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Ho CH, Shieh LT, Lin CH, Guo HR, Ho YC, Ho SY. The role of adjuvant radiotherapy for intracranial malignant meningiomas: analysis of a nationwide database. J Neurooncol 2024:10.1007/s11060-024-04720-4. [PMID: 38814405 DOI: 10.1007/s11060-024-04720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE This study aimed to examine the effect of postoperative radiotherapy on survival outcomes in patients with malignant meningiomas. METHODS We identified patients with malignant meningioma diagnosed between 2007 and 2018 using the Taiwan Cancer Registry and followed them up using the death registry. Survival was compared between patients with and without adjuvant radiotherapy. The potential confounding factors evaluated in this study included age, sex, comorbidities, and the Charlson Comorbidity Index (CCI). RESULTS The analysis included 204 patients; 94 (46%) received adjuvant radiotherapy. The two groups had similar sex distributions (p = 0.53), mean age (p = 0.33), histologic subtype (p = 0.13), and CCI (p = 0.62). The prognosis of malignant meningioma was poor, with a median overall survival (OS) of 2.4 years. The median OS was 3.0 years (interquartile range (IQR) [1.4-6.1], and 2.0 years (IQR [0.5-3.9]) in the radiotherapy and non-radiotherapy groups, respectively (p = 0.001). However, Kaplan-Meier curves with the log-rank test showed no significant difference in OS between the two groups (p = 0.999). Controlling for age group, sex, histologic subtype, treatment, comorbidities, and CCI, adjuvant radiotherapy did not impart a survival benefit (hazard ratio [HR] = 0.87; 95% confidence interval [CI]: 0.6‒1.26); however, only factor of higher comorbidity score (HR = 2.03, 95%CI: 1.04‒3.94) was associated with unfavorable survival. CONCLUSION This population-based retrospective analysis suggests that the role of radiotherapy remains unclear and underscores the need for randomized clinical trials to assess the usefulness of adjuvant radiotherapy in malignant meningioma.
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Affiliation(s)
- Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan , Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan , Taiwan
| | - Li-Tsun Shieh
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, 71004, Taiwan
| | - Chia-Hui Lin
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Chia Ho
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Sheng-Yow Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan.
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2
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Li C, Qin J, Xue F, Shen Z, Lin Q, Xue Y, Chen X. Rethinking the effects of adjuvant beam radiation therapy on overall survival in atypical meningioma patients: age considerations. Front Neurol 2024; 15:1360741. [PMID: 38560728 PMCID: PMC10978650 DOI: 10.3389/fneur.2024.1360741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background This study aimed to investigate the effects of adjuvant beam radiation therapy (ABRT) on overall survival (OS) in patients with primary single intracranial atypical meningioma (AM), with a focus on age-related outcomes. Methods We conducted a retrospective study using data from SEER database. Our cohort consisted of patients diagnosed with a primary single intracranial AM tumor and had undergone surgery. The primary endpoint was OS. For survival analysis, univariable and multivariable Cox regression analysis were performed. A multivariable additive Cox model was used to assess the functional relationship between age and OS in patients with or without ABRT. Results Of the 2,759 patients included, 1,650 underwent gross total resection and 833 received ABRT. Multivariable Cox analysis indicated that ABRT did not significantly influence OS across the entire cohort. According to the multivariable generalized additive Cox model, the relative risk of all-cause mortality increased with advancing age in both ABRT-yes and ABRT-no group. ABRT-yes had a lower relative risk than ABRT-no when age ≤ 55 years old while a higher relative risk when age > 55 years old. Subsequent multivariable Cox analysis showed that ABRT was associated with a significant lower risk for all-cause mortality in patients with age ≤ 55 years old while a significant higher risk in patients with age > 55 years old. Conclusion Our study found that ABRT enhanced OS in younger primary single intracranial AM patients. But we also revealed a negative correlation between OS and ABRT in older patients.
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Affiliation(s)
- Chao Li
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajun Qin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Xue
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhaoli Shen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Lin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yajun Xue
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianzhen Chen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
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3
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Früh A, Bodnar B, Nachbar M, Gradhand J, Kalinauskaite G, Rubarth K, Truckenmueller P, Kaul D, Zips D, Vajkoczy P, Senger C, Acker G. Robotic stereotactic radiosurgery for intracranial meningiomas in elderly patients: assessment of treatment efficacy and safety. Front Oncol 2024; 14:1329696. [PMID: 38347835 PMCID: PMC10860398 DOI: 10.3389/fonc.2024.1329696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) has been increasingly used to treat intracranial pathologies in elderly patients. The treatment efficiency of SRS has been demonstrated in meningiomas, with excellent local control. We aimed to analyze the safety of robotic SRS in elderly patients with meningiomas. Methods We searched for patients with suspected WHO °I meningioma ≥ 60 years old, who underwent CyberKnife (CK) SRS from January 2011 to December 2021. Tumor localization was categorized using the "CLASS" algorithmic scale. Tumor response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria for meningiomas. Adverse effects were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and a cox regression was performed to investigate possible predictors. Results We identified 82 patients with 102 CK-treated lesions that matched the criteria for the first SRS. The median age was 70 [IQR 64-75] years, and 24.3% of the patients were aged > 75 years. Multiple lesions (up to six) were treated in 14.1% of the SRS-sessions. A previous surgery was performed in 57.3% of lesions, with a median time interval of 41 [IQR 10 - 58] months between the initial surgical procedure and the SRS treatment. In 47.9% of cases, CLASS 3 meningiomas at high-risk locations were irradiated. Single fraction radiosurgery was applied to 62.5% of the lesions, while in the remaining cases multi-session SRS with three to five fractions was used. During the median follow-up period of 15.9 months, lesion size progression was observed in 3 cases. Karnofsky Performance Status (KPS) declined by ≥ 20 points in four patients. Adverse effects occurred in 13 patients, while only four patients had CTCAE ≥2 toxicities. Hereby only one of these toxicities was persistent. The occurrence of complications was independent of age, planned target volume (PTV), high-risk localization, and surgery before SRS. Conclusion The data indicates that SRS is a safe, efficient, and convenient treatment modality for elderly patients with meningioma, even at high-risk locations.
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Affiliation(s)
- Anton Früh
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health Biomedical Innovation Academy, Berlin, Germany
| | - Bohdan Bodnar
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcel Nachbar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julia Gradhand
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kerstin Rubarth
- Insitute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Insitute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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4
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Cello G, Patel RV, McMahon JT, Santagata S, Bi WL. Impact of H3K27 trimethylation loss in meningiomas: a meta-analysis. Acta Neuropathol Commun 2023; 11:122. [PMID: 37491289 PMCID: PMC10369842 DOI: 10.1186/s40478-023-01615-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
Trimethylation of lysine 27 on histone 3 (H3K27me3) loss has been implicated in worse prognoses for patients with meningiomas. However, there have been challenges in measuring H3K27me3 loss, quantifying its impact, and interpreting its clinical utility. We conducted a systematic review across Pubmed, Embase, and Web of Science to identify studies examining H3K27me3 loss in meningioma. Clinical, histopathological, and immunohistochemistry (IHC) characteristics were aggregated. A meta-analysis was performed using a random-effects model to assess prevalence of H3K27me3 loss and meningioma recurrence risk. Study bias was characterized using the NIH Quality Assessment Tool and funnel plots. Nine publications met inclusion criteria with a total of 2376 meningioma cases. The prevalence of H3K27me3 loss was 16% (95% CI 0.09-0.27), with higher grade tumors associated with a significantly greater proportion of loss. H3K27me3 loss was more common in patients who were male, had recurrent meningiomas, or required adjuvant radiation therapy. Patients were 1.70 times more likely to have tumor recurrence with H3K27me3 loss (95% CI 1.35-2.15). The prevalence of H3K27me3 loss in WHO grade 2 and 3 meningiomas was found to be significantly greater in tissue samples less than five years old versus tissue of all ages and when a broader definition of IHC staining loss was applied. This analysis demonstrates that H3K27me3 loss significantly associates with more aggressive meningiomas. While differences in IHC and tumor tissue age have led to heterogeneity in studying H3K27me3 loss, a robust prognostic signal is present. Our findings suggest an opportunity to improve study design and standardize tissue processing to optimize clinical viability of this epigenetic marker.
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Affiliation(s)
- Gregory Cello
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruchit V Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James Tanner McMahon
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sandro Santagata
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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5
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Patel RV, Yao S, Huang RY, Bi WL. Application of radiomics to meningiomas: A systematic review. Neuro Oncol 2023; 25:1166-1176. [PMID: 36723606 PMCID: PMC10237421 DOI: 10.1093/neuonc/noad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quantitative imaging analysis through radiomics is a powerful technology to non-invasively assess molecular correlates and guide clinical decision-making. There has been growing interest in image-based phenotyping for meningiomas given the complexities in management. METHODS We systematically reviewed meningioma radiomics analyses published in PubMed, Embase, and Web of Science until December 20, 2021. We compiled performance data and assessed publication quality using the radiomics quality score (RQS). RESULTS A total of 170 publications were grouped into 5 categories of radiomics applications to meningiomas: Tumor detection and segmentation (21%), classification across neurologic diseases (54%), grading (14%), feature correlation (3%), and prognostication (8%). A majority focused on technical model development (73%) versus clinical applications (27%), with increasing adoption of deep learning. Studies utilized either private institutional (50%) or public (49%) datasets, with only 68% using a validation dataset. For detection and segmentation, radiomic models had a mean accuracy of 93.1 ± 8.1% and a dice coefficient of 88.8 ± 7.9%. Meningioma classification had a mean accuracy of 95.2 ± 4.0%. Tumor grading had a mean area-under-the-curve (AUC) of 0.85 ± 0.08. Correlation with meningioma biological features had a mean AUC of 0.89 ± 0.07. Prognostication of the clinical course had a mean AUC of 0.83 ± 0.08. While clinical studies had a higher mean RQS compared to technical studies, quality was low overall with a mean RQS of 6.7 ± 5.9 (possible range -8 to 36). CONCLUSIONS There has been global growth in meningioma radiomics, driven by data accessibility and novel computational methodology. Translatability toward complex tasks such as prognostication requires studies that improve quality, develop comprehensive patient datasets, and engage in prospective trials.
