Long-Term Follow-Up, Treatment Strategies, Functional Outcome, and Health-Related Quality of Life after Surgery for WHO Grade 2 and 3 Intracranial Meningiomas

Abstract

Progression-free survival (PFS) and overall survival (OS) for WHO grade 2 and 3 intracranial meningiomas are poorly described, and long-term results and data evaluating the routine use of supplementary fractionated radiotherapy (RT) or stereotactic radiosurgery (SRS) has been inconclusive. The aim of this study was to determine the long-term PFS and OS at a center that does not employ routine adjuvant RT. For this purpose, a retrospective population-based cohort study was conducted of all WHO grade 2 and 3 meningiomas surgically treated between 2005 and 2013. The cohort was uniformly defined according to the WHO 2007 criteria to allow comparisons to previously published reports. Patient records were reviewed, and patients were then prospectively contacted for structured quality-of-life assessments. In total, 51 consecutive patients were included, of whom 43 were WHO grade 2 and 8 were grade 3. A Simpson grade 1-2 resection was achieved in 62%. The median PFS was 31 months for grade 2 tumors, and 3.4 months for grade 3. The median OS was 13 years for grade 2, and 1.4 years for grade 3. The MIB-1-index was significantly associated with an increased risk for recurrence (p = 0.018, OR 1.12). The median PFS was significantly shorter for high-risk tumors compared to the low-risk group (10 vs. 46 months; p = 0.018). The surviving meningioma patients showed HRQoL measures comparable to that of the general population, with the exception of significantly more anxiety and depression. All patients who worked before surgery returned to work after their treatment. In conclusion, we confirm dismal prognoses in patients with grade 2 and 3 meningiomas, with tumor-related deaths resulting in severely reduced OS. However, the cohort was heterogenous, and a large subgroup of both grade 2 and 3 meningiomas was alive at 10 years follow-up, suggesting that a cure is possible. In addition, fractionated radiotherapy and chemotherapy had little benefit when introduced for recurrent and progressive diseases.

Keywords: WHO grade 2; WHO grade 3; chemotherapy; gamma-knife radiosurgery; health-related quality of life; meningioma; neurosurgery; patient-reported outcomes; radiotherapy; return to work.

Figure 1

Flowchart showing the patient inclusion process.

Figure 2

Bar chart showing the total amount of treatment sessions for each individual patient, as well as if the patient responded to the health-related quality of life questionnaire.

Figure 3

Bar chart showing the Karnofsky Performance Status before surgery, after surgery, and at the 3–6 months postoperative follow-up.

Figure 4

The Kaplan–Meier survival curve of tumor recurrence or growth following surgical resection of WHO grade 2 or 3 meningiomas. The median PFS occurred at 31 months for grade 2 and at 3.4 months for grade 3 meningiomas.

Figure 5

The Kaplan–Meier survival curve of overall survival following surgical resection of the included cohort, stratified by WHO grade. The median OS occurred at 13 years for grade 2 and at 1.4 years for grade 3 meningiomas.