1
|
Prakadan SM, Alvarez-Breckenridge CA, Markson SC, Kim AE, Klein RH, Nayyar N, Navia AW, Kuter BM, Kolb KE, Bihun I, Mora JL, Bertalan MS, Shaw B, White M, Kaplan A, Stocking JH, Wadsworth MH, Lee EQ, Chukwueke U, Wang N, Subramanian M, Rotem D, Cahill DP, Adalsteinsson VA, Miller JW, Sullivan RJ, Carter SL, Brastianos PK, Shalek AK. Genomic and transcriptomic correlates of immunotherapy response within the tumor microenvironment of leptomeningeal metastases. Nat Commun 2021; 12:5955. [PMID: 34642316 PMCID: PMC8511044 DOI: 10.1038/s41467-021-25860-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
Leptomeningeal disease (LMD) is a devastating complication of solid tumor malignancies, with dire prognosis and no effective systemic treatment options. Over the past decade, the incidence of LMD has steadily increased due to therapeutics that have extended the survival of cancer patients, highlighting the need for new interventions. To examine the efficacy of immune checkpoint inhibitors (ICI) in patients with LMD, we completed two phase II clinical trials. Here, we investigate the cellular and molecular features underpinning observed patient trajectories in these trials by applying single-cell RNA and cell-free DNA profiling to longitudinal cerebrospinal fluid (CSF) draws from enrolled patients. We recover immune and malignant cell types in the CSF, characterize cell behavior changes following ICI, and identify genomic features associated with relevant clinical phenomena. Overall, our study describes the liquid LMD tumor microenvironment prior to and following ICI treatment and demonstrates clinical utility of cell-free and single-cell genomic measurements for LMD research.
Collapse
Affiliation(s)
- Sanjay M Prakadan
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Christopher A Alvarez-Breckenridge
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Neurosurgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Samuel C Markson
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Albert E Kim
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Robert H Klein
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naema Nayyar
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Andrew W Navia
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Benjamin M Kuter
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Kellie E Kolb
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Ivanna Bihun
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Joana L Mora
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Mia Solana Bertalan
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Brian Shaw
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Michael White
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Kaplan
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Jackson H Stocking
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Marc H Wadsworth
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ugonma Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy Wang
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Megha Subramanian
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Denisse Rotem
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Viktor A Adalsteinsson
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey W Miller
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ryan J Sullivan
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Scott L Carter
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Priscilla K Brastianos
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.
| | - Alex K Shalek
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Broad Institute, Harvard University & Massachusetts Institute of Technology, Cambridge, MA, USA.
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, & Massachusetts General Hospital, Cambridge, MA, USA.
- Division of Health Science & Technology, Harvard Medical School, Cambridge, MA, USA.
- Program in Computational & Systems Biology, Massachusetts Institute of Technology, Cambridge, MA, USA.
| |
Collapse
|
2
|
Brastianos PK, Strickland MR, Lee EQ, Wang N, Cohen JV, Chukwueke U, Forst DA, Eichler A, Overmoyer B, Lin NU, Chen WY, Bardia A, Juric D, Dagogo-Jack I, White MD, Dietrich J, Nayyar N, Kim AE, Alvarez-Breckenridge C, Mahar M, Mora JL, Nahed BV, Jones PS, Shih HA, Gerstner ER, Giobbie-Hurder A, Carter SL, Oh K, Cahill DP, Sullivan RJ. Phase II study of ipilimumab and nivolumab in leptomeningeal carcinomatosis. Nat Commun 2021; 12:5954. [PMID: 34642329 PMCID: PMC8511104 DOI: 10.1038/s41467-021-25859-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Leptomeningeal disease (LMD) is a common complication from solid tumor malignancies with a poor prognosis and limited treatment options. We present a single arm Phase II study of 18 patients with LMD receiving combined ipilimumab and nivolumab until progression or unacceptable toxicity (NCT02939300). The primary end point is overall survival at 3 months (OS3). Secondary end points include toxicity, cumulative time-to-progression at 3 months, and progression-free survival. A Simon two-stage design is used to compare a null hypothesis OS3 of 18% against an alternative of 44%. Median follow up based on patients still alive is 8.0 months (range: 0.5 to 15.9 months). The study has met its primary endpoint as 8 of 18 (OS3 0.44; 90% CI: 0.24 to 0.66) patients are alive at three months. One third of patients have experienced one (or more) grade-3 or higher adverse events. Two patients have discontinued protocol treatment due to unacceptable toxicity (hepatitis and colitis, respectively). The most frequent adverse events include fatigue (N = 7), nausea (N = 6), fever (N = 6), anorexia (N = 6) and rash (N = 6). Combined ipilimumab and nivolumab has an acceptable safety profile and demonstrates promising activity in LMD patients. Larger, multicenter clinical trials are needed to validate these results.
Collapse
Affiliation(s)
| | - Matthew R Strickland
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy Wang
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Justine V Cohen
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ugonma Chukwueke
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | - April Eichler
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Beth Overmoyer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Wendy Y Chen
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Aditya Bardia
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Dejan Juric
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Michael D White
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jorg Dietrich
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Naema Nayyar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Albert E Kim
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Maura Mahar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joana L Mora
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian V Nahed
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Pamela S Jones
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Helen A Shih
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | | | - Scott L Carter
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Kevin Oh
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniel P Cahill
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ryan J Sullivan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| |
Collapse
|
3
|
Soni P, Davison MA, Shao J, Momin A, Lopez D, Angelov L, Barnett GH, Lee JH, Mohammadi AM, Kshettry VR, Recinos PF. Extent of resection and survival outcomes in World Health Organization grade II meningiomas. J Neurooncol 2020; 151:173-179. [PMID: 33205354 DOI: 10.1007/s11060-020-03632-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE WHO grade II meningiomas behave aggressively, with recurrence rates as high as 60%. Although complete resection in low-grade meningiomas is associated with a relatively low recurrence rate, the impact of complete resection for WHO grade II meningiomas is less clear. We studied the association of extent of resection with overall and progression-free survivals in patients with WHO grade II meningiomas. METHODS A retrospective database review was performed to identify all patients who underwent surgical resection for intracranial WHO grade II meningiomas at our institution between 1995 and 2019. Kaplan-Meier analysis was used to compare overall and progression-free survivals between patients who underwent gross total resection (GTR) and those who underwent subtotal resection (STR). Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and mortality. RESULTS Of 214 patients who underwent surgical resection for WHO grade II meningiomas (median follow-up 53.4 months), 158 had GTR and 56 had STR. In Kaplan-Meier analysis, patients who underwent GTR had significantly longer progression-free (p = 0.002) and overall (p = 0.006) survivals than those who underwent STR. In multivariable Cox proportional-hazards analysis, GTR independently predicted prolonged progression-free (HR 0.57, p = 0.038) and overall (HR 0.44, p = 0.017) survivals when controlling for age, tumor location, and adjuvant radiation. CONCLUSIONS Extent of resection independently predicts progression-free and overall survivals in patients with WHO grade II meningiomas. In an era of increasing support for adjuvant treatment modalities in the management of meningiomas, our data support maximal safe resection as the primary goal in treatment of these patients.
Collapse
Affiliation(s)
- Pranay Soni
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Davison
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
| | - Jianning Shao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Arbaz Momin
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Diana Lopez
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Lilyana Angelov
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Gene H Barnett
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joung H Lee
- Department of Neurological Surgery, Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Alireza M Mohammadi
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Varun R Kshettry
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Pablo F Recinos
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA.
- Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
4
|
Giordan E, Marton E, Wennberg AM, Guerriero A, Canova G. A review of solitary fibrous tumor/hemangiopericytoma tumor and a comparison of risk factors for recurrence, metastases, and death among patients with spinal and intracranial tumors. Neurosurg Rev 2020; 44:1299-1312. [PMID: 32556679 DOI: 10.1007/s10143-020-01335-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
Meningeal solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) had been combined into a single classification until 2016. Recurrence and metastases rates are still understudied, especially for spinal SFT/HPCs. Here, we describe CNS SFT/HPCs and predictors for recurrence, metastases, and death, in spinal and intracranial SFT/HPCs, separately. We collected data from studies with patient-level data available on primary SFT/HPCs from multiple online databases. Clinico-demographic data, surgical outcomes, recurrence, metastases, and death rates were abstracted. We used logistic and Cox regression models to identify predictors for recurrence, metastases, and death for spinal and intracranial SFT/HPCs. Twenty-nine studies (368 patients) were included. Higher histological grade and subtotal resection were associated with recurrence (p values < 0.05), while higher histological grade and recurrence (p values < 0.005) were associated with metastases formation. Time to recurrence (p < 0.005) and metastases (p < 0.001) formation were shorter for spinal SFT/HPCs. Death rates were higher among intracranial SFT/HPC patients (p value = 0.001). Among patients with higher histological grade, rates of metastases formation were different between intracranial and spinal SFT/HPCs. Risk of metastases was higher in the first 5 years from surgery for both intracranial and spinal SFT/HPCs. Meningeal SFT/HPCs patients have high rates of recurrence and metastasis, which occur mostly within the first 5 years after diagnosis. Spinal and intracranial SFT/HPCs show similar behavior, but spinal SFT/HPCs tend to develop metastases and recurrences in a shorter interval of time. Careful follow-up for spinal SFT/HPCs should be considered because spinal cases seem to be slightly more aggressive and require more attention.
Collapse
Affiliation(s)
- Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, Treviso, Italy.
| | | | - Alexandra M Wennberg
- Department of Neuroscience, University of Padova and Padova Neuroscience Center, Padova, Italy
| | - Angela Guerriero
- Department of Pathology, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Canova
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, Treviso, Italy
| |
Collapse
|
5
|
Bunevicius A, Laws ER, Saudargiene A, Tamasauskas A, Iervasi G, Deltuva V, Smith TR, Bunevicius R. Common genetic variations of deiodinase genes and prognosis of brain tumor patients. Endocrine 2019; 66:563-572. [PMID: 31452060 DOI: 10.1007/s12020-019-02016-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Thyroid hormone (TH) metabolism can have prognostic significance in brain tumors. We studied the association of common variations in three deiodinase gene single-nucleotide polymorphisms (SNPs) with circulating TH concentrations and prognosis of brain tumor patients. METHODS Patients admitted for glioma and meningioma surgery between January, 2010 and September, 2011 were evaluated for functional status (Barthel Index or BI) and circulating free tri-iodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) concentrations. Ten common SNPs in the DIO1 gene; five SNPs in the DIO2 gene; and one SNP in the DIO3 gene were genotyped. Follow-up continued until November, 2017. RESULTS In glioblastoma patients, the DIO1 SNP rs2235544 CC genotype was associated with significantly lower risk of death at 2 years when compared to AA + CA genotypes after adjusting for patient gender, age, pre-operative functional status, adjuvant therapy, and extent of resection (HR = 0.34, 95% CI: 0.13-0.84, p = 0.019). The TT genotype vs. CC + TC genotypes of the DI02 SNP rs12885300 was associated with increased mortality risk after adjusting for patient gender, age, pre-operative functional status, adjuvant therapy, extent of resection, and FT3/FT4 (HR = 3.13, 95% CI: 1.20-8.16, p < 0.019). The C-allele of the DI01 SNP rs2235544 was related to increased circulating free T3/ free T4 ratio in glioma and meningioma patients, indicating greater T4 to T3 conversion. CONCLUSIONS SNPs of DIO1 gene (rs2235544) and DIO2 gene (rs12885300) have independent prognostic significance in glioblastoma patients. The C-allele of the DIO1 (rs2235544) is associated with greater T4 to T3 conversion.
Collapse
Affiliation(s)
- Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Brigham and Women's Hospital, Boston, MA, USA.