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Affiliation(s)
- Ruchit V Patel
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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6
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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; 45:2639-2658. [PMID: 35543810 DOI: 10.1007/s10143-022-01773-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
Malignant meningioma is a rare, aggressive form of meningioma. Radiation is commonly included in treatment guidelines either as adjuvant radiotherapy (RT) or stereotactic radiosurgery (SRS). Nevertheless, the treatment recommendations are not supported by prospective comparative trials and systematical, critical evaluation of supportive evidence is lacking. For this systematic review, studies analyzing the effectiveness of adjuvant RT and SRS 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 ratios 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 was 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 SRS, 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 experienced complications. Adjuvant RT is usually considered 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 RT in malignant meningiomas.
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Affiliation(s)
- Amon Bergner
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Mirian
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tiit Illimar Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen, Denmark.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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7
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Millesi M, Ryba AS, Hainfellner JA, Roetzer T, Berghoff AS, Preusser M, Heller G, Tomasich E, Sahm F, Roessler K, Wolfsberger S. DNA Methylation Associates With Clinical Courses of Atypical Meningiomas: A Matched Case-Control Study. Front Oncol 2022; 12:811729. [PMID: 35356207 PMCID: PMC8959647 DOI: 10.3389/fonc.2022.811729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023] Open
Abstract
Background Accounting for 15–20% of all meningiomas, WHO grade II meningiomas represent an intermediate group regarding risk of tumor recurrence. However, even within this subgroup varying clinical courses are observed with potential occurrence of multiple recurrences. Recently, DNA methylation profiles showed their value for distinguishing biological behaviors in meningiomas. Therefore, aim of this study was to investigate DNA methylation profiles in WHO grade II meningiomas. Methods All patients that underwent resection of WHO grade II meningiomas between 1993 and 2015 were screened for a dismal course clinical course with ≥2 recurrences. These were matched to control cases with benign clinical courses without tumor recurrence. DNA methylation was assessed using the Infinium Methylation EPIC BeadChip microarray. Unsupervised hierarchical clustering was performed for identification of DNA methylation profiles associated with such a dismal clinical course. Results Overall, 11 patients with WHO grade II meningiomas with ≥2 recurrences (Group dismal) and matched 11 patients without tumor recurrence (Group benign) were identified. DNA methylation profiles revealed 3 clusters—one comprising only patients of group dismal, a second cluster comprising mainly patients from group benign and a third cluster comprising one group dismal and one group benign patient. Based on differential methylation pattern associations with the Wnt and the related cadherin signaling pathway was observed. Conclusion DNA methylation clustering showed remarkable differences between two matched subgroups of WHO grade II meningiomas. Thus, DNA methylation profiles may have the potential to support prognostic considerations regarding meningioma recurrence and radiotherapeutic treatment allocation after surgical resection.
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Affiliation(s)
- Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
| | - Alice Senta Ryba
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Roetzer
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit (CCU), German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Unit, Medical University of Vienna, Vienna, Austria
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Radiation therapy for atypical and anaplastic meningiomas: an overview of current results and controversial issues. Neurosurg Rev 2022; 45:3019-3033. [PMID: 35665867 PMCID: PMC9492595 DOI: 10.1007/s10143-022-01806-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 02/03/2023]
Abstract
Meningiomas are the most common intracranial tumors. Most meningiomas are WHO grade 1 tumors whereas less than one-quarter of all meningiomas are classified as atypical (WHO grade 2) and anaplastic (WHO grade 3) tumors, based on local invasiveness and cellular features of atypia. Surgical resection remains the cornerstone of meningioma therapy and represents the definitive treatment for the majority of patients; however, grade 2 and grade 3 meningiomas display more aggressive behavior and are difficult to treat. Several retrospective series have shown the efficacy and safety of postoperative adjuvant external beam radiation therapy (RT) for patients with atypical and anaplastic meningiomas. More recently, two phase II prospective trials by the Radiation Therapy Oncology Group (RTOG 0539) and the European Organisation for Research and Treatment of Cancer (EORTC 2042) have confirmed the potential benefits of fractionated RT for patients with intermediate and high-risk meningiomas; however, several issues remain a matter of debate. Controversial topics include the timing of radiation treatment in patients with totally resected atypical meningiomas, the optimal radiation technique, dose and fractionation, and treatment planning/target delineation. Ongoing randomized trials are evaluating the efficacy of early adjuvant RT over observation in patients undergoing gross total resection.
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9
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Dissaux G, Josset S, Thillays F, Lucia F, Bourbonne V, Pradier O, Pasquier D, Biau J. Radiotherapy of benign intracranial tumours. Cancer Radiother 2021; 26:137-146. [PMID: 34953692 DOI: 10.1016/j.canrad.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We present the updated recommendations of the French Society for Radiation Oncology on benign intracranial tumours. Most of them are meningiomas, vestibular schwannomas, pituitary adenomas, craniopharyngiomas, and glomus tumours. Some grow very slowly, and can be observed without specific treatment, especially if they are asymptomatic. Symptomatic or growing tumours are treated by surgery, which is the reference treatment. When surgery is not possible, due to the location of the lesion, or general conditions, radiotherapy can be applied, as it is if there is a postoperative growing residual tumour, or a local relapse. Indications have to be discussed at a multidisciplinary panel, with precise evaluation of the benefit and risks of the treatments. The techniques to be used are the most modern ones, as multimodal imaging and image-guided radiation therapy. Stereotactic treatments, using fractionated or single doses depending on the size or the location of the tumours, are commonly realized, to avoid as much a possible the occurrence of late side effects.
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Affiliation(s)
- G Dissaux
- Département de radiothérapie, CHRU Morvan, Latim, Inserm, UMR 1101, université de Brest, Isbam, UBO, UBL, 2, avenue Foch, 29200 Brest, France.
| | - S Josset
- Service de physique médicale, Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - F Thillays
- Département de radiothérapie, Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - F Lucia
- Département de radiothérapie, CHRU Morvan, Latim, Inserm, UMR 1101, université de Brest, Isbam, UBO, UBL, 2, avenue Foch, 29200 Brest, France
| | - V Bourbonne
- Département de radiothérapie, CHRU Morvan, Latim, Inserm, UMR 1101, université de Brest, Isbam, UBO, UBL, 2, avenue Foch, 29200 Brest, France
| | - O Pradier
- Département de radiothérapie, CHRU Morvan, Latim, Inserm, UMR 1101, université de Brest, Isbam, UBO, UBL, 2, avenue Foch, 29200 Brest, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France; Centre de recherche en informatique, signal et automatique de Lille (Cristal) UMR 9189, université de Lille, 59000 Lille, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Inserm, U1240 Imost, université Clermont-Auvergne, 63011 Clermont-Ferrand, France
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Simonetti G, Silvani A, Tramacere I, Farinotti M, Legnani F, Pinzi V, Pollo B, Erbetta A, Gaviani P. Long term follow up in 183 high grade meningioma: A single institutional experience. Clin Neurol Neurosurg 2021; 207:106808. [PMID: 34293659 DOI: 10.1016/j.clineuro.2021.106808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Meningiomas are usually considered benign lesions, however a proportion of them shows a more aggressive behavior, defined high-grade meningiomas (HGM). Effective medical treatments are lacking, especially at the time of recurrence. METHODS Through a retrospective analysis, we examined epidemiological, diagnostic, therapeutic, recurrence information and survival data of HGM treated at our institution between 2010 and 2018. RESULTS 183 patients (105 females and 78 males), with median age of 58 years (25-88), were included; 168 were atypical, 12 anaplastic, 3 rhabdoid. Overall, m-PFS was 4.2 years, and m-OS was 10.3 years. Gross-total resection had a 5-year survival rate of 95% compared with subtotal/partial resection (86% and 67%) (p = 0.002). Higher expression of Ki-67/MIB-1 seems associated with higher risk of death (HR:1.06 with 95% CI, 1.00-1.12, p = 0.03). No statistically significant differences were seen in survival between the group managed with a wait-and-see strategy vs the group treated with RT while a difference on PFS was seen (4.1 years vs 5.2 years p = 0.03). After second recurrence, the most employed treatments were systemic therapies with a very limited effect on disease control. CONCLUSIONS Data confirmed the aggressive behavior of HGM. The extent of resection seems to correlate with a favorable outcome regardless histological subtypes. The role of RT remains controversial, with no statistically significant impact on OS but a possible role on PFS. Recurrent HGM remains the real challenge, to date no chemotherapies are able to achieve disease control. Future research should focus on biological/molecular predictors in order to achieve a patient-tailored treatment.
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Affiliation(s)
- G Simonetti
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy.
| | - A Silvani
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy
| | - I Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy
| | - M Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - F Legnani
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Università degli Studi, Milan, Italy
| | - V Pinzi
- Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - B Pollo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - P Gaviani
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milan, Italy
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11
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Maggio I, Franceschi E, Tosoni A, Nunno VD, Gatto L, Lodi R, Brandes AA. Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas. CNS Oncol 2021; 10:CNS72. [PMID: 34015955 PMCID: PMC8162186 DOI: 10.2217/cns-2021-0003] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Abstract
Meningiomas are the most common primary intracranial tumors. The majority of meningiomas are benign, but they can present different grades of dedifferentiation from grade I to grade III (anaplastic/malignant) that are associated with different outcomes. Radiological surveillance is a valid option for low-grade asymptomatic meningiomas. In other cases, the treatment is usually surgical, aimed at achieving a complete resection. The use of adjuvant radiotherapy is the gold standard for grade III, is debated for grade II and is not generally indicated for radically resected grade I meningiomas. The use of systemic treatments is not standardized. Here we report a review of the literature on the clinical, radiological and molecular characteristics of meningiomas, available treatment strategies and ongoing clinical trials.
