BENIGN MENINGIOMAS - PRIMARY-TREATMENT SELECTION AFFECTS SURVIVAL

Purpose: To examine the effect of primary treatment selection on outco mes for benign intracranial meningiomas at the University of Florida. Methods and Materials: For 262 patients, the impact of age, Karnofsky performance status, pathologic features, tumor size, tumor location, a nd treatment modality on local control and cause-specific survival was analyzed (minimum potential follow-up, 2 years; median follow-up, 8.2 years). Extent of surgery was classified by Simpson grade. Treatment groups: surgery alone (n = 229), surgery and postoperative radiotherap y (RT) (n = 21), RT alone (n = 7), radiosurgery alone (n = 5). Surviva l analysis: Kaplan-Meier method,vith univariate and multivariate analy sis. Results: At 15 years, local control was 76% after total excision (TE) and 87% after subtotal excision plus RT (SE+RT), both significant ly better (p = 0.0001) than after SE alone (30%). Cause-specific survi val at 15 years was reduced after treatment with SE alone (51%), compa red with TE (88%) or SE+RT (86%) (p = 0.0003). Recurrence after primar y treatment portended decreased survival, independent of initial treat ment group or salvage treatment selection (p = 0.001). Atypical pathol ogic features predicted reduced 15-year local control (54 vs. 71%) and cause-specific survival rates (57 vs. 86%). Multivariate analysis for cause-specific survival revealed treatment group (SE vs. others; p = 0.0001),pathologic features (atypical vs. typical; p = 0.0056), and Ka rnofsky performance status (greater than or equal to 80 vs. <80; p = 0 .0153) as significant variables. Conclusion: Benign meningiomas are we ll managed by TE or SE+RT. SE alone is inadequate therapy and adversel y affects cause-specific survival. Atypical pathologic features predic t a poorer outcome, suggesting possible benefit from more aggressive t reatment. Because local recurrence portends lower survival rates, prim ary treatment choice is important. (C) 1997 Elsevier Science Inc.