- Harvard University, Boston, MA, USA.
| | - Edward R Laws
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard University, Boston, MA, USA
| | - Ausra Saudargiene
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Vytenis Deltuva
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Timothy R Smith
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard University, Boston, MA, USA
| | | |
Collapse
|
6
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
7
|
Cardona AF, Ruiz-Patiño A, Zatarain-Barrón ZL, Hakim F, Jiménez E, Mejía JA, Ramón JF, Useche N, Bermúdez S, Pineda D, Cifuentes H, Rojas L, Ricaurte L, Pino LE, Balaña C, Arrieta O. Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib. PLoS One 2019; 14:e0217340. [PMID: 31220093 PMCID: PMC6586269 DOI: 10.1371/journal.pone.0217340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/10/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the effectiveness of octreotide/everolimus vs. sunitinib for the systemic treatment of recurrent aggressive meningiomas. Methods 31 patients with recurrent or refractory WHO II or WHO III meningiomas were examined in two reference centers in Colombia. Patients who had systemic treatment (sunitinib, everolimus/octreotide) and a complete follow-up were included. Overall survival (OS), progression-free survival (PFS) and toxicities were evaluated. Additionally, tissue samples were examined for PDGFRβ and VEGFR2, their expression was correlated with outcomes. Results Twenty-two patients (72%) were female with a median age of 55 years (SD±15.3). The most prevalent histology was anaplastic meningioma in 20 patients (65%) with 48% of patients suffering from three previous relapses before the start of systemic treatment. A total of 14 patients received combination therapy with octreotide/everolimus, 11 received sunitinib and the remaining 6 received other second-line agents. Median OS was 37.3 months (95%CI 28.5–42.1) and the PFS during the treatment with everolimus/octreotide (EO) and sunitinib (Su) was 12.1 months (95%CI 9.2–21.1) and 9.1 months (95%CI 6.8–16.8); p = 0.43), respectively. The OS of the group treated with the EO→Su→Bev sequence (1st/2nd/3rd line) was 6.5 months longer than the Su→EO→Bev sequence (36.0 vs. 29.5 months) (p = 0.0001). When analyzing molecular markers, the positive PDGFRβ and negative VEGFR2 expression were associated with longer survival both in OS and PFS. Conclusion Sunitinib and octreotide/everolimus have similar efficacy and safety in the systemic management of refractory meningioma. VEGFR2 and PDGFRβ expression are associated with better outcomes.
Collapse
Affiliation(s)
- Andrés F. Cardona
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
- Molecular Oncology and Biology Systems Group (G-FOX), Universidad El Bosque, Bogotá, Colombia
- * E-mail: ,
| | | | | | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Enrique Jiménez
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Juan Armando Mejía
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Juan Fernando Ramón
- Neurosurgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
| | - Nicolás Useche
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Neuroscience Department, Universidad El Bosque, Bogotá, Colombia
- Neuroradiology Section, Radiology Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Diego Pineda
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Neuroradiology Section, Clínica del Country, Bogotá, Colombia
| | | | - Leonardo Rojas
- Brain Tumor Section, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research–FICMAC, Bogotá, Colombia
| | - Luis Eduardo Pino
- Clinical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carmen Balaña
- Neuro-Oncology Section, Oncology Department, Hospital Germans Trias I Pujol, Catalan Institute of Oncology–ICO, Barcelona, Spain
| | - Oscar Arrieta
- Laboratory of Experimental Oncology, Instituto Nacional de Cancerología (INCaN), México City, México
| |
Collapse
|
8
|
Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS. Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005-2015, using the Central Brain Tumor Registry of the United States. Neuro Oncol 2019; 21:380-391. [PMID: 30295804 PMCID: PMC6380426 DOI: 10.1093/neuonc/noy162] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meningioma incidence increases significantly with age. In the expanding elderly population, we lack complete understanding of population-based trends in meningioma incidence/survival. We provide an updated, comprehensive analysis of meningioma incidence and survival for individuals aged over 65. METHODS Data were obtained from the Central Brain Tumor Registry of the United States (CBTRUS) from 2005-2015 for nonmalignant and malignant meningioma. Age-adjusted incidence rates per 100000 person-years were analyzed by age, sex, race, ethnicity, location, and treatment modalities. Survival was analyzed using Kaplan-Meier and multivariable Cox proportional hazards models for a subset of CBTRUS data. RESULTS Nonmalignant meningioma incidence doubled from adults age 65-69 years to adults over age 85 years and was significantly greater in females than males for all ages. Malignant meningioma incidence did not differ by sex for any age grouping. Nonmalignant and malignant meningioma incidence was significantly greater in black populations versus others. Nonmalignant meningioma survival was worse with age, in black populations, and in males, including when analyzed by 5-year age groups. Surgical resection and radiation did not improve survival compared with resection alone in nonmalignant meningioma. CONCLUSIONS This study reports increasing nonmalignant meningioma incidence in the elderly, increased incidence in black populations, and in females. In contrast, malignant meningioma incidence did not differ between sexes. Risk of death was higher for black individuals and males. Additionally, radiation did not confer a survival advantage when combined with resection for nonmalignant meningioma. Thus, we identify clinically relevant discrepancies in meningioma incidence/survival that require further study.
Collapse
Affiliation(s)
- Rebecca L Achey
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Julia Schroer
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vishesh Khanna
- Department of Internal Medicine, Stanford University, Stanford, California
| | - Carol Kruchko
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| |
Collapse
|
9
|
Ros-Sanjuan A, Iglesias-Moroño S, Carrasco-Brenes A, Bautista-Ojeda D, Arraez-Sanchez MA. Atypical Meningiomas: Histologic and Clinical Factors Associated With Recurrence. World Neurosurg 2019; 125:e248-e256. [PMID: 30684705 DOI: 10.1016/j.wneu.2019.01.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atypical meningioma is a heterogeneous group of tumors with an unpredictable behavior. Our objectives were to study patients with atypical meningioma, monitor their follow-up, identify the histologic characteristics, and analyze factors associated with severe outcomes. METHODS This retrospective study involved 28 patients with atypical meningioma from 1994 to 2014. The histologic samples were reviewed under current criteria. The association with recurrence and survival was analyzed statistically for clinical, therapeutic, histologic, and molecular factors. RESULTS The average age at the time of diagnosis was 55.5 years (range, 18-83 years) and 57% were female. Total resection (Simpson grade I) was performed in 10 cases (38%). Adjuvant radiotherapy was given to 13 patients. During the 77-month follow-up, 64% had a recurrence or progression. The average time to first recurrence and overall survival were 43.83 months and 149 months, respectively. Recurrence was found in 85% of the patients whose samples presented necrosis. Of the tumors, 84% showed a high mitotic index (4-20 mitoses/10 high-power field). Of the 4 patients with a low mitotic index (<4 mitoses/10 high-power field), the degree of resection was subtotal and 3 experienced disease progression. Of patients with Ki67 >9.9%, 67% had recurrence. The degree of resection was the only variable significantly associated with tumor recurrence. CONCLUSIONS The high rate of recurrence observed and the short disease-free survival exemplify the unpredictable behavior of atypical meningiomas. Total resection was the only significant factor associated with recurrence. However, the presence of atypical features, such as necrosis or high Ki67, is frequent in patients with disease progression.
Collapse
Affiliation(s)
- Angela Ros-Sanjuan
- Neurosurgery Department, Hospital Regional Universitario, Malaga, Spain.
| | | | | | | | | |
Collapse
|
10
|
Shackleford GM, Mahdi MY, Moats RA, Hawes D, Tran HC, Finlay JL, Hoang TQ, Meng EF, Erdreich-Epstein A. Continuous and bolus intraventricular topotecan prolong survival in a mouse model of leptomeningeal medulloblastoma. PLoS One 2019; 14:e0206394. [PMID: 30608927 PMCID: PMC6319703 DOI: 10.1371/journal.pone.0206394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/18/2018] [Indexed: 01/12/2023] Open
Abstract
Leptomeningeal metastasis remains a difficult clinical challenge. Some success has been achieved by direct administration of therapeutics into the cerebrospinal fluid (CSF) circumventing limitations imposed by the blood brain barrier. Here we investigated continuous infusion versus bolus injection of therapy into the CSF in a preclinical model of human Group 3 medulloblastoma, the molecular subgroup with the highest incidence of leptomeningeal disease. Initial tests of selected Group 3 human medulloblastoma cell lines in culture showed that D283 Med and D425 Med were resistant to cytosine arabinoside and methotrexate. D283 Med cells were also resistant to topotecan, whereas 1 μM topotecan killed over 99% of D425 Med cells. We therefore introduced D425 Med cells, modified to express firefly luciferase, into the CSF of immunodeficient mice. Mice were then treated with topotecan or saline in five groups: continuous intraventricular (IVT) topotecan via osmotic pump (5.28 μg/day), daily bolus IVT topotecan injections with a similar daily dose (6 μg/day), systemic intraperitoneal injections of a higher daily dose of topotecan (15 μg/day), daily IVT pumped saline and daily intraperitoneal injections of saline. Bioluminescence analyses revealed that both IVT topotecan treatments effectively slowed leptomeningeal tumor growth in the brains. Histological analysis showed that they were associated with localized brain necrosis, possibly due to backtracking of topotecan around the catheter. In the spines, bolus IVT topotecan showed a trend towards slower tumor growth compared to continuous (pump) IVT topotecan, as measured by bioluminescence. Both continuous and bolus topotecan IVT showed longer survival compared to other groups. Thus, both direct IVT topotecan CSF delivery methods produced better anti-medulloblastoma effect compared to systemic therapy at the dosages used here.
Collapse
Affiliation(s)
- Gregory M. Shackleford
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United states of America
| | - Min Y. Mahdi
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United states of America
| | - Rex A. Moats
- Department of Radiology, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United states of America
| | - Debra Hawes
- Department of Pathology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, United states of America
| | - Hung C. Tran
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United states of America
| | - Jonathan L. Finlay
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United states of America
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United states of America
| | - Tuan Q. Hoang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United states of America
| | - Ellis F. Meng
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United states of America
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California, United states of America
| | - Anat Erdreich-Epstein
- Department of Pathology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, United states of America
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Pediatrics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United states of America
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United states of America
| |
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
12
|
Zattra CM, Zhang DY, Broggi M, Velz J, Vasella F, Seggewiss D, Schiavolin S, Bozinov O, Krayenbühl N, Sarnthein J, Ferroli P, Regli L, Stienen MN. Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes. J Neurooncol 2018; 142:49-57. [PMID: 30474767 PMCID: PMC6399174 DOI: 10.1007/s11060-018-03058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
Purpose Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process. Electronic supplementary material The online version of this article (10.1007/s11060-018-03058-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Costanza Maria Zattra
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - David Y Zhang
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Morgan Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Julia Velz
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominik Seggewiss
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Silvia Schiavolin
- Public Health and Disability Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Paolo Ferroli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| |
Collapse
|
13
|
Collord G, Tarpey P, Kurbatova N, Martincorena I, Moran S, Castro M, Nagy T, Bignell G, Maura F, Young MD, Berna J, Tubio JMC, McMurran CE, Young AMH, Sanders M, Noorani I, Price SJ, Watts C, Leipnitz E, Kirsch M, Schackert G, Pearson D, Devadass A, Ram Z, Collins VP, Allinson K, Jenkinson MD, Zakaria R, Syed K, Hanemann CO, Dunn J, McDermott MW, Kirollos RW, Vassiliou GS, Esteller M, Behjati S, Brazma A, Santarius T, McDermott U. An integrated genomic analysis of anaplastic meningioma identifies prognostic molecular signatures. Sci Rep 2018; 8:13537. [PMID: 30202034 PMCID: PMC6131140 DOI: 10.1038/s41598-018-31659-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/16/2018] [Indexed: 12/21/2022] Open
Abstract
Anaplastic meningioma is a rare and aggressive brain tumor characterised by intractable recurrences and dismal outcomes. Here, we present an integrated analysis of the whole genome, transcriptome and methylation profiles of primary and recurrent anaplastic meningioma. A key finding was the delineation of distinct molecular subgroups that were associated with diametrically opposed survival outcomes. Relative to lower grade meningiomas, anaplastic tumors harbored frequent driver mutations in SWI/SNF complex genes, which were confined to the poor prognosis subgroup. Aggressive disease was further characterised by transcriptional evidence of increased PRC2 activity, stemness and epithelial-to-mesenchymal transition. Our analyses discern biologically distinct variants of anaplastic meningioma with prognostic and therapeutic significance.
