World Health Organization grade 3 meningioma treatment [Neurosurgery Wiki]

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====== World Health Organization grade 3 meningioma treatment ======

see also [[Anaplastic meningioma treatment]].
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From the available data, surgical resection followed by RT and salvage therapy can lead to extended survival
((Rosenberg LA, Prayson RA, Lee J, Reddy C, Chao ST, Barnett GH, Vogelbaum MA, Suh JH. Long-term experience with World Health Organization grade III (malignant) meningiomas at a single institution. Int J Radiat Oncol Biol Phys. 2009 Jun 1;74(2):427-32. doi: 10.1016/j.ijrobp.2008.08.018. PMID: 19427553.)).

===== Adjuvant radiotherapy and stereotactic radiosurgery =====

For a systematic review, studies analyzing the effectiveness of [[adjuvant]] [[radiotherapy]] and [[stereotactic radiosurgery]] in grade 3 (gr. 3) meningioma were reviewed. Thirty studies met the [[inclusion criteria]] for qualitative synthesis, and 6 studies were assessed in quantitative analysis. In quantitative analysis, the weighted average of [[hazard ratio]]s for adjuvant RT in [[univariate]] analyses of [[overall survival]] (OS) was 0.55 (CI: 0.41; 0.69). The median 5-year OS after adjuvant RT in gr. 3 meningiomas were 56.3%, and the median OS ranged from 24 to 80 months for patients treated with adjuvant RT versus 13 to 41.2 months in patients not treated. For [[stereotactic radiosurgery]], the 3-year [[progression-free survival]] was 0% in one study and 57% in another. The 2-year OS ranged from 25 to 75% in 2 studies. The quality of [[evidence]] was rated as "very low" in 14 studies analyzed, and considerable allocation [[bias]] was detected. Treatment [[toxicity]] was reported in 47% of the studies. The severity, according to the [[CTCAE]], ranged from grades I-V and 5.3 to 100% of patients experiencing complications. Adjuvant RT is usually considered the standard of care for WHO grade 3 meningiomas, although supporting evidence was of low quality. Better evidence from registries and prospective trials can improve the evidence base for adjuvant [[fractionated radiotherapy]] in [[malignant meningioma]]s
((Bergner A, Maier AD, Mirian C, Mathiesen TI. Adjuvant radiotherapy and stereotactic radiosurgery in grade 3 meningiomas - a systematic review and meta-analysis. Neurosurg Rev. 2022 May 11. doi: 10.1007/s10143-022-01773-9. Epub ahead of print. PMID: 35543810.)).