Abstract
BACKGROUND: Malignant meningiomas (WHO Grade III) are rare, aggressive tumors with poor prognosis and high recurrence rates. Gross total resection (GTR) is the preferred treatment; however, recurrence remains a challenge, especially after subtotal resection (STR). The role of adjuvant radiotherapy (RT) and chemotherapy in improving patient outcomes remains controversial. This systematic review and meta-analysis assessed the impact of surgical extent, adjuvant therapies, and prognostic factors on survival and recurrence of malignant meningiomas. METHODS: A systematic review and meta-analysis were conducted using the PubMed, Cochrane Library, and Scopus databases. Eligible studies included retrospective and prospective cohorts, case-control studies, and clinical trials reporting the surgical extent (GTR vs. STR), adjuvant therapy, survival, and recurrence. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane Risk of Bias Tool. Meta-analysis was performed using random- and fixed-effects models and heterogeneity was assessed using the I² statistic. RESULTS: Sixteen studies (2,208 patients) met the inclusion criteria. The 5-year overall survival (OS) ranged from 40% to 90%, with GTR significantly improving survival (HR = 0.54, 95% CI: 0.50-0.58, p < 0.00001) [1]. Recurrence rates were lower in GTR cases (50-90% in STR). Adjuvant RT improved progression-free survival (HR = 0.36, 95% CI: 0.18-0.70) in STR patients, but its benefit post-GTR was unclear. Chemotherapy had no significant effect on patient survival [2]. Key prognostic factors included tumor location, patient age, Ki-67 index, and histology [3, 4]. CONCLUSION: GTR is the strongest predictor of long-term survival, whereas STR requires adjuvant RT for disease control. The role of chemotherapy remains uncertain, necessitating further research into targeted therapies. Standardized treatment protocols and long-term surveillance are essential to improve patient outcomes [5].