Collapse
Affiliation(s)
- Grace Collord
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Patrick Tarpey
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Natalja Kurbatova
- European Molecular Biology Laboratory, European Bioinformatics Institute, EMBL-EBI, Wellcome Trust Genome Campus, Hinxton, CB10 1SD, UK
| | - Inigo Martincorena
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Sebastian Moran
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Manuel Castro
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Tibor Nagy
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Graham Bignell
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Francesco Maura
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matthew D Young
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Jorge Berna
- Mobile Genomes and Disease, Molecular Medicine and Chronic diseases Centre (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, 15706, Spain
| | - Jose M C Tubio
- Mobile Genomes and Disease, Molecular Medicine and Chronic diseases Centre (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, 15706, Spain
| | - Chris E McMurran
- Department of Neurosurgery, Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Adam M H Young
- Department of Neurosurgery, Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Mathijs Sanders
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Erasmus University Medical Center, Department of Hematology, Rotterdam, The Netherlands
| | - Imran Noorani
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Neurosurgery, Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Stephen J Price
- Department of Neurosurgery, Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Colin Watts
- Department of Neurosurgery, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Elke Leipnitz
- Klinik und Poliklink für Neurochirurgie, "Carl Gustav Carus" Universitätsklinikum, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Matthias Kirsch
- Klinik und Poliklink für Neurochirurgie, "Carl Gustav Carus" Universitätsklinikum, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Gabriele Schackert
- Klinik und Poliklink für Neurochirurgie, "Carl Gustav Carus" Universitätsklinikum, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Danita Pearson
- Department of Pathology, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
| | - Abel Devadass
- Department of Pathology, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
| | - Zvi Ram
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - V Peter Collins
- Department of Pathology, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
| | - Kieren Allinson
- Department of Pathology, Cambridge University Hospital, CB2 0QQ, Cambridge, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre, Liverpool, L9 7LJ, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, L9 7LJ, UK
| | - Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre, Liverpool, L9 7LJ, UK
- Institute of Integrative Biology, University of Liverpool, Liverpool, L9 7LJ, UK
| | - Khaja Syed
- Department of Neurosurgery, The Walton Centre, Liverpool, L9 7LJ, UK
- Institute of Integrative Biology, University of Liverpool, Liverpool, L9 7LJ, UK
| | - C Oliver Hanemann
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, Devon, PL4 8AA, UK
| | - Jemma Dunn
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, Devon, PL4 8AA, UK
| | - Michael W McDermott
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, 94143-0112, USA
| | - Ramez W Kirollos
- Department of Neurosurgery, Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - George S Vassiliou
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Haematology, Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK
| | - Manel Esteller
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Catalonia, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
| | - Sam Behjati
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Alvis Brazma
- European Molecular Biology Laboratory, European Bioinformatics Institute, EMBL-EBI, Wellcome Trust Genome Campus, Hinxton, CB10 1SD, UK
| | - Thomas Santarius
- Department of Neurosurgery, Department of Clinical Neuroscience, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
| | - Ultan McDermott
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK.
- Institute of Translational Medicine, University of Liverpool, Liverpool, L9 7LJ, UK.
- AstraZeneca, CRUK Cambridge Institute, Robinson Way, Cambridge, CB2 0RE, UK.
| |
Collapse
|
14
|
Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashby LS, Modi JM, Alleman AM, Galvin J, Brachman D, Jenrette JM, De Groot J, Bovi JA, Werner-Wasik M, Knisely JPS, Mehta MP. Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 2018; 129:35-47. [PMID: 28984517 PMCID: PMC5889346 DOI: 10.3171/2016.11.jns161170] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This is the first clinical outcomes report of NRG Oncology RTOG 0539, detailing the primary endpoint, 3-year progression-free survival (PFS), compared with a predefined historical control for intermediate-risk meningioma, and secondarily evaluating overall survival (OS), local failure, and prospectively scored adverse events (AEs). METHODS NRG Oncology RTOG 0539 was a Phase II clinical trial allocating meningioma patients to 1 of 3 prognostic groups and management strategies according to WHO grade, recurrence status, and resection extent. For the intermediate-risk group (Group 2), eligible patients had either newly diagnosed WHO Grade II meningioma that had been treated with gross-total resection (GTR; Simpson Grades I-III) or recurrent WHO Grade I meningioma with any resection extent. Pathology and imaging were centrally reviewed. Patients were treated with radiation therapy (RT), either intensity modulated (IMRT) or 3D conformal (3DCRT), 54 Gy in 30 fractions. The RT target volume was defined as the tumor bed and any nodular enhancement (e.g., in patients with recurrent WHO Grade I tumors) with a minimum 8-mm and maximum 15-mm margin, depending on tumor location and setup reproducibility of the RT method. The primary endpoint was 3-year PFS. Results were compared with historical controls (3-year PFS: 70% following GTR alone and 90% with GTR + RT). AEs were scored using NCI Common Toxicity Criteria. RESULTS Fifty-six patients enrolled in the intermediate-risk group, of whom 3 were ineligible and 1 did not receive RT. Of the 52 patients who received protocol therapy, 4 withdrew without a recurrence before 3 years leaving 48 patients evaluable for the primary endpoint, 3-year PFS, which was actuarially 93.8% (p = 0.0003). Within 3 years, 3 patients experienced events affecting PFS: 1 patient with a WHO Grade II tumor died of the disease, 1 patient with a WHO Grade II tumor had disease progression but remained alive, and 1 patient with recurrent WHO Grade I meningioma died of undetermined cause without tumor progression. The 3-year actuarial local failure rate was 4.1%, and the 3-year OS rate was 96%. After 3 years, progression occurred in 2 additional patients: 1 patient with recurrent WHO Grade I meningioma and 1 patient with WHO Grade II disease; both remain alive. Among 52 evaluable patients who received protocol treatment, 36 (69.2%) had WHO Grade II tumors and underwent GTR, and 16 (30.8%) had recurrent WHO Grade I tumors. There was no significant difference in PFS between these subgroups (p = 0.52, HR 0.56, 95% CI 0.09-3.35), validating their consolidation. Of the 52 evaluable patients, 44 (84.6%) received IMRT, and 50 (96.2%) were treated per protocol or with acceptable variation. AEs (definitely, probably, or possibly related to protocol treatment) were limited to Grade 1 or 2, with no reported Grade 3 events. CONCLUSIONS This is the first clinical outcomes report from NRG Oncology RTOG 0539. Patients with intermediate-risk meningioma treated with RT had excellent 3-year PFS, with a low rate of local failure and a low risk of AEs. These results support the use of postoperative RT for newly diagnosed gross-totally resected WHO Grade II or recurrent WHO Grade I meningioma irrespective of resection extent. They also document minimal toxicity and high rates of tumor control with IMRT. Clinical trial registration no.: NCT00895622 (clinicaltrials.gov).
Collapse
Affiliation(s)
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | - Arie Perry
- University of California-San Francisco, CA
| | | | | | | | | | | | | | - John De Groot
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | |
Collapse
|
15
|
Abstract
Since 1976 the Lombardy Cancer Registry (RTL) has recorded all malignant tumors and the benign tumors of the nervous system, bladder and liver occurring in the Varese province. The aims of this report are: to describe age-specific incidence rates of the different oncotypes of primary nervous system tumors (PNSTs) and to analyze the duration of survival of the patients according to the histotype of the neoplasm. From 1976 to 1981, the RTL recorded 498 PNST: 213 tumors of glial origin, 132 tumors of mesodermal tissues, 15 tumors of multipotential cell origin, 37 tumors of nerve roots, 8 of vascular origin, and 54 PNST in which the histotype was not specified. For tumors of glial origin, the 60–69 year age class showed the highest incidence rate: 16 per 100,000/year. The incidence rate of tumors of mesodermal tissues reached the maximum value of 7.9 per 100,000/year in the age group of 75 years and over. Tumors of multipotential cell origin had a maximum incidence of 2.2 in the 60–69 year age class. The probability of survival at 5 years after diagnosis was computed by the method of Kaplan and Meier (15), and the log rank procedure was used to test statistical differences among survivors. Tumors of glial origin, excluding ependymomas and papillomas of choroid plexus, had a 5-year survival probability of 14%. Age (categorized in ≤50 and > 50 years) and histologic grade (grades I+II and grades III+IV) were analyzed as prognostic factors for tumors of glial origin: a younger age was the most predictive prognostic factor in grade I+II tumors (probability of survival = 53% in the group ≤50 years vs 0 in the group > 50 years; p < 0.005). In the less differentiated tumors there were no differences between the two age groups. Patients with tumors of mesodermal tissues had a 5-year probability of survival of 83%. Subjects younger than 50 years had a probability of survival of 95%, whereas older patients had a probability of 79%. For the other oncotypes, the 5-year survival probability was: 50% for tumors of multipotential cell origin, 63% for ependymomas and papillomas of the choroid plexus, 64% for tumors of vascular derivation, and 21% for PNST with not specified histotype.
Collapse
Affiliation(s)
- M Sant
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Servizio di Epidemiologia, Milano, Italia
| | | | | | | | | | | |
Collapse
|
16
|
De B, Kinnaman MD, Wexler LH, Kramer K, Wolden SL. Central nervous system relapse of rhabdomyosarcoma. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26710. [PMID: 28696016 PMCID: PMC7343338 DOI: 10.1002/pbc.26710 10.1002/pbc.26766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/26/2017] [Accepted: 06/12/2017] [Indexed: 11/24/2023]
Abstract
PURPOSE The optimal management of central nervous system (CNS) relapse of rhabdomyosarcoma (RMS) is unclear. We examined diagnosis, management, and outcomes of patients with RMS developing CNS relapse. METHODS Records of 23 patients diagnosed with CNS relapse between 1999 and 2016 were reviewed. Median age at presentation of CNS relapse was 15 years (range, 1-34 years). High-risk features at initial presentation were as follows: 16 alveolar patients, 13 Stage IV, and 13 with primary tumor in parameningeal locations. RESULTS CNS relapse occurred at a median 12 months (range, 1-23 months) from diagnosis and most common presenting symptoms were headache (n = 9), nausea/vomiting (n = 8), visual difficulty (n = 5), and none (n = 5). Leptomeningeal metastases were detected in 21 patients while only 2 developed parenchymal metastases without leptomeningeal involvement. Fifteen patients received CNS-directed radiation therapy (RT), including craniospinal irradiation to a median 36 Gy (range, 18-36 Gy) and/or whole brain radiotherapy to a median 30 Gy (range, 6-41.4 Gy). Three patients received concurrent chemotherapy. Follow-up magnetic resonance imaging was conducted in 13 patients after RT initiation with 8 demonstrating improvement, 2 with stable disease, and 3 with progression. Twelve patients were tested for reactivity to I-131-labeled monoclonal antibody 8H9, and three tested positive and received at least one intra-Ommaya dose; all three lived >12 months post-CNS relapse. Twenty‐two patients died of CNS disease and one of treatment complications, with metastatic disease at other sites. Median survival post-CNS relapse was 5 months (range, 0.1-49 months). CONCLUSIONS The prognosis for patients with RMS developing CNS relapse remains poor. Treatment including CNS-directed RT should be considered and investigation into preventative therapies is warranted.
Collapse
Affiliation(s)
- Brian De
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael D. Kinnaman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H. Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
17
|
Góes P, Santos BFO, Suzuki FS, Salles D, Stávale JN, Cavalheiro S, de Paiva Neto MA. Necrosis is a consistent factor to recurrence of meningiomas: should it be a stand-alone grading criterion for grade II meningioma? J Neurooncol 2017; 137:331-336. [PMID: 29270884 DOI: 10.1007/s11060-017-2721-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate spontaneous necrosis as a possible isolated factor for progression and recurrence in grade I meningiomas classified according to the current World Health Organization (WHO) classification. Meningiomas are the most frequently reported primary intracranial tumours, accounting for more than 35%. The 2016 WHO classification of central nervous system tumors stratifies meningiomas in grades I (benign), II (atypical), and III (malignant), according to histopathological aspects and the risk of progression or recurrence. Among 110 patients with intracranial meningiomas, 70 were WHO grade I meningiomas with no findings of atypia (G1WON), 15 were WHO grade I with necrosis (G1WN), 21 were WHO grade II (G2), and 4 were WHO grade III (G3). The mean follow-up was 5.9 ± 0.2 years. High performance scale (KPS ≥ 80) was different (p < 0.001) between WHO grade I meningiomas without (81.4%) and with (60%) necrosis. The 5-year mortality rate was 1.4, 6.7 and 5.9% for G1WON, G1WN and G2, respectively, with significant difference (p = 0.011) related to the presence of necrosis. The risk of recurrence was 3.7 times higher in G1WN than in G1WON (p = 0.017), and 4.2 times in G2 (p = 0.010). Progression-free survival (PFS) was clearly higher in patients with G1WON compared to G1WN and G2 (p = 0.002 and p < 0.001, respectively). There was no significant difference in PFS between G1WN and G2 (p = 0.692). Retreatment was also superior in meningioma with necrosis. Our findings provide clear statistical data to consider that patients with benign meningiomas and histologic findings of spontaneous necrosis are at increased risk of progression and recurrence compared to those with benign lesion without atypical features. Statistical analysis curves also suggest that these lesions behave more similarly to those currently classified as WHO grade II meningioma.
