%); however, time to recurrence was not significantly different between the two populations. Conclusion We observe that AM in the skull base location have higher recurrence rates than we would expect from grade-I meningioma. These data suggest that ART may offer benefit to the overall observed frequency of recurrence of SBL AM; however, the time to recurrence between patients who received ART and those who did not was not statistically significant in survival analysis.

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