A TYPICAL AND MALIGNANT MENINGIOMAS - AN OUTCOME REPORT OF 17 CASES

Limited data are available concerning the outcome of patients with aty pical and malignant meningiomas. We therefore analyzed the outcome of seventeen patients with meningiomas (9 atypical; 8 malignant) at Thoma s Jefferson University Hospital between 1973 and 1996. Strict adherenc e to the 1993 WHO criteria for the typing of CNS tumors was maintained . The median potential follow-up period for all patients was 87 months . The age at diagnosis ranged from 22 to 72 (mean 51.8 years). There w ere 5 males and 12 females. The mean tumor diameter was 4.45 cm. Of th e 16 cases where the extent of surgical resection was known, 4 were pa rtial and 12 were complete resections. Six patients (35%) had dural or cortical invasion by tumor. Fifteen patients received postoperative m egavoltage photon irradiation (mean 61 Gy). One of these fifteen pts. received an additional 20 Gy with Au-198 implantation and 1 received p ost-radiation chemotherapy for recurrent disease. The overall survival rate for all patients at 5 and 10 years were 87% and 58% respectively . The 5- and 10-year survival rates for atypical meningiomas were 87% and 58%; for malignant meningiomas the survival rates were 60% and 60% respectively. Five patients (30%) have died. Three of these 5 patient s initially received less than 54 Gy to the tumor bed and have died of recurrent disease. Local disease progression was documented in 11 pat ients (65%) after surgery and in 3 patients (18%) after radiation. The re was an improvement in performance status in 3 (18%) paients with a decline and no change seen in 1 (6%) and 13 (77%) respectively after r eceiving radiation. There appeared to be no difference in survival in patients as a function of dural or cortical invasion. Long term surviv al is possible for patients with atypical and malignant meningiomas tr eated with surgery and post-operative radiation. We are unable to dist inguish a difference in outcome between these two pathological entitie s. Dural and cortical invasion were not associated with a decrease in survival. In addition, improved tumor control and survival may be asso ciated with increased radiation dose.