Collapse
Affiliation(s)
- Pedro Góes
- Department of Neurosurgery, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil.
| | | | - Fernando Seiji Suzuki
- Department of Neurosurgery, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - Débora Salles
- Department of Pathology, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - João Noberto Stávale
- Department of Pathology, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - Sérgio Cavalheiro
- Department of Neurosurgery, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | | |
Collapse
|
18
|
Dohm A, McTyre ER, Chan MD, Fan C, Isom S, Bourland JD, Mott RT, Cramer CK, Tatter SB, Laxton AW. Early or late radiotherapy following gross or subtotal resection for atypical meningiomas: Clinical outcomes and local control. J Clin Neurosci 2017; 46:90-98. [PMID: 28917587 PMCID: PMC5693228 DOI: 10.1016/j.jocn.2017.08.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
We report a single institution series of surgery followed by either early adjuvant or late radiotherapy for atypical meningiomas (AM). AM patients, by WHO 2007 definition, underwent subtotal resection (STR) or gross total resection (GTR). Sixty-three of a total 115 patients then received fractionated or stereotactic radiation treatment, early adjuvant radiotherapy (≤4months after surgery) or late radiotherapy (at the time of recurrence). Kaplan Meier method was used for survival analysis with competing risk analysis used to assess local failure. Overall survival (OS) at 1, 2, and 5years for all patients was 87%, 85%, 66%, respectively. Progression free survival (PFS) at 1, 2, and 5years for all patients was 65%, 30%, and 18%, respectively. OS at 1, 2, and 5years was 75%, 72%, 55% for surgery alone, and 97%, 95%, 75% for surgery+radiotherapy (log-rank p-value=0.0026). PFS at 1, 2, and 5years for patients undergoing surgery without early adjuvant radiotherapy was 64%, 49%, and 27% versus 81%, 73%, and 59% for surgery+early adjuvant radiotherapy (log-rank p-value=0.0026). The cumulative incidence of local failure at 1, 2, and 5years for patients undergoing surgery without early External Beam Radiation Therapy (EBRT) was 18.7%, 35.0%, and 52.9%, respectively, versus 4.2%, 13.3%, and 20.0% for surgery and early EBRT (p-value=0.02). Adjuvant radiotherapy improves OS in patients with AM. Early adjuvant radiotherapy improves PFS, likely due to the improvement in local control seen with early adjuvant EBRT.
Collapse
Affiliation(s)
- Ammoren Dohm
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States.
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Claire Fan
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ryan T Mott
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| |
Collapse
|
19
|
Zhang X. Expression, correlation and prognostic significance of CD133, P57 and HSF1 in meningioma. Eur Rev Med Pharmacol Sci 2017; 21:4600-4605. [PMID: 29131275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The present study investigated the expressions of CD133, P57 and HSF1 in meningioma so as to explore their protagonists in the prognosis of meningioma. PATIENTS AND METHODS The subjects in the present study included 57 cases of pathologically diagnosed patients with meningioma and 38 cases of non-meningioma patients. The immunofluorescence method was used to detect CD133, p57, and HSF1 expressions in the meningioma tissue. The reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used for expression studies in both the normal as well as meningioma tissues. RESULTS Immunofluorescence results showed high levels of expression of CD133, P57 and HSF1 in meningioma tissues. Further, the results of variance analyses confirmed that the expressions of CD133, P57, and HSF1 in meningioma tissues and normal brains tissue were significantly different (p < 0.01). CONCLUSIONS Expressions of CD133, p57, and HSF1 in meningioma are exceptionally high. The above observation could be exploited for the development of a novel treatment for a brain tumor and better clinical diagnosis as well.
Collapse
Affiliation(s)
- X Zhang
- Tianjin Brain Trauma Center, Tianjin Huanhu Hospital, Tianjin, China.
| |
Collapse
|
20
|
Abstract
We analyzed the characteristics of patients with World Health Organization (WHO) grade III meningioma to identify factors that may predict tumor recurrence and overall survival (OS).We retrospectively reviewed the patients diagnosed with WHO grade III meningioma who were surgically treated at our institute between 2008 and 2016. Survival outcome was assessed by Kaplan-Meier analysis. Cox regression analyses were performed to identify the prognostic factors associated with tumor recurrence and OS.Forty-two patients were included. The mean follow-up time was 23.2 months (range 2-75 months). At the end of analysis, 30 patients were found with tumor recurrence. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) were 51.6%, 33.9%, and 12.0%, respectively. At final follow-up, 23 patients were deceased, the 1-year, 3-year, and 5-year OS were 66.2%, 39.7%, and 35.8%, respectively. Twenty-eight newly diagnosed patients were included, and the 1-year, 3-year, and 5-year RFS were 63.5%, 44.3%, and 19.4%, respectively, and the 1-year, 3-year, and 5-year OS were 74.6%, 52.5%, and 46.7%, respectively. Extent of resection was the only factor associated with tumor recurrence and OS.WHO grade III meningioma is rare, and difficult to manage with a high rate of recurrence and poor OS. Extent of resection is an independent prognostic factor related to tumor recurrence and OS. We could not confirm the usefulness of Ki-67. We suggest that more aggressive treatment, such as safety maximizing cytoreduction by surgery, would improve treatment outcomes.
Collapse
Affiliation(s)
| | | | - Yanlin Song
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | |
Collapse
|
21
|
Olar A, Wani KM, Wilson CD, Zadeh G, DeMonte F, Jones DTW, Pfister SM, Sulman EP, Aldape KD. Global epigenetic profiling identifies methylation subgroups associated with recurrence-free survival in meningioma. Acta Neuropathol 2017; 133:431-444. [PMID: 28130639 PMCID: PMC5600514 DOI: 10.1007/s00401-017-1678-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Abstract
Meningioma is the most common primary brain tumor and carries a substantial risk of local recurrence. Methylation profiles of meningioma and their clinical implications are not well understood. We hypothesized that aggressive meningiomas have unique DNA methylation patterns that could be used to better stratify patient management. Samples (n = 140) were profiled using the Illumina HumanMethylation450BeadChip. Unsupervised modeling on a training set (n = 89) identified 2 molecular methylation subgroups of meningioma (MM) with significantly different recurrence-free survival (RFS) times between the groups: a prognostically unfavorable subgroup (MM-UNFAV) and a prognostically favorable subgroup (MM-FAV). This finding was validated in the remaining 51 samples and led to a baseline meningioma methylation classifier (bMMC) defined by 283 CpG loci (283-bMMC). To further optimize a recurrence predictor, probes subsumed within the baseline classifier were subject to additional modeling using a similar training/validation approach, leading to a 64-CpG loci meningioma methylation predictor (64-MMP). After adjustment for relevant clinical variables [WHO grade, mitotic index, Simpson grade, sex, location, and copy number aberrations (CNAs)] multivariable analyses for RFS showed that the baseline methylation classifier was not significant (p = 0.0793). The methylation predictor, however, was significantly associated with tumor recurrence (p < 0.0001). CNAs were extracted from the 450k intensity profiles. Tumor samples in the MM-UNFAV subgroup showed an overall higher proportion of CNAs compared to the MM-FAV subgroup tumors and the CNAs were complex in nature. CNAs in the MM-UNFAV subgroup included recurrent losses of 1p, 6q, 14q and 18q, and gain of 1q, all of which were previously identified as indicators of poor outcome. In conclusion, our analyses demonstrate robust DNA methylation signatures in meningioma that correlate with CNAs and stratify patients by recurrence risk.
Collapse
Affiliation(s)
- Adriana Olar
- Departments of Pathology and Laboratory Medicine and Neurosurgery, Medical University of South Carolina and Hollings Cancer Center, 171 Ashley Ave., MSC 908, Charleston, SC, 29425, USA.
| | - Khalida M Wani
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 W Holcombe Blvd., Houston, TX, 77030, USA
| | - Charmaine D Wilson
- Center for Nursing Research, The University of Texas School of Nursing, 6901 Bertner St., Houston, TX, 77030, USA
| | - Gelareh Zadeh
- Princess Margaret Cancer Centre, MacFeeters-Hamilton Brain Tumour Centre, College Street 101, Toronto, M5G 1L7, ON, Canada
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Network (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Network (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Erik P Sulman
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 W Holcombe Blvd., Houston, TX, 77030, USA
- Departments of Radiation Oncology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Kenneth D Aldape
- Princess Margaret Cancer Centre, MacFeeters-Hamilton Brain Tumour Centre, College Street 101, Toronto, M5G 1L7, ON, Canada
| |
Collapse
|
22
|
Vaubel RA, Chen SG, Raleigh DR, Link MJ, Chicoine MR, Barani I, Jenkins SM, Aleff PA, Rodriguez FJ, Burger PC, Dahiya S, Perry A, Giannini C. Meningiomas With Rhabdoid Features Lacking Other Histologic Features of Malignancy: A Study of 44 Cases and Review of the Literature. J Neuropathol Exp Neurol 2016; 75:44-52. [PMID: 26705409 PMCID: PMC5009417 DOI: 10.1093/jnen/nlv006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The behavior of rhabdoid meningiomas otherwise lacking malignant features remains unknown as most of the originally reported aggressive cases showed anaplastic histologic features independently of rhabdoid phenotype. We studied 44 patients with rhabdoid meningiomas lacking anaplastic features. Median age at diagnosis was 48.6 years (range 10-79). Location was supratentorial in 28 (63.6%), skull base in 15 (34.1%), and spinal in 1 (2.3%). Tumor grade was otherwise World Health Organization grade I (n = 22, 50%) or II (n = 22, 50%). Rhabdoid cells represented <20% of the tumor in 12 cases (27.3%), 20% to 50% in 18 (40.9%), and >50% in 14 (31.8%). Median clinical follow-up, available for 38 patients, was 5.0 years (range 0.17-14.2). Recurrence occurred in 9 patients (5-year recurrence-free survival, 73.7%) with a significantly higher risk in subtotally resected tumors (p = 0.043). Rhabdoid cell percentage was not associated with recurrence. Six patients died (4 of disease, 2 of unclear causes); 5-year overall survival was 86.7%, a mortality in excess of that expected in grade I-II meningiomas but much lower than originally reported. Review of 50 similar previously reported cases confirmed our findings. We suggest that rhabdoid meningiomas be graded analogously to nonrhabdoid tumors, with caution that some may still behave aggressively and close follow-up is recommended.
