Atypical Meningioma: Referral Patterns, Treatment and Adherence to Guidelines

• Published in: Canadian journal of neurological sciences 2017-05, Vol.44 (3), p.283-287
• Main Authors: Alghamdi, Majed, Li, Haocheng, Olivotto, Ivo, Easaw, Jay, Kelly, John, Nordal, Robert, Lim, Gerald
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alberta - epidemiology; Brain cancer; Female; Females; Follow-Up Studies; Guideline Adherence - standards; Humans; Male; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - mortality; Meningeal Neoplasms - therapy; Meningioma - diagnosis; Meningioma - mortality; Meningioma - therapy; Middle Aged; Multivariate analysis; Nervous system; Original Articles; Patients; Postoperative Care - methods; Postoperative Care - mortality; Postoperative Care - standards; Practice Guidelines as Topic - standards; Radiation Oncologists - standards; Radiation therapy; Referral and Consultation - standards; Retrospective Studies; Surgery; Survival Rate - trends; Treatment Outcome; Tumors
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2016.449

Objective: To determine the referral rate to radiation oncologist (RO), use of postoperative radiotherapy (PORT) and the impact of a clinical practice guideline (CPG) on patients with atypical meningioma (AM). Methods: A retrospective review of meningioma patients (n=526) treated between 2003 and 2013 was undertaken. Patients’ characteristics, extent of surgical resection (EOR), RO referral, PORT, date and treatment of first recurrence were collected for all patients >18 years with a new diagnosis of AM after surgical resection (n=83). Progression free survival (PFS) and overall survival (OS) according to EOR were assessed by the Log-Rank test of Kaplan-Meier survival. Results: Median age was 57 years. EOR was gross total (GTR) in 44 patients, subtotal (STR) in 36 patients and 3 patients had unknown EOR. RO referral rate was 26.5% (n=22); 5 patients initially had GTR and 17 had STR. Only 7 patients received PORT. At a median follow up time of 29 months, recurrences occurred in 28 patients, 4 had GTR, 21 had STR and 3 had an unknown EOR. With PORT, 2 patients developed recurrence. 5-year PFS was 62% after GTR and 33% after STR (P=0.002). 5-year OS was 92% after GTR and 83% after STR (P=0.45). Conclusion: In this cohort with AM, RO referral rate was low and was not influenced by the CPG. Use of PORT was also low. Given the lack of conclusive evidence supporting PORT in such patients, a multidisciplinary approach, including RO consultation, is needed to provide patients with optimal and individualised care. Méningiome atypique : tendances d’orientation et de traitement, et application des lignes directrices. Objectif: Le but de l’étude était de déterminer le taux d’orientation à un radio-oncologue (RO), l’utilisation de la radiothérapie postopératoire (RTPO) et l’impact d’une ligne directrice de pratique clinique (LDPC) sur les patients atteints d’un méningiome atypique (MA). Méthodologie: Nous avons procédé à une revue rétrospective des dossiers des patients atteints d’un méningiome (n=526) traités entre 2003 et 2013. Nous avons recueilli les caractéristiques des patients, l’ampleur de la résection chirurgicale (ARC), l’orientation vers un RO, la RTPO, la date et le traitement de la première récidive pour tous les patients de plus de 18 ans chez qui un nouveau diagnostic de MA avait été posé après la résection chirurgicale (n=83). Nous avons évalué la survie sans progression (SSP) et la survie globale (SG) selon l’ARC au moyen du test de Kaplan-Meier de l’ég