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Affiliation(s)
- Ilaria Maggio
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Enrico Franceschi
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Alicia Tosoni
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Vincenzo Di Nunno
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Lidia Gatto
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Raffaele Lodi
- IRCSS Istituto di Scienze Neurologiche di Bologna, Bologna 40139, Italy
| | - Alba A Brandes
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
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12
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Schuring-Pereira M, Hagenbeek R, Mast M, Nandoe Tewarie R, van Santvoort JPC, van Duinen S, Wiggenraad R. Atypical meningioma: patterns of postradiotherapy recurrences. Br J Neurosurg 2021; 35:591-596. [PMID: 34074192 DOI: 10.1080/02688697.2021.1922606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE There is no consensus on a target definition and optimal dose in radiotherapy for atypical meningioma (AM). Insight into the postradiotherapy recurrence pattern is needed for optimal target definition and local control. The objective was to describe the patterns of recurrence after postoperative or salvage radiotherapy in patients with AM. MATERIALS AND METHODS A retrospective analysis was conducted of patients treated for intracranial AM with (fractionated) stereotactic radiotherapy (FSRT). The relationships between postradiotherapy recurrences, the dura and irradiated volume were established. Moreover, the dose prescriptions and fractionation schedules were converted to a reference to determine the relationship between dose and local control. RESULTS The included patients received 57 (F)SRT treatments and 73 surgeries. Recurrent disease was found in 21 of 29 patients (72%) and after 39 of 57 (F)SRTs (68%). The median interval to first recurrence was 39.7 months. Of these recurrences, 25 were in-field, 11 were marginal, and 3 were out of field. In-field recurrence rates after biological equivalent doses < 60 Gy or ≥ 60 Gy were 50% and 21%. All recurrences were connected to the dura. Of the marginal recurrences, 64% were within 2 cm and 91% were within 3 cm of the volume receiving the prescribed dose. CONCLUSIONS AM frequently recurs after radiotherapy. All postradiotherapy recurrences were connected to the dura. Most marginal recurrences occurred within 3 cm of the irradiated abnormal dura. The lowest rate of in-field recurrences occurred after equivalent doses of least 60 Gy in 2 Gy fractions suggesting a dose-effect relationship.
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Affiliation(s)
| | - Rogier Hagenbeek
- Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Mirjam Mast
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Rishi Nandoe Tewarie
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Jan P C van Santvoort
- Department of Medical Physics, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sjoerd van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruud Wiggenraad
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, The Netherlands
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13
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Wilson TA, Huang L, Ramanathan D, Lopez-Gonzalez M, Pillai P, De Los Reyes K, Kumal M, Boling W. Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management. Front Oncol 2020; 10:565582. [PMID: 33330036 PMCID: PMC7714950 DOI: 10.3389/fonc.2020.565582] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Although the majority of meningiomas are slow-growing and benign, atypical and anaplastic meningiomas behave aggressively with a penchant for recurrence. Standard of care includes surgical resection followed by adjuvant radiation in anaplastic and partially resected atypical meningiomas; however, the role of adjuvant radiation for incompletely resected atypical meningiomas remains debated. Despite maximum treatment, atypical, and anaplastic meningiomas have a strong proclivity for recurrence. Accumulating mutations over time, recurrent tumors behave more aggressively and often become refractory or no longer amenable to further surgical resection or radiation. Chemotherapy and other medical therapies are available as salvage treatment once standard options are exhausted; however, efficacy of these agents remains limited. This review discusses the risk factors, classification, and molecular biology of meningiomas as well as the current management strategies, novel therapeutic approaches, and future directions for managing atypical and anaplastic meningiomas.
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Affiliation(s)
| | - Lei Huang
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Promod Pillai
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Warren Boling
- Loma Linda University, Loma Linda, CA, United States
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Reddy AK, Ryoo JS, Denyer S, McGuire LS, Mehta AI. Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis. Neurosurg Focus 2020; 46:E3. [PMID: 31153148 DOI: 10.3171/2019.3.focus1971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.
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15
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Alhourani A, Aljuboori Z, Yusuf M, Woo SY, Hattab EM, Andaluz N, Williams BJ. Management trends for anaplastic meningioma with adjuvant radiotherapy and predictors of long-term survival. Neurosurg Focus 2020; 46:E4. [PMID: 31153143 DOI: 10.3171/2019.3.focus1960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to describe effects of adjuvant radiotherapy (RT) for anaplastic meningiomas (AMs) on long-term survival, and to analyze patient and RT characteristics associated with long-term survival.METHODSThe authors queried a retrospective cohort of patients with AM from the National Cancer Database (NCDB) diagnosed between 2004 and 2015 to describe treatment trends. For outcome analysis, patients with at least 10 years of follow-up were included, and they were stratified based on adjuvant RT status and propensity matched to controls for covariates. Survival curves were compared. A data-driven approach was used to find a biologically effective dose (BED) of RT with the largest difference between survival curves. Factors associated with long-term survival were quantified.RESULTSThe authors identified 2170 cases of AM in the NCDB between 2004 and 2015. They observed increased use of adjuvant RT in patients treated with higher doses. A total of 178 cases met the inclusion criteria for outcome analysis. Forty-five percent (n = 80) received adjuvant RT. Patients received a BED of 80.23 ± 16.6 Gy (mean ± IQR). The median survival time was not significantly different (32.8 months for adjuvant RT vs 38.5 months for no RT; p = 0.57, log-rank test). Dichotomizing the patients at a BED of 81 Gy showed maximal difference in survival distribution with a decrease in median survival in favor of no adjuvant RT (31.2 months for adjuvant RT vs 49.7 months for no RT; p = 0.03, log-rank test), but this difference was not significant after false discovery rate correction. Age was a significant predictor for long-term survival.CONCLUSIONSAMs are aggressive tumors that carry a poor prognosis. Conventional adjuvant RT improves local control. However, the effect of adjuvant radiation on overall survival is unclear. Further investigation into this area is warranted.
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Affiliation(s)
| | | | | | | | - Eyas M Hattab
- 3Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky
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Li Y, Lu D, Feng D, Cheng H, Huang Q, Zhao H, Chen P, Qin H, Cai Q. Management of incidental anterior skull base large and giant meningiomas in elderly patients. J Neurooncol 2020; 148:481-488. [PMID: 32529449 DOI: 10.1007/s11060-020-03484-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The incidence of meningiomas among the elderly is considered to be high, and are at increased risk of severe morbidity and mortality following surgery due to their aging physiology and unexpected comorbidities. This study aimed to evaluate the optimal management strategies of meningiomas in elderly patients. METHODS We retrospectively analyzed 150 patients with incidental large (≥ 3 cm) and giant (≥ 6 cm) anterior skull base meningiomas from 2009 to 2018. These patients were divided into elderly group (≥ 65 years, n = 70) and younger group (< 65 years, n = 80). Information of patients with regard to their medical records, operative details, relevant imaging, and follow-up data were obtained from their respective electronic medical records. RESULTS The elderly patients had significantly longer length of hospital stay (15.9 ± 3.5) compared to younger patients (13.6 ± 3.6, P < 0.001). Karnofsky Performance Scale (KPS) at discharge was significantly lower in elderly group when compared to younger group (P = 0.04). However, the KPS at 1-year after surgery was similar between the two groups. In addition, there was no significant difference in the incidence of surgical complications between the two groups. Multivariate regression analysis of postoperative complications revealed blood loss ≥ 800 mL (P = 0.007) and BMI (< 18.5 or ≥ 24, P < 0.001) as risk factors, rather than age. CONCLUSIONS Surgical resection in elderly patients with incidental anterior skull base large and giant meningiomas is considered to be a safe and effective therapeutic option owing to acceptable mortality, postoperative complications and postoperative clinical outcomes.
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Affiliation(s)
- Yuqian Li
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Dan Lu
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, 710100, Shaanxi, China
| | - Dayun Feng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Hongyu Cheng
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, Shaanxi, China
| | - Qian Huang
- College of Basic Medicine, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Haikang Zhao
- Department of Neurosurgery, The Second Hospital Affiliated of Xi'an Medical University, Xi'an, 710038, Shaanxi, China
| | - Peng Chen
- Department of Neurosurgery, The Second Hospital Affiliated of Xi'an Medical University, Xi'an, 710038, Shaanxi, China
| | - Huaizhou Qin
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Qing Cai
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Moreau JT, Hankinson TC, Baillet S, Dudley RWR. Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database. NPJ Digit Med 2020; 3:12. [PMID: 32025573 PMCID: PMC6992687 DOI: 10.1038/s41746-020-0219-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/10/2020] [Indexed: 01/17/2023] Open
Abstract
Meningiomas are known to have relatively lower aggressiveness and better outcomes than other central nervous system (CNS) tumors. However, there is considerable overlap between clinical and radiological features characterizing benign, atypical, and malignant tumors. In this study, we developed methods and a practical app designed to assist with the diagnosis and prognosis of meningiomas. Statistical learning models were trained and validated on 62,844 patients from the Surveillance, Epidemiology, and End Results database. We used balanced logistic regression-random forest ensemble classifiers and proportional hazards models to learn multivariate patterns of association between malignancy, survival, and a series of basic clinical variables-such as tumor size, location, and surgical procedure. We demonstrate that our models are capable of predicting meaningful individual-specific clinical outcome variables and show good generalizability across 16 SEER registries. A free smartphone and web application is provided for readers to access and test the predictive models (www.meningioma.app). Future model improvements and prospective replication will be necessary to demonstrate true clinical utility. Rather than being used in isolation, we expect that the proposed models will be integrated into larger and more comprehensive models that integrate imaging and molecular biomarkers. Whether for meningiomas or other tumors of the CNS, the power of these methods to make individual-patient predictions could lead to improved diagnosis, patient counseling, and outcomes.