Collapse
Affiliation(s)
- Rachael A Vaubel
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Selby G Chen
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - David R Raleigh
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Michael J Link
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Michael R Chicoine
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Igor Barani
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Sarah M Jenkins
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Patrice Abell Aleff
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Fausto J Rodriguez
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Peter C Burger
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Sonika Dahiya
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Arie Perry
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California
| | - Caterina Giannini
- From the Department of Anatomic Pathology (RAV, CG), Mayo Clinic, Rochester Minnesota; Department of Neurosurgery (SGC), Mayo Clinic, Jacksonville, Florida; Department of Radiation Oncology (DRR, IB), University of California, San Francisco, California; Department of Neurosurgery (MJL), Mayo Clinic, Rochester Minnesota; Department of Neurologic Surgery (MRC), Washington University, St. Louis, Missouri; Departments of Biomedical Statistics and Informatics (SMJ), Mayo Clinic, Rochester Minnesota, Departments of Biochemistry and Molecular Biology (PAA), Mayo Clinic, Rochester Minnesota; Department of Pathology (FJR, PCB), Johns Hopkins University, Baltimore, Maryland; Departments of Pathology and Immunology/Anatomic and Molecular Pathology (SD), Washington University, St. Louis, Missouri; Department of Pathology (AP), University of California, San Francisco, California.
| |
Collapse
|
23
|
Wolden SL, Lyden ER, Arndt CA, Hawkins DS, Anderson JR, Rodeberg DA, Morris CD, Donaldson SS. Local Control for Intermediate-Risk Rhabdomyosarcoma: Results From D9803 According to Histology, Group, Site, and Size: A Report From the Children's Oncology Group. Int J Radiat Oncol Biol Phys 2015; 93:1071-6. [PMID: 26581144 PMCID: PMC5147527 DOI: 10.1016/j.ijrobp.2015.08.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine local control according to clinical variables for patients with intermediate-risk rhabdomyosarcoma (RMS) treated on Children's Oncology Group protocol D9803. PATIENTS AND METHODS Of 702 patients enrolled, we analyzed 423 patients with central pathology-confirmed group III embryonal (n=280) or alveolar (group III, n=102; group I-II, n=41) RMS. Median age was 5 years. Patients received 42 weeks of VAC (vincristine, dactinomycin, cyclophosphamide) or VAC alternating with VTC (T = topotecan). Local therapy with 50.4 Gy radiation therapy with or without delayed primary excision began at week 12 for group III patients. Patients with group I/II alveolar RMS received 36-41.4 Gy. Local failure (LF) was defined as local progression as a first event with or without concurrent regional or distant failure. RESULTS At a median follow-up of 6.6 years, patients with clinical group I/II alveolar RMS had a 5-year event-free survival rate of 69% and LF of 10%. Among patients with group III RMS, 5-year event-free survival and LF rates were 70% and 19%, respectively. Local failure rates did not differ by histology, nodal status, or primary site, though there was a trend for increased LF for retroperitoneal (RP) tumors (P=.12). Tumors ≥5 cm were more likely to fail locally than tumors <5 cm (25% vs 10%, P=.0004). Almost all (98%) RP tumors were ≥5 cm, with no difference in LF by site when the analysis was restricted to tumors ≥5 cm (P=.86). CONCLUSION Local control was excellent for clinical group I/II alveolar RMS. Local failure constituted 63% of initial events in clinical group III patients and did not vary by histology or nodal status. The trend for higher LF in RP tumors was related to tumor size. There has been no clear change in local control over RMS studies, including IRS-III and IRS-IV. Novel approaches are warranted for larger tumors (≥5 cm).
Collapse
Affiliation(s)
- Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Elizabeth R Lyden
- Department of Preventive and Societal Medicine, Nebraska Medical Center, Omaha, Nebraska
| | - Carola A Arndt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Douglas S Hawkins
- Division of Hematology/Oncology, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - James R Anderson
- Frontier Science and Technology Research Foundation, Madison, Wisconsin
| | - David A Rodeberg
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Carol D Morris
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
24
|
Maranzano E, Draghini L, Casale M, Arcidiacono F, Anselmo P, Trippa F, Giorgi C. Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas. Strahlenther Onkol 2015; 191:953-60. [PMID: 26490452 DOI: 10.1007/s00066-015-0915-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this work was to evaluate long-term results of moderate hypofractionated stereotactic radiotherapy (hFSRT) for intracranial meningiomas. PATIENTS AND METHODS In all, 77 consecutive patients with 80 lesions were included. Median age was 65 years (range 23-82 years), male/female ratio was 21/56, and the median Karnofsky performance status was 90 (range 60-100). In 31 lesions (39 %), diagnosis was based upon clinical and radiological data; 37 lesions were histologically proven as World Health Organization (WHO) grade I and 12 grade II meningiomas. Median treatment volume was 23 cc. Prescribed doses were 45 Gy in 15 fractions of 3 Gy (15 × 3 Gy) or 42 Gy in 14 fractions of 3 Gy (14 × 3 Gy). RESULTS After a median follow-up of 56 months, 49 (61 %) lesions received 14 × 3 Gy and 31 (39 %) 15 × 3 Gy. Local control (LC) rate remained unchanged at 84 % at 5 and 10 years. Overall survival and disease-specific survival (DSS) were 76 and 93 % at 5 years, 72 and 89 % at 10 years, respectively. With univariate analysis, previous surgery and WHO grade II tumor were negative prognostic factors for LC and DSS. With multivariate analysis only tumor grade was an independent prognostic factor for LC. No clinically significant acute and/or late toxicities were observed. CONCLUSION Moderate hFSRT was effective and safe with an excellent tolerance profile. It can be an alternative treatment option for patients with recurrent or inoperable large meningiomas. The low number of fractions administered with hFSRT led to reduce treatment-related discomfort for patients. Grade II tumor and previous surgery were negative prognosis factors.
Collapse
Affiliation(s)
- Ernesto Maranzano
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy.
| | - Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Michelina Casale
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Fabio Arcidiacono
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| | - Cesare Giorgi
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Via T. di Joannuccio, 1, 05100, Terni, Italy
| |
Collapse
|
25
|
Cho KM, Kim YJ, Kim SH, Kim JW, Lee JO, Han JH, Lee KW, Kim JH, Kim CY, Bang SM, Kim IA, Kim JS, Lee JS. Salvage Treatment with Intracerebrospinal Fluid Thiotepa in Patients with Leptomeningeal Metastasis After Failure of Methotrexate-based Treatment. Anticancer Res 2015; 35:5631-5638. [PMID: 26408736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the efficacy of intracerebrospinal fluid (intra-CSF) thiotepa in patients with leptomeningeal metastasis (LM) after failure of a methotrexate-based treatment. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients with LM who received 10 mg of intra-CSF thiotepa twice a week. RESULTS Out of 40 patients, 25 were females (63%), and 31 (78%) had an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2. Fourteen out of the 30 evaluable patients (47%) had a cytological response to intra-CSF thiotepa. The median overall survival (OS) after treatment with thiotepa was 19.4 weeks (95% confidence interval (CI)=15.3-23.5). Grade 3 toxicities were thrombocytopenia (N=2), bacterial meningitis (N=2), and pneumonia (N=1). According to a multivariate analysis, an ECOG PS ≥2 (hazard ratio (HR)=5.11, 95% CI=1.39-18.80, p=0.014), clinical improvement (HR=0.09, 95% CI=0.03-0.29, p<0.001), and radiation for LM after intra-CSF thiotepa (HR=0.33, 95% CI=0.11-0.97, p=0.043) were independently associated with survival. CONCLUSION Intra-CSF thiotepa seems to be a meaningful salvage treatment for patients with LM whose disease progresses after a methotrexate-based treatment.
Collapse
Affiliation(s)
- Kyoung-Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Ah Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
26
|
Silva CBDO, Ongaratti BR, Trott G, Haag T, Ferreira NP, Leães CGS, Pereira-Lima JFS, Oliveira MDC. Expression of somatostatin receptors (SSTR1-SSTR5) in meningiomas and its clinicopathological significance. Int J Clin Exp Pathol 2015; 8:13185-13192. [PMID: 26722517 PMCID: PMC4680462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Abstract
Meningiomas are benign brain tumors that are usually to recur. Studies have shown in vitro and in vivo that meningiomas, regardless of histology and classification, express somatostatin receptors (SSTRs). We investigated the immunohistochemical expression of five SSTR subtypes (SSTR1-SSTR5) in tumor tissue sections from 60 patients with diagnosis of meningioma who underwent surgical resection and relating it to patient age and sex, tumor histology, location, regrowth/recurrence and follow-up. Mean (SD) patients age was 53.18 (12.6) years and 44 were women (73.3%). According to the WHO histological grading criteria, 47 (78.3%) meningiomas were grade I, 11 (18.3%) were grade II, and 2 (3.3%) were grade III. All five SSTRs were expressed in our sample, at frequencies ranging from 61.6 to 100%, with a predominance of SSTR2. SSTR5 was more frequently expressed in tumors benign than in tumors malignant (P<0.013). Recurrence-free survival rate at 2 years was 75.2%. There were no significant differences in SSTR expression regarding age, sex, tumor location and regrowth/recurrence. SSTR expression was detected at a significant frequency in this series. SSTR5 showed higher expression in tumors benign supporting the use of these SSTRs in diagnostic of meningiomas and their influence in process of tumorigenesis in meningiomas recurrence.
Collapse
Affiliation(s)
- Camila Batista de Oliveira Silva
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Bárbara Roberta Ongaratti
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Geraldine Trott
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Taiana Haag
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Nelson Pires Ferreira
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Carolina Garcia Soares Leães
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Julia Fernanda Semmelmann Pereira-Lima
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| | - Miriam da Costa Oliveira
- Department of Laboratory of Pathology, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
- Neuroendocrinology Center, Hospital Complex Santa Casa de Porto Alegre, University of Health Sciences of Porto AlegreRio Grande do Sul, Brazil
| |
Collapse
|
27
|
Ushio Y, Arita N, Hayakawa T, Yamada K, Koh S, Nagatani M, Yoshimine T, Mogami H. Leptomeningeal dissemination of primary brain tumors in children: clinical and experimental studies. Prog Exp Tumor Res 2015; 30:194-205. [PMID: 3628806 DOI: 10.1159/000413677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
28
|
Backer-Grøndahl T, Moen BH, Arnli MB, Torseth K, Torp SH. Immunohistochemical characterization of brain-invasive meningiomas. Int J Clin Exp Pathol 2014; 7:7206-7219. [PMID: 25400818 PMCID: PMC4230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
Brain-invasive meningiomas have an adverse prognosis, so it is important to detect and correctly evaluate brain invasion by light microscopy. Furthermore, the underlying biological mechanisms responsible for brain-invasive growth are incompletely understood. The primary aim of this study was to identify immunohistochemical markers that could improve identification and evaluation of brain invasion in meningiomas. A second aim was to investigate the process of brain invasion using immunohistochemical markers of proliferation, extracellular matrix modulation, and cell adhesion. From a series of 196 human meningiomas, 67 cases were selected for analysis because of the presence of brain tissue in tumor specimens. Fourteen of these 67 meningiomas were brain-invasive. Invasiveness was determined primarily by evaluation of hematoxylin-erytrosin-saffron- (HES-) stained specimens, although glial fibrillary acidic protein (GFAP), anti-collagen IV, and cluster of differentiation 44 (CD44) markers provided additional information. It was important to examine microscopic sections from various levels of the paraffin-embedded tissue block to adequately assess invasiveness. Sections stained using antibodies against Ki-67/MIB-1, phospohistone-H3 (PHH3), matrix metalloproteinase-9 (MMP-9), cathepsin D, plasminogen activator inhibitor-1 (PAI-1), and E-cadherin antigens were used to characterize brain-invasive meningiomas and to investigate the process of brain invasion. Only increased expression of the extracellular matrix modulator MMP-9 correlated with brain-invasive growth (p=0.025). Examination of HES-stained sections identified brain invasion. Use of relevant immunohistochemical markers did not contribute substantially to this evaluation. Evaluation of stepwise sections should be considered when brain-invasive growth is suspected. MMP-9 may be an important mediator of brain-invasive growth.
