Central Nervous System

PV QA 2 - Poster Viewing Q&A 2

MO_3_2530 - Atypical histopathological features and the risk of progression/recurrence in WHO grade I-II meningiomas

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Atypical histopathological features and the risk of progression/recurrence in WHO grade I-II meningiomas
W. Hwang1, N. Lamba2, D. W. Kim2, A. E. Marciscano3, A. O. Stemmer-Rachamimov4, W. Curry5, F. G. Barker II5, R. L. Martuza5, S. Santagata6, I. F. Dunn7, E. B. Claus8, W. L. Bi9, A. A. Aizer10, B. Alexander10, K. S. Oh5, J. S. Loeffler11, and H. A. Shih12; 1Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, MA, 2Harvard Medical School, Boston, MA, 3Johns Hopkins University School of Medicine, Baltimore, MD, 4Department of Pathology, Massachusetts General Hospital, Boston, MA, 5Massachusetts General Hospital, Boston, MA, 6Brigham & Women's Hospital, Boston, MA, 7Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 8Yale University School of Public Health, New Haven, CT, 9Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, 10Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, 11Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 12Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Purpose/Objective(s): Given the overlap in clinical behavior of meningiomas with different histopathological grades, additional information is needed for optimal risk stratification. The WHO defines five atypical histopathological features: high nuclear to cytoplasmic ratio, increased cellularity, sheeting, prominent nucleoli, and necrosis. Per the 2016 classification, WHO grade I meningiomas may have 0-2 atypical features while 3 or more atypical features characterizes WHO grade II meningiomas. For grade I meningiomas, we previously demonstrated that the presence of 1-2 atypical features and non-Simpson grade I resection were independently predictive of progression/recurrence (P/R) after treatment. The purpose of this study was to determine whether the prognostic value of atypical features and non-Simpson grade I resection extends across all non-malignant meningiomas (grade I-II).

Materials/Methods: Individual data from 266 consecutive patients with WHO grade I (n = 221) and grade II (n = 45) meningiomas who underwent surgical resection between 2001 and 2015 at two academic centers and had a minimum follow-up period of one year were pooled. P/R was defined radiographically and time to P/R was measured from the date of surgery.

Results: Median follow-up was 61 months. Approximately 6% of grade 1 patients and 48% of grade 2 patients received adjuvant radiotherapy. Patients were stratified by number of atypical features: 0 (n = 90), 1 (n = 72), 2 (n = 68), 3 (n = 17), and 4-5 (n = 19). The risk of P/R increased with the number of atypical features (log-rank test: p = 0.004). The 9-yr estimated freedom from P/R (FFPR) based on number of atypical features were: 0 (78% [95% CI, 62%-88%]), 1 (73% [95% CI, 53%-86%]), 2 (63% [95% CI, 40%-79%]), 3 (56% [95% CI, 18-82%]), and 4-5 (38% [95% CI, 14-62%]). On multivariate analysis, both the number of atypical features (HR 1.30 [95% CI, 1.06-1.60]; p = 0.01) and non-Simpson grade I resection (HR 8.02 [95% CI, 3.18-20.2]; p < 0.0005) were associated with increased risk of P/R. In patients without any atypical features who underwent Simpson grade I resection, the 9-yr FFPR was 97% [95% CI, 79%-99.5%]. In contrast, for patients with 4-5 atypical features who underwent non-Simpson grade I resection, the 9-yr FFPR was 22% [95% CI, 3.6%-49%].

Conclusion: A greater number of atypical features and non-Simpson grade I resection were independently associated with progression/recurrence of WHO grade I-II meningiomas. Patients with these features may benefit from intensified therapy.

Author Disclosure: W. Hwang: None. A.E. Marciscano: None. A.O. Stemmer-Rachamimov: None. F.G. Barker II: None. R.L. Martuza: None. I.F. Dunn: None. E.B. Claus: None. W.L. Bi: None. B. Alexander: Research Grant; Celgene, Puma, Eli Lilly. Consultant; Bristol-Myers Squibb. K.S. Oh: Research Grant; Elekta, Merck & Co., Inc. CME editor; IJROBP. J.S. Loeffler: None. H.A. Shih: Employee; Dartmouth Hitchcock. Honoraria; UpToDate. Chief, CNS & Eye Radiat Oncol Services; Massachusetts General Hospital. Associate Medical Director; MGH Proton Therapy Center. Associate Director; Harvard Radiation Oncology Program.

William Hwang, MD, PhD

Massachusetts General Hospital

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