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Affiliation(s)
- Jeremy T. Moreau
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC Canada
- Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children’s Hospital, Montreal, QC Canada
| | - Todd C. Hankinson
- Department of Pediatric Neurosurgery, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO USA
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC Canada
| | - Roy W. R. Dudley
- Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children’s Hospital, Montreal, QC Canada
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Impact of postoperative radiotherapy on recurrence of primary intracranial atypical meningiomas. J Neurooncol 2020; 146:347-355. [PMID: 31900826 DOI: 10.1007/s11060-019-03382-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atypical meningiomas (WHO grade II) have high recurrence rate. However, data on the effect of radiotherapy (RT) is still conflicting. The aim of this study was to evaluate the influence of postoperative RT on the recurrence of primary atypical intracranial meningiomas. METHODS The medical records of all patients who underwent surgery (2007-2017 in 4 neurosurgical departments) for a histologically diagnosed primary atypical meningioma were reviewed to assess progression-free survival (PFS) and prognostic factors. RESULTS This analysis included 258 patients with a median age of 60 years (54.7% female). The predominant tumor locations were convexity and falx (60.9%) followed by the skull base (37.2%). Simpson grade I-II resection was achieved in 194 (75.2%) patients, Simpson grade III-IV in 53 patients (20.5%). Tumor progressed in 54 cases (20.9%). Postoperative RT was performed in 46 cases (17.8%). RT was more often applied after incomplete resection (37.7% vs. 13.4% Simpson III-IV vs. I-II). A multivariate analysis showed a significantly shorter PFS associated with Simpson III-IV [HR 1.19, (95% CI) 1.09-1.29, p < 0.001] and age > 65 years [HR 2.89, (95% CI) 1.56-5.33, p = 0.001]. A subgroup analysis with a minimal follow-up of 36 months revealed that Simpson III-IV [HR 3.01, 95% CI 1.31-6.931.03-1.24, p = 0.009] and age > 65 years [HR 2.48, 95% CI 1.20-5.13, p = 0.014] reduced PFS. The impact of postoperative RT on PFS remained statistically insignificant, even in a propensity-score matched survival analysis [n = 46; p = 0.438; OR 0.710 (0.299-1.687)]. CONCLUSIONS In the present study, postoperative RT did not improve PFS. The most important prognostic factors remain the extent of resection and age.
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Kolakshyapati M, Ikawa F, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M, Kurisu K. Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma. Neurosurg Focus 2019; 44:E14. [PMID: 29606047 DOI: 10.3171/2018.1.focus17730] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Elderly patients are particularly at risk for severe morbidity following surgery. Among the various risk factors, age and skull base location of meningioma are known to be poor prognostic factors in meningioma surgery. The authors conducted this study to analyze significant preoperative risk factors in elderly patients with skull base meningioma. METHODS A total of 265 elderly patients (≥ 65 years old) with meningioma were surgically treated at the authors' institute and affiliated hospitals between 2000 and 2016, and these cases were reviewed. Among them, 57 patients with skull base meningioma were evaluated. Among the various risk factors, the authors analyzed age, sex, Karnofsky Performance Scale (KPS) score, American Society of Anesthesiologists score, and tumor size, location, and pathology. Body mass index (BMI) and serum albumin were investigated as the frailty factors. The authors also reviewed 11 surgical studies of elderly patients ≥ 60 years old with meningioma. RESULTS The mean age was 72.4 ± 5.7 years, and 42 patients were female (73.6%). The mean size of meningioma was 36.6 ± 14.8 mm at the maximum diameter, and the mean follow-up period was 31.1 ± 31.5 months. (The continuous variables are expressed as the mean ± SD.) Histopathological investigation revealed a higher incidence (71.9%) of WHO Grade I. The rates of deterioration after surgery, at 3 months, and at 1 year were 33.3%, 37.3%, and 39.1%, respectively. Univariate analysis revealed location, preoperative KPS score, BMI level 2, and serum albumin level (p = 0.010, 0.017, 0.0012, and 0.0019, respectively) to be poor prognostic factors. Multivariate analysis revealed that location (p = 0.038) and BMI (p = 0.035) were risk factors for KPS score deterioration immediately after surgery. According to the 11 papers reviewed, the median rate (25th-75th percentile) of skull base-related location was 43.5% (39.6-47.75); for asymptomatic status the mean was 24%; and for mortality at 3 months and 1 year the medians were 6.3% (0.7-7.1) and 8% (4.8-9.4), respectively. CONCLUSION Careful preoperative assessment based on the frailty concept was essential for better outcome in elderly patients with skull base meningioma. The BMI is appropriate as a quantitative factor for measure of frailty, particularly in elderly individuals with skull base meningioma. Further prospective randomized controlled trials are necessary to validate frailty as a preoperative risk factor. Not only patient selection but also surgical timing was an important factor.
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Li D, Jiang P, Xu S, Li C, Xi S, Zhang J, Chen Y, Jiang X, Zhang X, Sai K, Wang J, Mou Y, Ke C, Chen Z. Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas. J Neurooncol 2019; 145:125-134. [PMID: 31493161 PMCID: PMC6775537 DOI: 10.1007/s11060-019-03278-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE We aim to investigate the impacts of extent of resection and adjuvant radiotherapy on survival of high-grade meningiomas (WHO grade II-III) according to modern diagnosis and management. METHODS Patients with high-grade meningiomas were identified in the Surveillance Epidemiology and End Results (SEER) database between 2000 and 2015 and used for survival analysis. Propensity score matching (PSM) was conducted to reduce selection bias. Another 92 patients from Sun Yat-sen University Cancer Center (SYSUCC) were used for validation. RESULTS 530 patients were enrolled from SEER. Patients with gross total resection (GTR) had no significantly different overall survival (OS) compared with those with subtotal resection (STR), even after performing PSM between these two groups. Multivariable analysis found that age ≥ 65 years (HR 2.22, P < 0.001), tumor diameter > 6 cm (HR 1.59, P = 0.004) and grade III tumor (HR 4.31, P < 0.001) were associated with worse OS. Stratification analysis showed that adjuvant radiotherapy conferred significantly improved OS for grade III meningiomas, but not for grade II meningiomas, regardless of resection extent. In SYSUCC cohort, resection extent was also not significantly associated with OS. However, patients with GTR (Simpson grade I-III) had distinctly increased progression-free survival (PFS) than those with STR (P < 0.001). Additionally, for grade II meningiomas after GTR, radiotherapy was unable to improve OS and PFS. CONCLUSION On modern management of high-grade meningiomas, GTR does not improve OS, but seems to be associated with increased PFS. Radiotherapy is reasonable as a supplement for treating grade III meningiomas, whereas its effect for grade II meningiomas remains uncertain and needs further validation by prospective study.
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Affiliation(s)
- Depei Li
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Pingping Jiang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Shijie Xu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Cong Li
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Shaoyan Xi
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ji Zhang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yinsheng Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Xiaobing Jiang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Xiangheng Zhang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Ke Sai
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Jian Wang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yonggao Mou
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Chao Ke
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
| | - Zhongping Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
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Jacob J, Feuvret L, Mazeron JJ, Simon JM, Canova CH, Riet FG, Blais E, Jenny C, Maingon P. Radioterapia dei tumori cerebrali primitivi dell’adulto. Neurologia 2019. [DOI: 10.1016/s1634-7072(18)41587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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22
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Smee R, Williams J, Kotevski D, Schneider M. Radiotherapy as a means of treating meningiomas. J Clin Neurosci 2019; 61:210-218. [DOI: 10.1016/j.jocn.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/07/2018] [Accepted: 10/03/2018] [Indexed: 11/16/2022]
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Zeng Q, Shi F, Guo Z. Effectiveness of Postoperative Radiotherapy on Atypical Meningioma Patients: A Population-Based Study. Front Oncol 2019; 9:34. [PMID: 30805304 PMCID: PMC6371043 DOI: 10.3389/fonc.2019.00034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/14/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose: It is controversial whether atypical meningioma patients undergoing gross-total resection (GTR) can benefit from postoperative radiotherapy (PORT). This study aimed to investigate the effectiveness of PORT on atypical meningioma patients. Methods: Patients diagnosed with atypical meningioma from 2008 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier survival curves were generated, and the log-rank test was used to compare the differences among groups. Univariable and multivariable COX regressions were conducted for survival analyses. Results: A total of 1,014 patients were enrolled. The 5-years survival rate of the overall patients was 79.0%. PORT was performed in 315 (31.1%) patients. The utilization rates of PORT in patients undergoing GTR and undergoing subtotal resection (STR) were 26.7% and 42.2%, respectively. For patients undergoing STR, log-rank test showed that overall survival (OS) time was significantly longer in patients receiving PORT than those not (p = 0.026). For patients undergoing GTR, OS time did not show significant association with PORT (p = 0.339). In addition, patients undergoing STR with PORT had no significantly different OS time compared with those undergoing GTR with PORT (p = 0.398). Multivariable Cox regression analysis showed that receipt of PORT (p = 0.187) was not an independent predictor of OS after adjustment. Conclusion: PORT may not prolong the OS in atypical meningioma patients undergoing GTR. However, patients undergoing STR may benefit from PORT and achieve similar OS to those undergoing GTR.
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Affiliation(s)
- Qiang Zeng
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Feina Shi
- Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhige Guo
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Jiang Y, Lv L, Li J, Ma W, Chen C, Zhou P, Jiang S. Clinical features, radiological findings, and treatment outcomes of high-grade lateral ventricular meningiomas: a report of 26 cases. Neurosurg Rev 2019; 43:565-573. [PMID: 30649647 DOI: 10.1007/s10143-019-01078-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/25/2018] [Accepted: 01/08/2019] [Indexed: 02/05/2023]
Abstract
High-grade meningiomas in ventricles are rare, where most published series only include a few patients. A retrospective analysis was performed on the clinical features, radiological findings, and treatment outcomes of 26 patients with high-grade meningiomas in lateral ventricles who were surgically treated in our hospital between July 2008 and July 2016. A female predilection (female/male = 1.4:1) was observed with a mean age of 42.4 years. Headache and/or vomiting (65.3%) were the most common initial symptom, and with symptom duration time ranging between 7 days and 5 years (mean 8.5 months). The lateral ventricle trigone area was the most common site (80.7%). Twenty-two patients (84.6%) obtained gross total resection. The 2007 WHO classification was used to classify 22 (84.6%) meningiomas as grade II and the remaining four tumors were graded III. These tumors accounted for a recurrence rate of 38.5% (10 of 26 patients) and a mortality rate of 11.5% (3 deaths) during the follow-up periods. The recurrence rate after the gross total resection was 27.3% (6 of 22 patients). Radiotherapy was administered as an adjuvant treatment in 12 patients (46.2%) after surgery. There were 4 recurrences out of the 12 patients who received radiotherapy and 6 of the 14 patients relapsed without radiotherapy (p = 0.58). The subtotal resection was considered a risk factor for recurrence. The postoperative radiotherapy seemed to have little significance for the high-grade meningiomas in the lateral ventricles. Long-term follow-up is required, regardless of the resection grade, and reoperation is feasible for patients with recurrence.
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Affiliation(s)
- Yong Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Liang Lv
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Weichao Ma
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Cheng Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Zhu H, Bi WL, Aizer A, Hua L, Tian M, Den J, Tang H, Chen H, Wang Y, Mao Y, Dunn IF, Xie Q, Gong Y. Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma. Cancer Med 2019; 8:13-20. [PMID: 30680963 PMCID: PMC6346222 DOI: 10.1002/cam4.1531] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/20/2022] Open
Abstract
The effect of adjuvant radiotherapy in management for high-grade meningiomas, especially atypical meningiomas, remains controversial. We aimed to explore the role of adjuvant radiotherapy in this population. A total of 162 adults with high-grade meningiomas (99 atypical meningiomas and 63 anaplastic meningiomas) were treated from 2003 to 2008 at Huashan Hospital. One hundred and seventeen patients presented with primary and 45 with recurrent disease. One hundred and fifteen patients (70.9%) were treated with adjuvant radiotherapy after surgical resection. The median follow-up was 76.5 months (range 1-142 months). Kaplan-Meier survival curve and Cox proportional hazards modeling were used for analyses. Adjuvant radiotherapy was associated with prolonged progression-free survival (PFS) and overall survival (OS) in patients with newly diagnosed anaplastic meningiomas irrespective of extent of resection (PFS, P = .001; OS, P = .003). Gross total resection was the only independent prognostic factor for those with newly diagnosed atypical meningiomas (PFS, P < .001; OS, P = .012). A survival benefit for adjuvant radiation was also found in subgroup analysis of patients with high-grade meningiomas who underwent subtotal resection (PFS, P = .023; OS, P = .013). Among recurrent high-grade meningiomas, radiotherapy offered no statistically significant improvement in either PFS or OS. Adjuvant radiotherapy is associated with improved survival in patients with newly diagnosed anaplastic meningiomas and those high-grade meningiomas following subtotal resection. However, there was no significant correlation identified between postoperative radiation and outcome for recurrent high-grade meningiomas. Future prospective randomized trials may help clarify the optimal tailored treatment for patients with high-grade meningioma.
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Affiliation(s)
- Hongda Zhu
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Wenya Linda Bi
- Department of NeurosurgeryCener for Skull Base and Pituitary SurgeryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Ayal Aizer
- Department of Radiation OncologyBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Lingyang Hua
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Mi Tian
- Department of Critical Care MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Jiaojiao Den
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Hailiang Tang
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Hong Chen
- Department of NeuropathologyHuashan HospitalFudan UniversityShanghaiChina
| | - Yin Wang
- Department of NeuropathologyHuashan HospitalFudan UniversityShanghaiChina
| | - Ying Mao
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Ian F. Dunn
- Department of NeurosurgeryCener for Skull Base and Pituitary SurgeryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Qing Xie
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Ye Gong
- Department of NeurosurgeryHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
- Department of Critical Care MedicineHuashan HospitalFudan UniversityShanghaiChina
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Shakir SI, Souhami L, Petrecca K, Mansure JJ, Singh K, Panet-Raymond V, Shenouda G, Al-Odaini AA, Abdulkarim B, Guiot MC. Prognostic factors for progression in atypical meningioma. J Neurosurg 2018; 129:1240-1248. [DOI: 10.3171/2017.6.jns17120] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe optimal adjuvant management for atypical meningiomas remains controversial. The aim of this study was to review long-term outcomes to identify potential prognostic factors for disease progression.METHODSFrom August 1992 to August 2013, 70 patients with atypical meningioma were treated at the authors’ institution. Pathology revision was performed based on WHO 2007 criteria. Patients with multiple tumors, neurofibromatosis Type 2, or inadequate imaging follow-up were not eligible. The authors performed pre- and postoperative serial measurements of tumor volume from MRI. Age, sex, tumor location, bone involvement, brain invasion, mitotic figures, preoperative disease volume, extent of resection, tumor growth rates, use of adjuvant postoperative radiation therapy (PORT), and residual tumor volume at the time of radiation therapy (RT) were assessed by univariate and multivariate analysis to determine their potential impact on disease progression.RESULTSForty patients (57%) underwent gross-total resection (GTR) and 30 (43%) underwent subtotal resection (STR). PORT was delivered to 12 patients (30%) with a GTR and in only 4 (13%) with an STR. The 5-year progression-free survival (PFS) rate for patients in the GTR group with or without PORT was 100% and 54.1%, respectively (p = 0.0058). PFS for patients in the STR group with or without PORT was 75% and 0%, respectively (p = 0.0026). On multivariate analysis, STR and PORT were the only independent significant prognostic factors for disease progression with hazard ratios of 5.4873 (95% CI 2.19–13.72, p = 0.0003) and 0.0464 (95% CI 0.0059–0.364, p = 0.0035), respectively. Based on Youden’s index statistic, a cutoff residual tumor volume of more than 8.76 cm3 at the time of RT was associated with worse PFS (13.6% vs 56%, p = 0.0079). Before receiving RT, the median relative and absolute growth rates and tumor doubling time for patients were 124.2%/year, 4.8 cm3/year, and 1.67 years, respectively. These indices changed after RT to 0.245%/year, −0.09 cm3/year, and −0.005 year, respectively (p < 0.05).CONCLUSIONSIn atypical meningioma, the use of PORT is associated with improved PFS even in patients who undergo GTR. Patients with residual tumor volume larger than 8.76 cm3 have an increased risk of disease progression and should be considered for early RT.
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Affiliation(s)
| | | | | | | | | | | | | | - Amal A. Al-Odaini
- 5Neuropathology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Marie-Christine Guiot
- 5Neuropathology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
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Pant S, Tonse R, Kannan S, Moiyadi A, Shetty P, Epari S, Sahay A, Sastri GJ, Jalali R, Gupta T. Impact of timing of radiation therapy on outcomes in atypical meningioma: A clinical audit. Pract Radiat Oncol 2018; 8:e275-e284. [DOI: 10.1016/j.prro.2018.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/29/2017] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
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Wang C, Kaprealian TB, Suh JH, Kubicky CD, Ciporen JN, Chen Y, Jaboin JJ. Overall survival benefit associated with adjuvant radiotherapy in WHO grade II meningioma. Neuro Oncol 2018; 19:1263-1270. [PMID: 28371851 DOI: 10.1093/neuonc/nox007] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Adjuvant radiotherapy (RT) after surgical resection of World Health Organization (WHO) grade II meningioma, also known as atypical meningioma (AM), is a topic of controversy. The purpose of this study is to compare overall survival (OS) with or without adjuvant RT after subtotal resection (STR) or gross total resection (GTR) in AM patients diagnosed according to the 2007 WHO classification. Methods The National Cancer Database was used to identify 2515 patients who were diagnosed with AM between 2009 and 2012 and underwent STR or GTR with or without adjuvant RT. Propensity score matching was first applied to balance covariates including age, year of diagnosis, sex, race, histology, and tumor size in STR or GTR cohorts stratified by adjuvant RT status. Multivariate regression according to the Cox proportional hazards model and Kaplan-Meier survival plots with log-rank test were then used to evaluate OS difference associated with adjuvant RT. Results GTR is associated with improved OS compared with STR. In the subgroup analysis, adjuvant RT in patients who underwent STR demonstrated significant association with improved OS compared with no adjuvant RT (adjusted hazard ratio [AHR] 0.590, P = .045); however, adjuvant RT is not associated with improved OS in patients who underwent GTR (AHR 1.093, P = .737). Conclusions Despite the lack of consensus on whether adjuvant RT reduces recurrence after surgical resection of AM, our study observed significantly improved OS with adjuvant RT compared with no adjuvant RT after STR.
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Affiliation(s)
- Chenyang Wang
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Tania B Kaprealian
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - John H Suh
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Charlotte D Kubicky
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Jeremy N Ciporen
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Yiyi Chen
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Jerry J Jaboin
- UCLA Department of Radiation Oncology, Los Angeles, California; Cleveland Clinic Department of Radiation Oncology, Cleveland, Ohio; Oregon Health & Science University Department of Radiation Medicine, Portland, Oregon; Oregon Health & Science University Department of Neurosurgery, Center for Health & Healing, Portland, Oregon; Oregon Health & Science University Department of Public Health & Preventive Medicine, Portland, Oregon
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Weber DC, Ares C, Villa S, Peerdeman SM, Renard L, Baumert BG, Lucas A, Veninga T, Pica A, Jefferies S, Ricardi U, Miralbell R, Stelmes JJ, Liu Y, Collette L, Collette S. Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042-26042). Radiother Oncol 2018; 128:260-265. [PMID: 29960684 DOI: 10.1016/j.radonc.2018.06.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The therapeutic strategy for non-benign meningiomas is controversial. The objective of this study was to prospectively investigate the impact of high dose radiation therapy (RT) on the progression-free survival (PFS) rate at 3 years in WHO grade II and III meningioma patients. MATERIALS AND METHODS In this multi-cohorts non-randomized phase II and observational study, non-benign meningioma patients were treated according to their WHO grade and Simpson's grade. Patients with atypical meningioma (WHO grade II) and Simpson's grade 1-3 [Arm 1] entered the non-randomized phase II study designed to show a 3-year PFS > 70% (primary endpoint). All other patients entered the 3 observational cohorts: WHO grade II Simpson grade 4-5 [Arm 2] and Grade III Simpson grade 1-3 or 4-5 [Arm 3&4] in which few patients were expected. RESULTS Between 02/2008 and 06/2013, 78 patients were enrolled into the study. This report focuses on the 56 (median age, 54 years) eligible patients with WHO grade II Simpson's grade 1-3 meningioma who received RT (60 Gy). At a median follow up of 5.1 years, the estimated 3-year PFS is 88.7%, hence significantly greater than 70%. Eight (14.3%) treatment failures were observed. The 3-year overall survival was 98.2%. The rate of late signs and symptoms grade 3 or more was 14.3%. CONCLUSIONS These data show that 3-year PFS for WHO grade II meningioma patients undergoing a complete resection (Simpson I-III) is superior to 70% when treated with high-dose (60 Gy) RT.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland; Radiation Oncology Department, University Hospital of Zürich, Switzerland.