Collapse
Affiliation(s)
- Thomas Backer-Grøndahl
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and TechnologyNTNU, Norway
| | - Bjørnar H Moen
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and TechnologyNTNU, Norway
| | - Magnus B Arnli
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and TechnologyNTNU, Norway
| | - Kathrin Torseth
- Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University HospitalNorway
| | - Sverre H Torp
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and TechnologyNTNU, Norway
- Department of Pathology and Medical Genetics, St. Olavs Hospital, Trondheim University HospitalNorway
| |
Collapse
|
29
|
Villalpando-Navarrete E, Rosas-Peralta VH, Sandoval-Balanzario MA. [Prognostic factors in elderly patient meningioma]. Rev Med Inst Mex Seguro Soc 2014; 52:530-537. [PMID: 25301128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Frequently, therapeutic decisions must be made in order to manage meningioma in geriatric patients. This study analyzes the prognostic factors, as well as the Clinical Radiological Grading Score (CRGS) as a complement to make therapeutic decisions. METHODS A retrospective study was conducted between 2009 and 2010. The study population consisted of 28 patients over 65 years of age. We analyzed clinical, imaging and histopathological factors. We used the chi-squared test and the Fisher exact test for quantitative variables, as well as the Mann-Whitney U for qualitative variables. RESULTS Overall mortality at 3, 6 and 12 months of follow-up was 7.14, 10.71 and 14.28 %, respectively. The analysis revealed that performance status with Karnofsky scale (p = 0.02), the location of the lesion (p = 0.002), histopathological malignancy grade (p = 0.038), and a score lower than 10 on the CRGS (p = 0.003) were associated with poor prognosis. CONCLUSIONS The neurosurgical management of geriatric patients is a therapeutic option with a favorable prognosis in patients with a score equal to or greater than 10 and those with adequate functional status.
Collapse
Affiliation(s)
- Edgar Villalpando-Navarrete
- Servicio de Neurocirugía, Hospital de Especialidades "Doctor Antonio Fraga Mouret", Centro Médico Nacional La Raza, Distrito Federal, México.
| | | | | |
Collapse
|
30
|
Hammouche S, Clark S, Wong AHL, Eldridge P, Farah JO. Long-term survival analysis of atypical meningiomas: survival rates, prognostic factors, operative and radiotherapy treatment. Acta Neurochir (Wien) 2014; 156:1475-81. [PMID: 24965072 DOI: 10.1007/s00701-014-2156-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 06/05/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The rarity and the inconsistent criteria for defining atypical meningioma prior to the WHO 2007 classification made its management and prognostic factors poorly understood. Only few articles have addressed the survival rates of WHO-classified atypical meningiomas. The small number or the disproportionate representation of irradiated patients was a weakness for these articles. This study evaluated whether the extent of surgery and receiving adjuvant radiotherapy after an initial operation along with other patient characteristics influenced the recurrence and survival rates of atypical meningiomas. METHODS The clinical and surgical notes of the 79 patients with grade II atypical meningioma treated at our center over 13 years were retrospectively evaluated. The histology grading was consistent with WHO 2007 classification. The Simpson grading system was used to assess the extent of surgical resection. Kaplan Meier analysis, Cox multivariate regression analysis, and the Log-rank test were conducted using STATA® statistical package. RESULTS The average age at the time of initial operation was 58 years, and 54 % were males. The mean follow-up period was 50 months. In Cox multivariate analysis, only Simpson grading was predictive of recurrence (hazard ratio = 2.22 / 1 increase in Simpson grade. p = 0.003). Simpson grade I patients had a relapse-free survival rate of 97 and 74 % at one and five years, respectively, compared with 88 and 32 % in the subtotal resection group (Simpson grades II to IV). There was no statistically significant correlation between recurrence and subjecting patients to postoperative radiotherapy. Apart from Simpson grade I patients, there was a general trend for worse outcome in irradiated patients. CONCLUSIONS The most important prognostic factor in determining recurrence was Simpson grading. There was no statistically significant impact of adjuvant radiotherapy on the recurrence of atypical meningiomas. Meta-analysis for the existing literature is needed.
Collapse
Affiliation(s)
- Salah Hammouche
- Neurosurgery Department, The Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, Merseyside, UK,
| | | | | | | | | |
Collapse
|
31
|
Kwon J, Chie EK, Kim K, Kim HJ, Wu HG, Kim IH, Oh DY, Lee SH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Ha SW. Impact of multimodality approach for patients with leptomeningeal metastases from solid tumors. J Korean Med Sci 2014; 29:1094-101. [PMID: 25120319 PMCID: PMC4129201 DOI: 10.3346/jkms.2014.29.8.1094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/08/2014] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to evaluate treatment patterns, outcome and prognosticators for patients with leptomeningeal metastases from solid tumor. Medical records of 80 patients from January 1, 2004 to May 31, 2011 were retrospectively reviewed. Most frequent site of origin was the lung (59%) followed by the breast (25%). Most patients were treated with intrathecal chemotherapy (90%) and/or whole brain radiotherapy (67.5%). Systemic therapy was offered to 27 patients (33.8%). Percentage of patients treated with single, dual, and triple modality were 32.5%, 43.8%, and 23.8%, respectively. Median survival was 2.7 months and 1 yr survival rate was 11.3%. Multivariate analysis showed that negative cerebrospinal fluid cytology, fewer chemotherapy regimen prior to leptomeningeal metastases, whole brain radiotherapy, systemic therapy, and combined modality treatment (median survival; single 1.4 vs. dual 2.8 vs. triple 8.3 months, P<0.001) had statistical significance on survival. Subgroup analysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy had significant independent impact on survival (median survival; 10.5 vs. 3.0 months, P=0.008). Unlike previous reports, survival of patients with NSCLC primary was comparable to breast primary. Furthermore, combined modality treatment for all patients and additionally targeted therapy for NSCLC patients should be considered in the treatment of leptomeningeal metastases from solid tumor.
Collapse
Affiliation(s)
- Jeanny Kwon
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung W. Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| |
Collapse
|
32
|
Bishop KD, Olszewski AJ. Epidemiology and survival outcomes of ocular and mucosal melanomas: a population-based analysis. Int J Cancer 2014; 134:2961-71. [PMID: 24272143 DOI: 10.1002/ijc.28625] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/13/2013] [Indexed: 01/15/2023]
Abstract
Extracutaneous melanomas are poorly characterized tumors that include ocular (OM), mucosal (MM) and leptomeningeal melanomas, often lacking standardized staging and treatment guidelines. We analyzed cases of cutaneous melanoma (CM, N = 219,890), OM (N = 7,069) and MM (N = 2,755) of different anatomical origins, diagnosed between 1988 and 2010, recorded in the Surveillance Epidemiology and End Results (SEER) database. Relative survival was studied in patients grouped by summary stage classification (localized, regional or distant disease) and in multivariate models adjusting for varying distribution of baseline factors. Unlike in CM, the incidence rate in MM increased exponentially with age. Five-year relative survival was significantly worse for OM (78%) and for most mucosal sites (aggregate 34%, range 3-69%) compared with CM (89%). The differences between primary sites were particularly pronounced in localized disease, with a hazard ratio of 5.7 for OM, 4.3-9.0 for external genital or oral cavity MM and 19.8-90.4 for other mucosal locations. Melanomas of the pharynx, gastrointestinal, urinary tract and vagina had poor outcomes regardless of clinical stage. In contrast to CM, there was no evidence of improved survival in OM and MM during the study period. A substantial proportion of patients with operable OM or MM underwent radical organ resections (13-88% depending on site and stage) or perioperative radiotherapy (0-66%). In conclusion, extracutaneous melanomas have a markedly worse survival than CM and aggressive locoregional management appears to be insufficient for their control. Because of poor outcomes in MM, studies of systemic therapy are warranted regardless of the extent of disease at presentation.
Collapse
Affiliation(s)
- Kenneth D Bishop
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI; Division of Hematology/Oncology, Rhode Island Hospital, Providence, RI
| | | |
Collapse
|
33
|
Fokas E, Henzel M, Surber G, Hamm K, Engenhart-Cabillic R. Stereotactic radiation therapy for benign meningioma: long-term outcome in 318 patients. Int J Radiat Oncol Biol Phys 2014; 89:569-75. [PMID: 24751409 DOI: 10.1016/j.ijrobp.2014.02.042] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the long-term outcome of stereotactic-based radiation therapy in a large cohort of patients with benign intracranial meningiomas. METHODS AND MATERIALS Between 1997 and 2010, 318 patients with histologically confirmed (44.7%; previous surgery) or imaging-defined (55.3%) benign meningiomas were treated with either fractionated stereotactic radiation therapy (79.6%), hypofractionated stereotactic radiation therapy (15.4%), or stereotactic radiosurgery (5.0%), depending on tumor size and location. Local control (LC), overall survival (OS), cause-specific survival (CSS), prognostic factors, and toxicity were analyzed. RESULTS The median follow-up was 50 months (range, 12-167 months). Local control, OS, and CSS at 5 years were 92.9%, 88.7%, and 97.2%, and at 10 years they were 87.5%, 74.1%, and 97.2%, respectively. In the multivariate analysis, tumor location (P=.029) and age >66 years (P=.031) were predictors of LC and OS, respectively. Worsening of pre-existing neurologic symptoms immediately after radiation therapy occurred in up to 2%. Clinically significant acute toxicity (grade 3°) occurred in 3%. Only grade 1-2 late toxicity was observed in 12%, whereas no new neurologic deficits or treatment-related mortality were encountered. CONCLUSIONS Patients with benign meningiomas predominantly treated with standard fractionated stereotactic radiation therapy with narrow margins enjoy excellent LC and CSS, with minimal long-term morbidity.
Collapse
Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Marburg, Germany; Department of Radiation Therapy and Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Martin Henzel
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Marburg, Germany
| | - Gunar Surber
- Department for Stereotactic Neurosurgery and Radiosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Klaus Hamm
- Department for Stereotactic Neurosurgery and Radiosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
34
|
Bumrungrachpukdee P, Pruphetkaew N, Phukaoloun M, Pheunpathom N. Recurrence of intracranial meningioma after surgery: analysis of influencing factors and outcome. J Med Assoc Thai 2014; 97:399-406. [PMID: 24964682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyze the recurrent rate, timing, and influential factors of recurrence, including clinical outcome in patients with intracranial meningioma who underwent surgery. MATERIAL AND METHOD The medical records of surgically treated intracranial meningioma patients with histological confirmation were reviewed. The diagnosis of recurrence was based on clinical condition and imaging study during follow-up. The recurrent rate, timing of recurrence, factors that influence the recurrence and clinical outcome were analyzed Clinical outcome was measured by the Glasgow outcome scale. RESULTS One hundred eighty one patients were recruited. Mean tumor diameter was 4.9 cm (1.2-9 cm). Mean follow-up was 32.3 months. Median recurrent time was 21.6 months and overall recurrent rate was 21.5% with 5-year recurrence-free survival rate of 65%. Factors associated with tumor recurrence were headache at presentation (p = 0.002), Simpson grade III (p = 0.012), Simpson grade IV (p < 0.001), Simpson grade V (p = 0.004), WHO grade II (p = 0.004) and WHO grade III (p < 0.001). Mortality rate in recurrent group was 12.8% compared with 3.5% in non-recurrent group (p = 0.039). The favorable outcome was higher in non-recurrent group 91.5% compared with 76.9% in recurrent group(p = 0.02483). CONCLUSION The risk factors of recurrence were headache at presentation, extent of resection, and histological grading. The extent of resection identified by Simpson grading effect the recurrent rate as stated previously in the literature. The higher histological grade was associated with higher recurrent rate. The wide range of timing of tumor recurrence needs both clinical evaluation and imaging study in short- and long-term follow-up especially in high-risk group. Recurrent meningioma increased rate of morbidity and mortality.
Collapse
|
35
|
Buglione M, De Bari B, Trevisan F, Ghirardelli P, Pedretti S, Triggiani L, Magrini SM. Role of external beam radiotherapy in the treatment of relapsing meningioma. Med Oncol 2014; 31:866. [PMID: 24504843 DOI: 10.1007/s12032-014-0866-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/24/2014] [Indexed: 11/26/2022]
Abstract
The role of radiotherapy in the treatment of relapsing meningiomas is not well established. Data of patients treated with radiotherapy for a relapsing meningioma were retrospectively analyzed. Overall survival (OS) was the primary endpoint of the analysis. Local control and acute and late toxicity rates have been also reported. From April 1986 to February 2011, 37 patients with a diagnosis of recurrent meningioma were treated. Median age was 64 years (range 36-79). A total of 18, 10, 5 and 4 patients were affected by relapsing benign, atypical, malignant meningiomas and meningiosarcomas, respectively (WHO classification). Median dose was 60 Gy (range 46-66 Gy). The median follow-up was 42 months (range 3-300 months). OS at 1, 3, 5 and 8 years was 81, 55.6, 43.9 and 25.8%, respectively (median OS 45 months). A strong statistical trend was observed toward better OS rates in patients treated with radiotherapy at first recurrence compared to those treated at the second (or more) recurrence (OS 50.5 vs. 30.8%, p=0.055). A statistical impact of the histology (WHO I vs. II, III and IV) on 5-year OS was also observed (OS 60 vs. 30%, 0 and 0%, p=0.010). Radiotherapy has been well tolerated, with no G2-4 neurological toxicity (RTOG toxicity score). Conventional radiation therapy has an important role in multidisciplinary approach in the treatment of recurrence of meningiomas. The histological type and the timing of the radiotherapy are prognostic factors in terms of survival.
Collapse
Affiliation(s)
- M Buglione
- Radiation Oncology Department, fESTRO, AO Spedali Civili - Istituto del Radio "O. Alberti", Università degli Studi di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | | | | | | | | | | | | |
Collapse
|
36
|
Li D, Hao SY, Wang L, Tang J, Xiao XR, Zhou H, Jia GJ, Wu Z, Zhang LW, Zhang JT. Surgical management and outcomes of petroclival meningiomas: a single-center case series of 259 patients. Acta Neurochir (Wien) 2013; 155:1367-83. [PMID: 23801089 DOI: 10.1007/s00701-013-1795-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/04/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical management of petroclival meningiomas is challenging. Various and inconsistent outcome and prognostic factors of the lesions have been evaluated previously. In the present study, the surgical outcome, philosophy, and experience of petroclival meningiomas are detailed based on a large patient series. METHODS A series of 259 patients with petroclival meningiomas (70 males and 189 females) were surgically treated. Clinical charts and radiographs were reviewed. Follow-up results were evaluated. RESULTS The preoperative Karnofsky Performance Scale (KPS) score was 74.2 ± 10.5. The mean tumor size was 4.3 ± 1.0 cm. The gross total resection (GTR) rate was 52.5%. During a mean follow-up period of 55.3 months, recurrence/progression (R/P) occurred in 11 patients. The recent KPS score was 78.4 ± 22.7, it improved in 139 (57.2%) patients and stabilized in 53 (21.8%) patients, and 201 (82.7%) patients lived independently. The risk factors affecting the KPS score included (but were not limited to) age ≥ 60, preoperative KPS ≤ 60, and brainstem edema. The adverse factors contributing to R/P-free survival included (but were not limited to) non-total resection and the absence of the subarachnoid space. The R/P-free survival rate was 94.5% at 5 years and 91.2% at 9 years. The overall survival rate was 94.7% at 5 years and 94.7% at 9 years. CONCLUSIONS Favorable outcomes from petroclival meningiomas could be achieved by microsurgery. Neurological function and quality of life were prioritized, and GTR was attempted. Risk factors should be considered in surgical schemes, and tumor recurrence should be aggressively monitored and treated.
Collapse
Affiliation(s)
- Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Aboukais R, Baroncini M, Zairi F, Reyns N, Lejeune JP. Early postoperative radiotherapy improves progression free survival in patients with grade 2 meningioma. Acta Neurochir (Wien) 2013; 155:1385-90; discussion 1390. [PMID: 23728501 DOI: 10.1007/s00701-013-1775-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Grade 2 meningiomas are a real problem in therapeutic management because of their tendency to reoccur. The most effective treatment is surgery. The role of adjuvant radiotherapy in this disease is still disputed due to its uncertain effect on progression-free survival. OBJECTIVE To show that early adjuvant radiotherapy is an effective treatment in patients with grade 2 meningiomas. MATERIALS AND METHODS A retrospective study was performed on all patients operated on for grade 2 meningioma in our center between 1994 and 2011. For every patient, we recorded the age at diagnosis, sex, background of neurofibromatosis type 2 (NF2) or meningiomatosis, location of meningioma, quality of tumor resection and whether the patient received early postoperative radiotherapy. These prognosis factors were studied using statistical tests. RESULTS We included 167 patients (94 women, 73 men, sex ratio = 1.28); the mean age at diagnosis was 53.8 years. Twenty-seven patients received early adjuvant radiotherapy after surgery. Patients who received early postoperative radiotherapy had a significantly longer progression-free survival (8.2 years) than patients without radiotherapy (5.7 years, p = 0.04). In multivariate analysis, quality of tumor resection and early postoperative radiotherapy decrease the risk of recurrence of meningioma (p < 0.05). CONCLUSION Adjuvant radiotherapy is an important therapeutic tool in the treatment of patients with grade 2 meningioma. It delays tumor progression and reduces the need for further surgery. Adjuvant radiotherapy must be considered as a treatment option in oncological multidisciplinary meetings, regardless of the quality of surgical resection.
Collapse
Affiliation(s)
- Rabih Aboukais
- Department of Neurosurgery, Lille University Hospital, rue E. Laine, 59037 Lille cedex, France.
| | | | | | | | | |
Collapse
|
38
|
Caltabiano R, Barbagallo GMV, Castaing M, Cassenti A, Senetta R, Cassoni P, Albanese V, Lanzafame S. Prognostic value of EGFR expression in de novo and progressed atypical and anaplastic meningiomas: an immunohistochemical and fluorescence in situ hybridization pilot study. J Neurosurg Sci 2013; 57:139-151. [PMID: 23486338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this study was to assess both the epidermal growth factor receptor (EGFR) protein expression by immunohistochemistry and the EGFR gene amplification by fluorescence in situ hybridization in meningiomas of different grade, in order to evaluate their possible role in the development of the disease. EGFR protein belongs to the family of tyrosine kinase growth factor receptors, which also includes HER2, HER3 and HER4. Elevated expression or activity of EGFR has been reported in several cancers, including brain tumours. EGFR activation can enhance the malignant potential of epithelial tissues. METHODS We investigated whether there was a difference in the EGFR protein expression and the EGFR gene amplification between the so called de novo malignant meningiomas and recurrent meningiomas with or without malignant progression from a previously lower grade tumor. Our goal was to evaluate if EGFR expression was a useful marker to select patients affected by meningioma with a major risk of recurrences. We also assessed the prognostic value of the EGFR expression on overall survival. RESULTS Progression from benign meningiomas to atypical or anaplastic meningiomas correlated with an increase in the expression of EGFR protein. Our study shows that EGFR immunostaining in meningiomas directly correlates to the tumor's grade. The EGFR expression did not correlate with the overall survival and the recurrence-free survival of the patients affected by meningioma (de novo, recurrent and progressed). CONCLUSION We submit that the EGFR expression is not a useful prognostic element to identify patients with a major risk of meningioma recurrence.
Collapse
Affiliation(s)
- R Caltabiano
- G.F. Ingrassia Department, University of Catania, Catania, Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Le Rhun E, Taillibert S, Zairi F, Pannier D, Boulanger T, Andre C, Cazin JL, Dubois F, Bonneterre J, Chamberlain MC. Prolonged survival of patients with breast cancer-related leptomeningeal metastases. Anticancer Res 2013; 33:2057-2063. [PMID: 23645756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND/AIM Prolonged overall survival (OS) has been reported for selected patients with leptomeningeal metastases (LM). The management and treatment of such patients is poorly-described. We report our experience on breast cancer (BC)-associated LM and patients with prolonged survival. PATIENTS AND METHODS Eleven patients with BC and LM had an OS >12 months in which treatment is described. RESULTS Combined intra-cerebro spinal fluid (CSF) and systemic treatment were administered until disease progression or toxicity in all but two patients. Involved-field radiotherapy was administered to two patients. Median OS in this selected cohort following LM diagnosis, was 21.0 (range=13-33.3) months. CONCLUSION Prolonged OS but also prolonged responses can be observed in BC with LM. An individualized and multi-disciplinary approach is advised for the management of these patients.
Collapse
Affiliation(s)
- Emilie Le Rhun
- Breast unit, Department of Medical Oncology, Oscar Lambret Center, Lille Cedex, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Wang DJ, Zheng MZ, Gong Y, Xie Q, Wang Y, Cheng HX, Mao Y, Zhong P, Che XM, Jiang CC, Huang FP, Zheng K, Li SQ, Gu YX, Bao WM, Yang BJ, Wu JS, Xie LQ, Tang HL, Zhu HD, Chen XC, Zhou LF. Papillary meningioma: clinical and histopathological observations. Int J Clin Exp Pathol 2013; 6:878-888. [PMID: 23638219 PMCID: PMC3638098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 03/13/2013] [Indexed: 06/02/2023]
Abstract
Papillary meningioma is a rare subtype of malignant meningiomas, which is classified by the World Health Organization as Grade III. Because of lack of large sample size case studies, many of the specific characteristics of papillary meningioma are unclear. This study investigated by retrospective analysis the clinical, radiological and histopathological findings of 17 papillary meningioma patients who underwent surgical resection or biopsy, to assess the characteristics of papillary meningioma. Eight female and nine male patients were included, with a mean age of 40 (range: 6 to 55) years. Tumors were mostly located in the cerebral convexity and showed irregular margins, absence of a peritumoral rim, heterogeneous enhancement and severe peritumoral brain edema on preoperative images. Brain invasion was often confirmed during the operations, with abundant to exceedingly abundant blood supply. Intratumoral necrosis and mitosis was frequently observed on routinely stained sections. The average MIB-1 labeling index was 6.9%. Seven cases experienced tumor recurrence or progression, while seven patients died 6 to 29 months after operation. Radiation therapy was given in 52.9% of all cases. Univariate analysis showed that only the existence of intratumoral necrosis and incomplete resection correlated with tumor recurrence. The 3-year progression free survival was 66.7% after gross total resection and 63.6% for other cases. The 3-year mortality rate was 50% after gross total resection and 63.6% for other cases. Papillary meningioma has specific clinical and histopathological characteristics. Tumor recurrence (or progression) and mortality are common. Gross total tumor resection resulted in less recurrence and mortality.
Collapse
Affiliation(s)
- Dai-Jun Wang
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Ming-Zhe Zheng
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Yin Wang
- Department of Neuropathology, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Hai-Xia Cheng
- Department of Neuropathology, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Ping Zhong
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Xiao-Ming Che
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Cheng-Chuan Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Feng-Ping Huang
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Kang Zheng
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Shi-Qi Li
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Yu-Xiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Wei-Min Bao
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Bo-Jie Yang
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Jing-Song Wu
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Li-Qian Xie
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Hai-Liang Tang
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Hong-Da Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Xian-Cheng Chen
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Liang-Fu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| |
Collapse
|
41
|
Markovic M, Antunovic V, Milenkovic S, Zivkovic N. Prognostic value of peritumoral edema and angiogenesis in intracranial meningioma surgery. J BUON 2013; 18:430-436. [PMID: 23818357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE In a series of 78 consecutive patients we analyzed the influence of peritumoral edema (PTE) and angiogenesis (vascular endothelial growth factor/ VEGF expression) on the prognosis of morbidity and postoperative complications after intracranial meningioma surgery. METHODS A retrospective analysis was performed of clinical, neuroradiological and histological data of 78 microsurgically treated patients with intracranial supratentorial meningioma, with follow-up period of at least one year. RESULTS The severity of PTE showed significant correlation with VEGF expression, and all patients with large PTE (>40 mm) had strong VEGF expression (>50%). Treatment outcome was significantly better in patients with low VEGF expression (p<0.05). All of the monitored postoperative complications were more frequent in the group with PTE.The duration of intensive care treatment in the group with PTE (mean 6.85 days) was significantly longer than in the group without PTE (mean 3.68 days) (p=0.003). In the group without PTE, the outcome was significantly better than in patients with PTE (p<0.01). CONCLUSION PTE in intracranial meningiomas has significant influence on the prognosis in surgically treated patients in terms of increased risk of morbidity and postoperative complications. VEGF expression is strongly correlated with PTE formation, which also affects the outcome in the management of patients with intracranial meningioma.
