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J Neurooncol (2015) 121:17 DOI 10.1007/s11060-014-1620-1
TOPIC REVIEW
Atypical meningoma: current management dilemmas and prospective clinical trials
Michael D. Jenkinson Damien C. Weber
Brian J. Haylock Conor L. Mallucci
Rasheed Zakaria Mohsen Javadpour
Received: 7 May 2014 / Accepted: 21 September 2014 / Published online: 26 September 2014 Springer Science+Business Media New York 2014
Abstract Atypical meningioma is an intermediate grade tumour with a greater risk of recurrence following surgical resection. Changes to the WHO classication have resulted in an increased reporting of these tumours. The role of early adjuvant radiotherapy after gross total resection has not been clearly dened and the literature evidence is of poor quality providing conicting information. This review assesses the evidence for current clinical practice, management dilemmas and the need for prospective clinical trials for atypical meningioma.
M. D. Jenkinson R. Zakaria
Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
M. D. Jenkinson (&) C. L. Mallucci
Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UKe-mail: [email protected]
D. C. WeberCenter for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerlande-mail: [email protected]
D. C. WeberUniversity of Bern, Bern, Switzerland
B. J. HaylockDepartment of Radiation Oncology, Clatterbridge Cancer Centre, Wirral 63 4YJ, UK
C. L. MallucciDepartment of Paediatric Neurosurgery, Alder Hey Childrens Hospital, Liverpool L12 2AP, UK
M. JavadpourDepartment of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
Keywords Atypical meningioma Surgery
Radiotherapy Trials
Introduction
Meningiomas arise from the arachnoid cap cells attached to the inner layer of the dura mater and account for 2533 % of all primary brain tumours in adults [1]. The 2007 WHO classication describes 15 histopathological subtypes and three different histological grades [2]. WHO grade I meningiomas are generally well-circumscribed, slow growing tumours with a low risk of recurrence (*10 % at 5 years) [2]. Atypical meningiomas are WHO grade II tumours that exhibit increased mitotic activity and have a higher recurrence rate (up to 40 % at 5 years) [36] and shorter survival times. Anaplastic meningiomas are WHO grade III that display frank features of malignancy, inevitably recur (5 year progression free survival (PFS) is only *10 % [7]), and are incurable. The primary treatment for symptomatic and enlarging meningioma is craniotomy and surgical excision aiming for gross total resection, however...