| | - Carmen Ares
- Radiation Oncology Department, Geneva University Hospital, Switzerland; Department of Radiation-Oncology, MAASTRO Clinic, & GROW School for Oncology, Maastricht University Medical Centre, The Netherlands
| | - Salvador Villa
- Department of Radiation Oncology, Catalan Institut of Oncology, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain
| | - Saskia M Peerdeman
- Department of Neurosurgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Laurette Renard
- Department of Radiation Oncology, University Hospital St Luc, Brussels, Belgium
| | - Brigitta G Baumert
- Department of Radiation-Oncology, MAASTRO Clinic, & GROW School for Oncology, Maastricht University Medical Centre, The Netherlands; Department of Radiation Oncology, Paracelsus Clinic Osnabrück and Univeristy of Münster, Germany
| | - Anna Lucas
- Department of Radiation Oncology, Institut Català d'Oncologia - L'Hospitalet, Barcelona, Spain
| | | | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
| | - Sarah Jefferies
- Oncology Department, Addenbrookes Hospital, Cambridge, United Kingdom
| | | | - Raymond Miralbell
- Radiation Oncology Department, Geneva University Hospital, Switzerland
| | | | - Yan Liu
- EORTC Headquarters, Brussels, Belgium
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Chen WC, Magill ST, Wu A, Vasudevan HN, Morin O, Aghi MK, Theodosopoulos PV, Perry A, McDermott MW, Sneed PK, Braunstein SE, Raleigh DR. Histopathological features predictive of local control of atypical meningioma after surgery and adjuvant radiotherapy. J Neurosurg 2018; 130:443-450. [PMID: 29624151 DOI: 10.3171/2017.9.jns171609] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/05/2017] [Indexed: 01/04/2023]
Abstract
OBEJECTIVE The goal of this study was to investigate the impact of adjuvant radiotherapy (RT) on local recurrence and overall survival in patients undergoing primary resection of atypical meningioma, and to identify predictive factors to inform patient selection for adjuvant RT. METHODS One hundred eighty-two patients who underwent primary resection of atypical meningioma at a single institution between 1993 and 2014 were retrospectively identified. Patient, meningioma, and treatment data were extracted from the medical record and compared using the Kaplan-Meier method, log-rank tests, multivariate analysis (MVA) Cox proportional hazards models with relative risk (RR), and recursive partitioning analysis. RESULTS The median patient age and imaging follow-up were 57 years (interquartile range [IQR] 45–67 years) and 4.4 years (IQR 1.8–7.5 years), respectively. Gross-total resection (GTR) was achieved in 114 cases (63%), and 42 patients (23%) received adjuvant RT. On MVA, prognostic factors for death from any cause included GTR (RR 0.4, 95% CI 0.1–0.9, p = 0.02) and MIB1 labeling index (LI) ≤ 7% (RR 0.4, 95% CI 0.1–0.9, p = 0.04). Prognostic factors on MVA for local progression included GTR (RR 0.2, 95% CI 0.1–0.5, p = 0.002), adjuvant RT (RR 0.2, 95% CI 0.1–0.4, p < 0.001), MIB1 LI ≤ 7% (RR 0.2, 95% CI 0.1–0.5, p < 0.001), and a remote history of prior cranial RT (RR 5.7, 95% CI 1.3–18.8, p = 0.03). After GTR, adjuvant RT (0 of 10 meningiomas recurred, p = 0.01) and MIB1 LI ≤ 7% (RR 0.1, 95% CI 0.003–0.3, p < 0.001) were predictive for local progression on MVA. After GTR, 2.2% of meningiomas with MIB1 LI ≤ 7% recurred (1 of 45), compared with 38% with MIB1 LI > 7% (13 of 34; p < 0.001). Recursive partitioning analysis confirmed the existence of a cohort of patients at high risk of local progression after GTR without adjuvant RT, with MIB1 LI > 7%, and evidence of brain or bone invasion. After subtotal resection, adjuvant RT (RR 0.2, 95% CI 0.04–0.7, p = 0.009) and ≤ 5 mitoses per 10 hpf (RR 0.1, 95% CI 0.03–0.4, p = 0.002) were predictive on MVA for local progression. CONCLUSIONS Adjuvant RT improves local control of atypical meningioma irrespective of extent of resection. Although independent validation is required, the authors’ results suggest that MIB1 LI, the number of mitoses per 10 hpf, and brain or bone invasion may be useful guides to the selection of patients who are most likely to benefit from adjuvant RT after resection of atypical meningioma.
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Affiliation(s)
| | | | | | | | | | | | | | - Arie Perry
- 2Neurological Surgery, and
- 3Pathology, University of California, San Francisco, California
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Affiliation(s)
| | - Matthieu Peyre
- Sorbonne Université, Paris, France
- Department of Neurosurgery, Pitié Salpêtrière Hospital, Paris, France
| | - Michel Kalamarides
- Sorbonne Université, Paris, France
- Department of Neurosurgery, Pitié Salpêtrière Hospital, Paris, France
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Sun SQ, Cai C, Murphy RKJ, DeWees T, Dacey RG, Grubb RL, Rich KM, Zipfel GJ, Dowling JL, Leuthardt EC, Simpson JR, Robinson CG, Chicoine MR, Perrin RJ, Huang J, Kim AH. Radiation Therapy for Residual or Recurrent Atypical Meningioma: The Effects of Modality, Timing, and Tumor Pathology on Long-Term Outcomes. Neurosurgery 2017; 79:23-32. [PMID: 26645969 DOI: 10.1227/neu.0000000000001160] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE To analyze features associated with progression after radiation therapy. METHODS Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P = .53), SRS vs EBRT (P = .45), and adjuvant vs salvage (P = .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] = 82.3, P < .001), embolization necrosis (HR = 15.6, P = .03), and brain invasion (HR = 3.8, P = .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P < .001). CONCLUSION This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality. ABBREVIATIONS AM, atypical meningiomaEBRT, external beam radiation therapyGTR, gross total resectionLC, locoregional controlOS, overall survivalPOE, preoperative embolizationRT, radiation therapySRS, stereotactic radiosurgerySTR, subtotal resection.
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Affiliation(s)
- Sam Q Sun
- ‡Washington University School of Medicine, St. Louis, Missouri; §Department of Pathology and Immunology, Washington University, St. Louis, Missouri; ¶Department of Neurosurgery, Washington University, St. Louis, Missouri; ‖Department of Radiation Oncology, Washington University, St. Louis, Missouri
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Atypical meningioma. A study on recurrence and disease-specific survival. Neurochirurgie 2017; 63:273-281. [DOI: 10.1016/j.neuchi.2017.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/10/2017] [Accepted: 03/20/2017] [Indexed: 01/28/2023]
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Cho M, Joo JD, Kim IA, Han JH, Oh CW, Kim CY. The Role of Adjuvant Treatment in Patients with High-Grade Meningioma. J Korean Neurosurg Soc 2017; 60:527-533. [PMID: 28881115 PMCID: PMC5594630 DOI: 10.3340/jkns.2016.1111.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/01/2017] [Accepted: 04/26/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the efficacy of adjuvant treatment in patients with high-grade meningioma. Methods A retrospective analysis was performed for patients with high-grade meningioma, World Health Organization grade 2 or 3, in a single center between 2003 and 2014. The patients were reviewed according to age at diagnosis, sex, the location of meningioma, degree of tumor resection, histological features, and type of adjuvant treatment. These factors were analyzed by Firth logistic regression analyses. Results Fifty-three patients with high-grade meningioma were enrolled. Thirty-four patients received adjuvant treatment; conventional radiotherapy or radiosurgery. Clinical follow-up ranged from 13–113 months with a median follow-up of 35.5 months. Gross total removal (GTR), Simpson grade 1 or 2, was achieved in 29 patients and, among them, 13 patients received adjuvant treatment. In the other 24 patients with non-GTR, conventional adjuvant radiotherapy and radiosurgery were performed in 11 and 10 patients, respectively. The other 3 patients did not receive any adjuvant treatment. Radiation-related complications did not occur. Of the 53 patients, 19 patients had suffered from recurrence. The recurrence rate in the adjuvant treatment group was 23.5% (8 out of 34). On the other hand, the rate for the non-adjuvant treatment group was 57.9% (11 out of 19) (odds ratio [OR]=0.208, p=0.017). In the GTR group, the recurrence rate was 7.5% (1 out of 13) for patients with adjuvant treatment and 50% (8 out of 16) for patients without adjuvant treatment (OR=0.121, p=0.04). Conclusion Adjuvant treatment appears to be safe and effective, and could lead to a lower recurrence rate in high-grade meningioma, regardless of the extent of removal. Our results might be used as a reference for making decisions when planning adjuvant treatments for patients with high-grade meningioma after surgery.
