Third Recurrent World Health Organization 1 Spinal Meningiomas: Case Series and Clinical Outcomes Following Surgery or Definitive Radiotherapy

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-02-19 DOI:10.1016/j.wneu.2025.123704

Ory Haisraely, Marcia Jaffe, Alicia Taliansky, Yaakov Richard Lawerence

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引用次数: 0

Abstract

Background

Spinal meningiomas (SMs) are rare, predominantly benign tumors that account for 1.2%–12.7% of all meningiomas. While surgical resection is the primary treatment, recurrence occurs in a subset of patients, necessitating subsequent therapies such as reoperation or definitive radiation therapy (RT). This study evaluates the outcomes of definitive RT versus third surgery for recurrent World Health Organization (WHO) grade 1 SM, focusing on progression-free survival (PFS) and treatment-related toxicities.

Methods

A retrospective review of 48 patients with third progression of WHO grade 1 SM was conducted between 2008 and 2021. Inclusion criteria required prior second surgery and a confirmed pathology of WHO grade 1. Patients who received RT after earlier surgeries or whose pathology upgraded to WHO grade 2 or 3 were excluded. Data on demographics, tumor characteristics, surgical outcomes, and RT parameters were analyzed. PFS was assessed using Kaplan-Meier survival analysis, and treatment-related toxicities were recorded.

Results

Of the 48 patients, 31 underwent third surgery and 17 received definitive RT (median dose: 54 Gy in 30 fractions). Median follow-up was 30 months. PFS at 36 months was comparable between surgery (77.4%) and RT (76.4%). Tumor size was larger in the surgery group (median 1.8 cm vs. 1 cm, P < 0.001). Neurological improvements were noted in 79.1% of surgery patients and 58.3% of RT patients. RT offered superior pain control, with no cases of radiation myelopathy observed.

Conclusions

Definitive RT appears to be a feasible alternative to third surgery for recurrent SM in selected patients, providing comparable PFS and manageable toxicities. Larger prospective studies are needed to validate these findings and refine treatment approaches for recurrent SM.

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS