Meningioma Recurrences: Risk Factors and Management

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 2053

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Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy
Interests: neurosurgery; neuro-oncology; neuropathology
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Guest Editor
Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
Interests: neuropathology; neuro-oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Intracranial meningiomas often recur even after gross total resection with or without adjuvant radiotherapy, with a rate ranging from 10 to 32 % at 10 years. The main risk factors include the WHO grade, the proliferation index ki-67, MIB 1, the extent of resection according to the Simpson classification and the postoperative adjuvant treatments. Other investigated factors are patient age and sex, tumor size and morphology, brain invasion.

The molecular biology of meningiomas has increasingly been studied in the last 15 years. Some molecular markers have been investigated, including NF-2, TRAF 7, SMO,POLR2A and TERT. They were found to be correlated with meningeal development and tumor location, tumor histological subtype, meningioma growth and aggressiveness.

The time of recurrence is rather variable. Although most recurrences occur within 5–7 years after the initial surgery, some meningiomas may recur even after more than 10 years. No gross total resection and high values of Ki-67 MIB-1 are predicting factors of shorter recurrences; these cases need a closer short-term clinical and radiological follow-up in the first few years after the operation.

Meningiomas may recur with different growth patterns. Most recur at the previous dural site or/and at its periphery, within 2 cm (local–peripheral); however, multi centric and diffuse recurrences may sometimes be observed. Flat-shaped tumor morphology with dural infiltration and high KI-67 and MIB 1 values at initial diagnosis are risk factors of diffuse regrowth.

The management of meningioma recurrences is often challenging. Gross total resection must be realized when possible, while preserving the neurological function. However, this is often hindered by several anatomical conditions, such as diffuse patterns of regrowth, loss of the brain tumor interface, extensive dural invasion and bone invasion in basal meningiomas.

Thus, the resection is often partial. Adjuvant radiotherapy is mandatory, if not already performed after the initial surgery.

Prof. Dr. Francesco Maiuri
Dr. Marialaura Del Basso De Caro
Guest Editors

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Keywords

  • meningioma
  • recurrences
  • risk factors

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Published Papers (2 papers)

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17 pages, 675 KB  
Systematic Review
Stereotactic Radiosurgery for Recurrent Meningioma: A Systematic Review of Risk Factors and Management Approaches
by Yuka Mizutani, Yusuke S. Hori, Paul M. Harary, Fred C. Lam, Deyaaldeen Abu Reesh, Sara C. Emrich, Louisa Ustrzynski, Armine Tayag, David J. Park and Steven D. Chang
Cancers 2025, 17(17), 2750; https://doi.org/10.3390/cancers17172750 - 23 Aug 2025
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Abstract
Background/Objectives: Recurrent meningiomas remain difficult to manage due to the absence of effective systemic therapies and comparatively high treatment failure rates, particularly in high-grade tumors. Stereotactic radiosurgery (SRS) offers a minimally-invasive and precise option, particularly for tumors in surgically complex locations. However, [...] Read more.
Background/Objectives: Recurrent meningiomas remain difficult to manage due to the absence of effective systemic therapies and comparatively high treatment failure rates, particularly in high-grade tumors. Stereotactic radiosurgery (SRS) offers a minimally-invasive and precise option, particularly for tumors in surgically complex locations. However, the risks associated with re-irradiation, and recent changes in the WHO classification of CNS tumors highlight the need for more personalized and strategic treatment approaches. This systematic review evaluates the safety, efficacy, and clinical considerations for use of SRS for recurrent meningiomas. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted using the PubMed, Scopus, and Web of Science databases for studies reporting outcomes of SRS in recurrent, pathologically confirmed intracranial meningiomas. Studies were excluded if they were commentaries, reviews, case reports with fewer than three cases, or had inaccessible full text. The quality and risk of bias of the included studies were assessed using the modified Newcastle-Ottawa Scale. Data on patient and tumor characteristics, SRS treatment parameters, clinical outcomes, adverse effects, and statistical analysis results were extracted. Results: Sixteen studies were included. For WHO Grade I tumors, 3- to 5-year progression-free survival (PFS) ranged from 85% to 100%. Grade II meningiomas demonstrated more variable outcomes, with 3-year PFS ranging from 23% to 100%. Grade III tumors had consistently poorer outcomes, with reported 1-year and 2-year PFS rates as low as 0% and 46%, respectively. SRS performed after surgery alone was associated with superior outcomes, with local control rates of 79% to 100% and 5-year PFS ranging from 40.4% to 91%. In contrast, tumors previously treated with radiotherapy, with or without surgery, showed substantially poorer outcomes, with 3- to 5-year PFS ranging from 26% to 41% and local control rates as low as 31%. Among patients with prior radiotherapy, outcomes were particularly poor in Grade II and III recurrent tumors. Toxicity rates ranged from 3.7% to 37%, and were generally higher for patients with prior radiation. Predictors of worse PFS included prior radiation, older age, and Grade III histology. Conclusions: SRS may represent a reasonable salvage option for carefully selected patients with recurrent meningioma, particularly following surgery alone. Outcomes were notably worse in high-grade recurrent meningiomas following prior radiotherapy, emphasizing the prognostic significance of both histological grade and treatment history. Notably, the lack of molecular and genetic data in most existing studies represents a key limitation in the current literature. Future prospective studies incorporating molecular profiling may improve risk stratification and support more personalized treatment strategies. Full article
(This article belongs to the Special Issue Meningioma Recurrences: Risk Factors and Management)
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17 pages, 2028 KB  
Systematic Review
The Role of Simpson Grading System in Spinal Meningioma Surgery: Institutional Case Series, Systematic Review and Meta-Analysis
by Giuseppe Corazzelli, Sergio Corvino, Valentina Cioffi, Ciro Mastantuoni, Maria Rosaria Scala, Salvatore Di Colandrea, Luigi Sigona, Antonio Bocchetti and Raffaele de Falco
Cancers 2025, 17(1), 34; https://doi.org/10.3390/cancers17010034 - 26 Dec 2024
Cited by 3 | Viewed by 1341
Abstract
Background: Although its validity has recently been questioned since its introduction, the Simpson grade has remained one of the most relevant factors in estimating the recurrence risk of intracranial meningiomas. This study aims to assess its role in spinal meningiomas through a retrospective [...] Read more.
Background: Although its validity has recently been questioned since its introduction, the Simpson grade has remained one of the most relevant factors in estimating the recurrence risk of intracranial meningiomas. This study aims to assess its role in spinal meningiomas through a retrospective analysis of a mono-institutional surgical series and literature meta-analysis. Methods: We conducted a systematic review and meta-analysis of the literature from 1980 to 2023, complemented by a mono-institutional series of 74 patients treated at “Santa Maria delle Grazie” hospital. Demographic, clinical, neuroradiological, pathological, surgical, and outcome data of case series were analyzed. For the meta-analysis, studies were selected based on predefined inclusion criteria, and a fixed-effects model was used to synthesize data due to assumed homogeneity among included studies. Statistical analyses included odds ratios (OR) for recurrence risk and assessment of publication bias using Peter’s test. Results: Mono-institutional sample included 74 patients, most of whom were women (85%) with a median age of 61.9 years. The thoracic spine was the most common tumor location (81%). Recurrences occurred in patients with Simpson grade II and III resections. The meta-analysis involved 2142 patients from 25 studies and revealed a significantly higher recurrence rate for Simpson grades III–V compared to grades I–II (OR 0.10; CI95 0.06–0.16). Additionally, Simpson grade II had a higher recurrence risk than grade I (OR 0.42; CI95 0.20–0.90). Conclusions: The Simpson grading remains a valid predictor of recurrence also for spinal meningiomas. Our findings revealed a significant increase in recurrence rate with higher Simpson grades. These results support the need to strive for Simpson grade I resection when feasible. Full article
(This article belongs to the Special Issue Meningioma Recurrences: Risk Factors and Management)
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