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Affiliation(s)
- Minjae Cho
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Deok Joo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations. Neurosurgery 2017; 83:333-344. [DOI: 10.1093/neuros/nyx408] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/21/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Aditya V Karhade
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra M G Larsen
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Cote
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heloise M Dubois
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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Stereotactic radiotherapy as primary definitive or postoperative treatment of intracranial meningioma of WHO grade II and III leads to better disease control than stereotactic radiotherapy of recurrent meningioma. J Neurooncol 2017; 134:407-416. [DOI: 10.1007/s11060-017-2540-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
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Atypical Meningioma: Referral Patterns, Treatment and Adherence to Guidelines. Can J Neurol Sci 2017; 44:283-287. [DOI: 10.1017/cjn.2016.449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractObjective:To determine the referral rate to radiation oncologist (RO), use of postoperative radiotherapy (PORT) and the impact of a clinical practice guideline (CPG) on patients with atypical meningioma (AM).Methods:A retrospective review of meningioma patients (n=526) treated between 2003 and 2013 was undertaken. Patients’ characteristics, extent of surgical resection (EOR), RO referral, PORT, date and treatment of first recurrence were collected for all patients >18 years with a new diagnosis of AM after surgical resection (n=83). Progression free survival (PFS) and overall survival (OS) according to EOR were assessed by the Log-Rank test of Kaplan-Meier survival.Results:Median age was 57 years. EOR was gross total (GTR) in 44 patients, subtotal (STR) in 36 patients and 3 patients had unknown EOR. RO referral rate was 26.5% (n=22); 5 patients initially had GTR and 17 had STR. Only 7 patients received PORT. At a median follow up time of 29 months, recurrences occurred in 28 patients, 4 had GTR, 21 had STR and 3 had an unknown EOR. With PORT, 2 patients developed recurrence. 5-year PFS was 62% after GTR and 33% after STR (P=0.002). 5-year OS was 92% after GTR and 83% after STR (P=0.45).Conclusion:In this cohort with AM, RO referral rate was low and was not influenced by the CPG. Use of PORT was also low. Given the lack of conclusive evidence supporting PORT in such patients, a multidisciplinary approach, including RO consultation, is needed to provide patients with optimal and individualised care.
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Bagshaw HP, Burt LM, Jensen RL, Suneja G, Palmer CA, Couldwell WT, Shrieve DC. Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 2016; 126:1822-1828. [DOI: 10.3171/2016.5.jns152809] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this paper was to evaluate outcomes in patients with atypical meningiomas (AMs) treated with surgery alone compared with surgery and radiotherapy at initial diagnosis, or at the time of first recurrence.METHODSPatients with pathologically confirmed AMs treated at the University of Utah from 1991 to 2014 were retrospectively reviewed. Local control (LC), overall survival (OS), Karnofsky Performance Status (KPS), and toxicity were assessed. Outcomes for patients receiving adjuvant radiotherapy were compared with those for patients treated with surgery alone. Kaplan-Meier and the log-rank test for significance were used for LC and OS analyses.RESULTSFifty-nine patients with 63 tumors were reviewed. Fifty-two patients were alive at the time of analysis with a median follow-up of 42 months. LC for all tumors was 57% with a median time to local failure (TTLF) of 48 months. The median TTLF following surgery and radiotherapy was 180 months, compared with 46 months following surgery alone (p = 0.02). Excluding Simpson Grade IV (subtotal) resections, there remained an LC benefit with the addition of radiotherapy for Simpson Grade I, II, and III resected tumors (median TTLF 180 months after surgery and radiotherapy compared with 46 months with surgery alone [p = 0.002]). Patients treated at first recurrence following any initial therapy (either surgery alone or surgery and adjuvant radiotherapy) had a median TTLF of 26 months compared with 48 months for tumors treated at first diagnosis (p = 0.007). There were 2 Grade 3 toxicities and 1 Grade 4 toxicity associated with radiotherapy.CONCLUSIONSAdjuvant radiotherapy improves LC for AMs. The addition of adjuvant radiotherapy following even a Simpson Grade I, II, or III resection was found to confer an LC benefit. Recurrent disease is difficult to control, underscoring the importance of aggressive initial treatment.
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Affiliation(s)
| | | | | | | | - Cheryl A. Palmer
- 3Pathology, University of Utah School of Medicine, Salt Lake City, Utah
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Review of controversies in management of non-benign meningioma. J Clin Neurosci 2016; 31:37-46. [DOI: 10.1016/j.jocn.2016.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/21/2016] [Accepted: 03/27/2016] [Indexed: 11/23/2022]
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Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, von Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal ECJ, Brandsma D, Henriksson R, Soffietti R, Weller M. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 2016; 17:e383-91. [PMID: 27599143 DOI: 10.1016/s1470-2045(16)30321-7] [Citation(s) in RCA: 536] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 02/08/2023]
Abstract
Although meningiomas are the most common intracranial tumours, the level of evidence to provide recommendations for the diagnosis and treatment of meningiomas is low compared with other tumours such as high-grade gliomas. The meningioma task force of the European Association of Neuro-Oncology (EANO) assessed the scientific literature and composed a framework of the best possible evidence-based recommendations for health professionals. The provisional diagnosis of meningioma is mainly made by MRI. Definitive diagnosis, including histological classification, grading, and molecular profiling, requires a surgical procedure to obtain tumour tissue. Therefore, in many elderly patients, observation is the best therapeutic option. If therapy is deemed necessary, the standard treatment is gross total surgical resection including the involved dura. As an alternative, radiosurgery can be done for small tumours, or fractionated radiotherapy in large or previously treated tumours. Treatment concepts combining surgery and radiosurgery or fractionated radiotherapy, which enable treatment of the complete tumour volume with low morbidity, are being developed. Pharmacotherapy for meningiomas has remained largely experimental. However, antiangiogenic drugs, peptide receptor radionuclide therapy, and targeted agents are promising candidates for future pharmacological approaches to treat refractory meningiomas across all WHO grades.
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Affiliation(s)
- Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany.
| | - Giuseppe Minniti
- Radiation Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Matthias Preusser
- Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kita Sallabanda
- Department of Neurosurgery, University Hospital San Carlos, Universidad Cumplutense de Madrid, Madrid, Spain; Department of Oncologia Radioterapia Robotizada-CyberKnife, IMOncology Madrid Arturo Soria, Madrid, Spain
| | | | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; CCU Neuropathology German Cancer Center (DKFZ), Heidelberg, Germany
| | - Pantelis Stavrinou
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Roger Henriksson
- Regional Cancer Centre Stockholm, Stockholm, Sweden; Department of Radiation Science and Oncology, University of Umeå, Umeå, Sweden
| | - Riccardo Soffietti
- Department of Neuro-Oncology, City of Health and Science University Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Casas Parera I, Báez A, Banfi N, Blumenkrantz Y, Halfon MJ, Barros M, Campero Á, Larrarte G, De Robles P, Rostagno R, Gonzalez Roffo A, Campanucci V, Igirio Gamero JL, Figueroa Intriago WL, Díaz Granados S, Martínez Tamborini N, Kuchkaryan VB, Lozano C. Meningiomas en neurooncología. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.neuarg.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment. J Neurooncol 2016; 129:337-45. [DOI: 10.1007/s11060-016-2181-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/05/2016] [Indexed: 01/28/2023]
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World Health Organization grade II meningiomas. Acta Neurochir (Wien) 2016; 158:921-9; discussion 929. [PMID: 27020441 DOI: 10.1007/s00701-016-2771-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND We analyzed WHO grade II meningioma cases to identify factors influencing survival. MATERIALS AND METHODS Between January 2000 and August 2015, 206 cases of World Health Organization (WHO) grade II meningioma were operated at our institution. This population underwent a total of 298 surgical resections and 55 patients received a radiotherapy. A Cox multivariate regression was conducted on clinical and histological criteria. RESULTS Sixty-four patients were deceased (31.1 %), of which 38 died following the disease progression (18.4 %). Overall survival probability at 1, 5, and 10 years were 95.4 %, 95 % CI [92.5, 98.4]; 84 %, 95 % CI [78.3, 90.2], and 72.9 %, 95 % CI [64.5, 82.4], respectively (Fig. 1a). At the end of the study, only 87 patients (42.2 %) were alive with no tumor residual or recurrence on the last scan. Age at diagnosis (hazard ratio (HR) = 0.31, 95 % CI [0.15, 0.63], p < 0.001), extent of resection (HR = 0.25, 95 % CI [0.12, 0.49], p < 0.001), and tumoral brain invasion (HR = 0.49, 95 % CI [0.25, 0.98], p = 0.040) were independent factors associated with the overall survival. The patients who received radiotherapy did not demonstrate a longer overall survival (p = 0.540). CONCLUSIONS WHO grade II meningioma significantly impaired the survival of the patients. In the adjusted Cox regression, a macroscopic gross total resection (Simpson grades 1, 2, and 3), an age below 62 years at diagnosis and the absence of brain invasion were independent factors associated with a longer survival. Radiotherapy may not increase the overall survival after complete or incomplete resection.
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Amsbaugh M, Ugiliweneza B, Burton E, Skirboll S, Woo S, Boakye M. Patterns of Care and Outcomes of Adjuvant Radiotherapy for Meningiomas: A Surveillance, Epidemiology, and End Results and Medicare Linked Analysis. Cureus 2016; 8:e567. [PMID: 27186449 PMCID: PMC4866867 DOI: 10.7759/cureus.567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The role of adjuvant stereotactic radiosurgery (SRS) and fractionated radiotherapy (XRT) are unknown in patients with resected meningiomas. Objective: To identify patterns of care and outcomes of adjuvant radiotherapy for meningiomas in the Linked Surveillance, Epidemiology, and End Results (SEER) Medicare data. Methods: A total of 1,964 patients older than 66 years included in the SEER-Medicare data, who were diagnosed with meningioma, and underwent craniotomy were included for analysis. Results: Patients were less likely to receive adjuvant therapy if they were older than 75 (OR 0.730, 95% CI 0.548-0.973), female sex (OR 0.731, 95% CI 0.547-0.978), or unmarried (OR 0.692, 95% CI 0.515-0.929). Patients were more likely to receive adjuvant treatment for Grade II/III tumors (OR 5.586, 95% CI 2.135-13.589), tumors over 5 cm (OR 1.850, 95% CI 1.332-2.567), or partial resection (OR 3.230, 95% CI 2.327-4.484). Yearly between 2000 and 2009, 10.65 – 19.77% of patients received adjuvant therapy. Although no survival benefit was seen with the addition of adjuvant therapy (p = 0.1236), the subgroup of patients receiving SRS had a decreased risk of death compared to those receiving surgery alone (aHR 0.544, 95% CI 0.318 – 0.929). Conclusion: Utilization of adjuvant XRT and SRS remained stable between 2000 and 2010. Male sex, young age, marriage, partial resection, Grade II/III tumors, and large tumors predicted the use of adjuvant therapy. For all patients, SRS decreased the risk of death compared to craniotomy alone.
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Affiliation(s)
| | | | | | - Stephen Skirboll
- Department of Neurosurgery, Stanford University School of Medicine
| | - Shiao Woo
- Radiation Oncology, University of Louisville
| | - Max Boakye
- Department of Neurosurgery, University of Louisville
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Mawrin C, Chung C, Preusser M. Biology and clinical management challenges in meningioma. Am Soc Clin Oncol Educ Book 2016:e106-15. [PMID: 25993161 DOI: 10.14694/edbook_am.2015.35.e106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Meningiomas are the most frequently occurring intracranial tumors. They are characterized by a broad spectrum of histopathologic appearance. Molecular alterations driving meningioma development, which affect the NF2 gene, are found in roughly 50% of patients. Rare genetic events in benign meningiomas are mutations in TRAF7, KLF4, AKT1, and SMO; all of these mutations are exclusive of NF2 alterations. Progression to a clinically aggressive meningioma is linked to inactivation of CDKN2A/B genes, and a plethora of signaling molecules have been described as activated in meningiomas, which supports the concept of successful clinical use of specific inhibitors. Established treatments include surgical resection with or without radiotherapy delivered in a single fraction, a few large fractions (radiosurgery), or multiple fractions (fractionated radiotherapy). For recurrent and aggressive tumors, inhibitors of the vascular endothelial growth factor (VEGF) pathway, such as vatalinib, bevacizumab, and sunitinib, showed signs of activity in small, uncontrolled studies, and prospective clinical studies will test the efficacy of the tetrahydroisoquinoline trabectedin and of SMO and AKT1 inhibitors.
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Affiliation(s)
- Christian Mawrin
- From the Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany; Department of Radiation Oncology, University of Toronto/Princess Margaret Cancer Centre, Toronto, Canada; Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Caroline Chung
- From the Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany; Department of Radiation Oncology, University of Toronto/Princess Margaret Cancer Centre, Toronto, Canada; Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- From the Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany; Department of Radiation Oncology, University of Toronto/Princess Margaret Cancer Centre, Toronto, Canada; Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Jenkinson MD, Waqar M, Farah JO, Farrell M, Barbagallo GMV, McManus R, Looby S, Hussey D, Fitzpatrick D, Certo F, Javadpour M. Early adjuvant radiotherapy in the treatment of atypical meningioma. J Clin Neurosci 2016; 28:87-92. [PMID: 26775147 DOI: 10.1016/j.jocn.2015.09.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/04/2015] [Accepted: 09/19/2015] [Indexed: 11/29/2022]
Abstract
Atypical meningiomas have a greater propensity to recur than benign meningiomas and the benefits of early adjuvant radiotherapy are unclear. Existing studies report conflicting results. This retrospective cohort study evaluated the role of early adjuvant radiotherapy following surgical resection of atypical meningioma. A triple center case-note review of adults with newly-diagnosed atypical meningiomas between 2001 and 2010 was performed. Pathology diagnosis was made according to the World Health Organization classification in use at the time of surgery. Patients with multiple meningiomas, neurofibromatosis type 2 and radiation-induced meningiomas were excluded. Extent of resection was defined as gross total resection (GTR; Simpson Grade I-III) or subtotal resection (STR; Simpson Grade IV-V). Survival analysis was performed using the Kaplan-Meier method. One hundred thirty-three patients were identified with a median age of 62years (range 22-86years) and median follow-up of 57.4months (range 0.1-152.2months). Tumors were mostly located in the convexity (50.4%) or falcine/parasagittal regions (27.1%). GTR (achieved in 85%) was associated with longer progression free survival (PFS) (5year PFS 81.2% versus 40.08%, log-rank=11.117, p=0.001) but not overall survival (OS) (5year OS 76.6% versus 39.7%, log-rank=3.652, p=0.056). Following GTR, early adjuvant radiotherapy was administered to 28.3% of patients and did not influence OS (5year OS 77.0% versus 75.7%, log-rank=0.075, p=0.784) or PFS (5year PFS 82.0% versus 79.3%, log-rank=0.059, p=0.808). Although extent of resection emerged as an important prognostic variable, early adjuvant radiotherapy did not influence outcome following GTR of atypical meningiomas. Prospective randomized controlled trials are planned.
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Affiliation(s)
- Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; Institute of Translational Medicine and School of Medicine, University of Liverpool, Liverpool, UK.
| | - Mueez Waqar
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK; Institute of Translational Medicine and School of Medicine, University of Liverpool, Liverpool, UK
| | - Jibril Osman Farah
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, UK
| | - Michael Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | | | - Robin McManus
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Seamus Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Hussey
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - David Fitzpatrick
- Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland
| | - Francesco Certo
- Department of Neurosurgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
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Atypical and malignant meningiomas: Considerations for treatment and efficacy of radiotherapy. J Clin Neurosci 2015. [DOI: 10.1016/j.jocn.2015.03.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Westwick HJ, Shamji MF. Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine 2015; 23:368-73. [DOI: 10.3171/2014.12.spine14974] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Most spinal meningiomas are intradural lesions in the thoracic spine that present with both local pain and myelopathy. By using the large prospective Surveillance, Epidemiology, and End Results (SEER) database, the authors studied the incidence of spinal meningiomas and examined demographic and treatment factors predictive of death.
METHODS
Using SEER*Stat software, the authors queried the SEER database for cases of spinal meningioma between 2000 and 2010. From the results, tumor incidence and demographic statistics were computed; incidence was analyzed as a function of tumor location, pathology, age, sex, and malignancy code. Survival was analyzed by using a Cox proportional hazards ratio in SPSS for age, sex, marital status, primary site, size quartile, treatment modality, and malignancy code. In this analysis, significance was set at a p value of 0.05.
RESULTS
The 1709 spinal meningiomas reported in the SEER database represented 30.7% of all primary intradural spinal tumors and 7.9% of all meningiomas. These meningiomas occurred at an age-adjusted incidence of 0.193 (95% CI 0.183–0.202) per 100,000 population and were closely related to sex (337 [19.7%] male patients and 1372 [80.3%] female patients). The Cox hazard function for mortality in males was higher (2.4 [95% CI1.7–3.5]) and statistically significant, despite the lower lesion incidence in males. All-cause survival was lowest in patients older than 80 years. Primary site and treatment modality were not significant predictors of mortality.
CONCLUSIONS
Spinal meningiomas represent a significant fraction of all primary intradural spinal tumors and of all meningiomas. The results of this study establish the association of lesion incidence and survival with sex, with a less frequent incidence in but greater mortality among males.
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Affiliation(s)
- Harrison J. Westwick
- 1Department of Surgery, Division of Neurosurgery, Centre Hospitalier de I’Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec
| | - Mohammed F. Shamji
- 2Toronto Western Hospital, Division of Neurosurgery; and
- 3Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lee SH, Lee EH, Lee SH, Lee YM, Kim HD, Kim YZ. Epigenetic Role of Histone 3 Lysine Methyltransferase and Demethylase in Regulating Apoptosis Predicting the Recurrence of Atypical Meningioma. J Korean Med Sci 2015; 30:1157-66. [PMID: 26240495 PMCID: PMC4520948 DOI: 10.3346/jkms.2015.30.8.1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 04/07/2015] [Indexed: 12/27/2022] Open
Abstract
Alteration of apoptosis is related with progression and recurrence of atypical meningiomas (AMs). However, no comprehensive study has been conducted regarding histone modification regulating apoptosis in AMs. This study aimed to determine the prognostic values of certain apoptosis-associated factors, and examine the role of histone modification on apoptosis in AMs. The medical records of 67 patients with AMs, as diagnosed during recent 13 yr, were reviewed retrospectively. Immunohistochemical staining was performed on archived paraffin-embedded tissues for pro-apoptotic factors (CASP3, IGFBP, TRAIL-R1, BAX, and XAF1), anti-apoptotic factors (survivin, ERK, RAF1, MDM2, and BCL2), and the histone modifying enzymes (MLL2, RIZ, EZH1, NSD2, KDM5c, JMJD2a, UTX, and JMJD5). Twenty-six (38.8%) patients recurred during the follow-up period (mean duration 47.7 months). In terms of time-to-recurrence (TTR), overexpression of CASP3, TRAIL-R1, and BAX had a longer TTR than low expression, and overexpression of survivin, MDM2, and BCL2 had a shorter TTR than low expression (P<0.05). Additionally, overexpression of MLL2, UTX, and JMJ5 had shorter TTRs than low expression, and overexpression of KDM5c had a longer TTR than low expression. However, in the multi-variate analysis of predicting factors for recurrence, low expression of CASP3 (P<0.001), and BAX (P<0.001), and overexpression of survivin (P=0.007), and MDM2 (P=0.037) were associated with recurrence independently, but any enzymes modifying histone were not associated with recurrence. Conclusively, this study suggests certain apoptosis-associated factors should be associated with recurrence of AMs, which may be regulated epigenetically by histone modifying enzymes.
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Affiliation(s)
- Sang Hyuk Lee
- Department of Neurosurgery and Division of Neurooncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eun Hee Lee
- Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung-Hun Lee
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Young Min Lee
- Department of Neurosurgery and Division of Neurooncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyung Dong Kim
- Department of Neurosurgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Young Zoon Kim
- Department of Neurosurgery and Division of Neurooncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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