Collapse
Affiliation(s)
- M Markovic
- Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, Serbia
| | | | | | | |
Collapse
|
42
|
Ke HL, Ke RH, Li B, Wang XH, Wang YN, Wang XQ. Association between laminin γ1 expression and meningioma grade, recurrence, and progression-free survival. Acta Neurochir (Wien) 2013; 155:165-71. [PMID: 23053286 DOI: 10.1007/s00701-012-1512-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/21/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laminins are central components of basement membranes and play important roles in cell adhesion, proliferation, and migration. However, the role of laminins in tumor progression has not been thoroughly investigated in meningiomas. OBJECTIVE The aim of the present study is to evaluate the expression of laminin γ1 in various grades of meningiomas in Chinese patients. METHODS In the current study, clinical and pathological data for 32 meningioma patients with various tumor grades were collected. The expression of laminin γ1 in each tumor was assessed by using quantitative real-time polymerase chain reaction (qPCR), Western blot and immunohistochemical analysis and was correlated with the meningioma grade, tumor recurrence and patient survival. Patient prognoses were attained and the progression-free survival was calculated based on the Kaplan-Meier method. A two-sided probability cutoff of 0.05 was chosen for statistical significance. RESULTS A total of 32 meningioma patients with various pathological subtypes (WHO grade I: 13, grade II: 10 and grade III: 9) were enrolled in this study. The qPCR results showed that laminin γ1 mRNA expression was significantly higher in grade III meningiomas than in grade I meningiomas (p < 0.05), although there was no significant difference in laminin γ1 expression between grade II and grade I meningiomas (p > 0.05). Western blot and immunohistochemistry analysis confirmed that the expression of laminin γ1 protein was relatively higher in grade III meningiomas when compared with grade I meningiomas. Higher levels of laminin γ1 expression in meningiomas are associated with a significantly shorter tumor recurrence time (p < 0.05) and a decreased patient survival time (p < 0.05). CONCLUSIONS Our results suggest that laminin γ1 is associated with meningioma grades and could play a role in enhancing tumor invasion. Laminin γ1 could be used as a predictor for meningioma recurrence and patient survival. Furthermore, laminin γ1 may represent a druggable molecular target for future therapies for tumors that overexpress this marker.
Collapse
Affiliation(s)
- Hong-Lin Ke
- Department of Emergency Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200233, China
| | | | | | | | | | | |
Collapse
|
43
|
Konovalov AN, Kozlov AV, Cherekaev VA, Shimansiĭ VN, Taniashin SV, Kornienko VN, Pronin IN, Golanov AV, Kobiakov GL, Shishkina LV, Ryzhova MV, Gol'bin DA, Galkin MV, Bocharov AA, Lasunin NV. Meningioma challenge: analysis of 80-year experience of Burdenko Neurosurgical institute and future perspectives. Zh Vopr Neirokhir Im N N Burdenko 2013; 77:12-23. [PMID: 23659116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The paper describes the history of meningioma surgery at Burdenko Neurosurgical Institute, analyses of accumulated series of patients and assesses effectiveness of different techniques for meningioma diagnosis and treatment of. We analyzed 15413 patients with meningiomas operated in Burdenko Neurosurgical Institute from 1932 to 2011. Mathematical analysis was performed using Statistica 6.0 program. Mortality rate during World War II reached a disastrous level of 45,8%, in 21st century it is below 1%. Temporary and permanent morbidity has also decreased. While in 1961 Karnofsky performance score was 71, in 2011 it became 83. The probability of postoperative tumour recurrence also diminished, from 40% in 1960-s to 29% in 1996 and presumably to 25% nowadays. Independent factors that influence the risk of recurrence are primary gross total resection, grade of anaplasia and radiation therapy. However, unreasonably aggressive surgery leads to significant increase of morbidity. Further improvement of surgical results in patients with meningiomas depends on implementation of new technologies for neurovisualization, abandoning extensive surgical approaches whenever possible, finding the "balance" between radical removal and expected functional outcome, wider application of radiosurgery and three-dimensional conformal radiation therapy.
Collapse
|
44
|
Duntze J, Metellus P, Litre CF, Eap C, Theret E, Colin P, Peruzzi P, Rousseaux P. Prise en charge des méningiomes OMS grade II et III : étude rétrospective monocentrique d’une série chirurgicale de 36 cas. Neurochirurgie 2012; 58:275-81. [PMID: 22425580 DOI: 10.1016/j.neuchi.2012.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/13/2011] [Accepted: 01/26/2012] [Indexed: 12/01/2022]
Affiliation(s)
- J Duntze
- Service de neurochirurgie, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Korfel A, Weller M, Martus P, Roth P, Klasen HA, Roeth A, Rauch M, Hertenstein B, Fischer T, Hundsberger T, Leithäuser M, Birnbaum T, Kirchen H, Mergenthaler HG, Schubert J, Berdel W, Birkmann J, Hummel M, Thiel E, Fischer L. Prognostic impact of meningeal dissemination in primary CNS lymphoma (PCNSL): experience from the G-PCNSL-SG1 trial. Ann Oncol 2012; 23:2374-2380. [PMID: 22396446 DOI: 10.1093/annonc/mdr627] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We evaluated the frequency and prognostic impact of meningeal dissemination (MD) in immunocompetent adult patients with primary central nervous system lymphoma treated in a randomized phase III trial. PATIENTS AND METHODS MD was evaluated at study entry and defined by lymphoma proof in the meningeal compartment detected by at least one of the following methods: cerebrospinal fluid (CSF) cytomorphology, detection of clonal B cells by IgH PCR in CSF or contrast enhancement of the leptomeninges on magnetic resonance imaging (MRI). RESULTS Data on MD were available in 415 patients, of those, MD was detected in 65 (15.7%): in 44/361 (12.2%) by CSF cytomorphology, in 16/152 (10.5%) by PCR and in 17/415 (4.1%) by MRI. Major patients' characteristics and therapy did not significantly differ between patients with MD (MD+) versus those without MD (MD-). There was a significant correlation of MD with CSF pleocytosis (>5/μl; P < 0.0001), but no correlation with CSF protein elevation (>45 mg/dl). Median progression-free survival was 6.7 months [95% confidence interval (CI) 0-14.5] in MD+ and 8.3 months (5.7-10.8) in MD- patients (P = 0.95); median overall survival was 21.5 months (95% CI 16.8-26.1) and 24.9 months (17.5-32.3), respectively (P = 0.98). CONCLUSION MD was detected infrequently and had no impact on outcome in this trial.
Collapse
Affiliation(s)
- A Korfel
- Department of Hematology & Oncology, Campus Benjamin Franklin, Charite Berlin, Berlin, Germany.
| | - M Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Tuebingen, Tuebingen
| | - P Martus
- Institute of Biostatistics, University Tuebingen, Tuebingen; Institute of Biostatistics, University Hospital Tuebingen, Tuebingen
| | - P Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Tuebingen, Tuebingen
| | - H A Klasen
- Department of Hematology & Oncology, Pius Hospital, Oldenburg
| | - A Roeth
- Department of Hematology, West German Cancer Center, University Hospital Essen, Essen
| | - M Rauch
- Department of Hematology & Oncology, Evangelisches Krankenhaus Bielefeld, Bielefeld
| | - B Hertenstein
- Department of Hematology & Oncology, Klinikum Bremen Mitte, Bremen
| | - T Fischer
- Department of Hematology & Oncology, University of Magdeburg, Magdeburg
| | - T Hundsberger
- Department of Hematology & Oncology, University Hospital Mainz, Mainz, Germany; Department of Neurology, Cantonal Hospital, St Gallen, Switzerland
| | - M Leithäuser
- Department of Hematology & Oncology, University Hospital Rostock, Rostock
| | - T Birnbaum
- Department of Neurology, University Hospital Grosshadern, Munich
| | - H Kirchen
- Department of Hematology & Oncology, Hospital Trier, Trier
| | - H-G Mergenthaler
- Department of Oncology & Hematology, Klinikum Stuttgart, Stuttgart
| | - J Schubert
- Department of Neurology, Hospital Minden, Minden
| | - W Berdel
- Department of Medicine A, University Hospital Muenster, Muenster
| | - J Birkmann
- Department of Hematology & Oncology, Hospital Nürnberg, Nürnberg
| | - M Hummel
- Department of Pathology, Campus Benjamin Franklin, Charite Berlin, Germany
| | - E Thiel
- Department of Hematology & Oncology, Campus Benjamin Franklin, Charite Berlin, Berlin, Germany
| | - L Fischer
- Department of Hematology & Oncology, Campus Benjamin Franklin, Charite Berlin, Berlin, Germany
| |
Collapse
|
46
|
van Alkemade H, de Leau M, Dieleman EM, Kardaun JW, van Os R, Vandertop WP, van Furth WR, Stalpers LJ. Impaired survival and long-term neurological problems in benign meningioma. Neuro Oncol 2012; 14:658-66. [PMID: 22406926 PMCID: PMC3337301 DOI: 10.1093/neuonc/nos013] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/19/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To assess long-term functional outcome and survival among patients with meningioma World Health Organization (WHO) grade I. METHODS Retrospective analysis of 205 patients after resection of WHO grade I intracranial meningioma from 1985 through 2003. Expected age- and sex-specific survival was calculated by applying Dutch life-table statistics to each patient for the individual duration of follow-up. Long-term functional outcome was assessed using a mailed questionnaire to the general practitioner. RESULTS The mean duration of follow-up was 11.5 years. Survival at 5, 10, 15, and 20 years was 92%, 81%, 63%, and 53%, respectively, which is significantly lower than the expected survival (94%, 86%, 78%, and 66%, respectively). Survival was worse with higher age (P < .001). Survival among patients younger than 45 years and older than 65 years was comparable to the expected survival but significantly worse among patients aged 45-65 years. Analysis of the cause of death suggests an excess mortality associated with both brain tumor death and stroke (P = .07). Recurrence rates at 5, 10, and 15 years were 18%, 26%, and 32%, respectively. Higher Simpson grade (P < .001) and lower age (P = .02) were associated with a higher recurrence rate. In 29 patients (14%) receiving radiotherapy, the 5-year recurrence rate was 18% and the 5-year survival was only 58%. Long-term functioning (≥ 5 years after last treatment) could be assessed in 89 long-term survivors: 29 patients (33%) showed no deficits, and 60 (67%) showed at least 1 neurological symptom, of whom 24 (27%) were unable to perform normal daily activities. CONCLUSION Long-term survival in WHO grade I meningioma is challenged in patients more than 45 years of age. Excess mortality seems to be associated with both tumor recurrence and stroke. The majority of patients have long-term neurological problems.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Lukas J.A. Stalpers
- Academic Medical Center, University of Amsterdam, Department of Radiation Oncology (H.v.A., M.d.L., E.D., R.v.O., L.S.), Neurosurgical Center Amsterdam, Amsterdam, The Netherlands (H.v.A., M.d.L., W.P.V., W.v.F.), and Statistics Netherlands,The Hague, The Netherlands (J.K.)
| |
Collapse
|
47
|
El Majdoub F, Elawady M, Bührle C, El-Khatib M, Hoevels M, Treuer H, Müller RP, Sturm V, Maarouf M. μMLC-LINAC radiosurgery for intracranial meningiomas of complex shape. Acta Neurochir (Wien) 2012; 154:599-604. [PMID: 22286691 DOI: 10.1007/s00701-012-1278-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 01/10/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND We present the long-term results of a consecutive series of patients with meningiomas treated by LINAC-radiosurgery using the micro-multi-leaf collimator technique (μMLC). METHODS Between May 2001 and July 2009, 78 patients (m: f = 024:54; median age, 56.8 years; range, 20.1-81 years) with 87 intracranial meningiomas (78 WHO I, seven WHO II, two WHO III) were treated with μMLC-LINAC radiosurgery at our institution, either as a primary or salvage treatment following one or more microsurgical procedures. Fifty-eight of 87 tumors (66.7%) were located in the skull base. The remaining 29 meningiomas (33.3%) were located in the convexity of the brain. The median tumor volume was 4.8 ml (range, 0.2-18.3 ml). The median tumor surface dose, maximal dose, and therapeutic isodose were 12 Gy, 16 Gy, and 75%, respectively. RESULTS For retrospective evaluation, we included 70 patients (78 tumors) with a minimum radiological follow-up of 24 months. After a median follow-up of 79.7 months (range, 24.2-109.1 months), 24 patients (34.3%) improved in their clinical status (paresis of N. abducens 18/48, facial paresis 4/8, and hemiparesis 2/9), 41 patients remained stable (58.6%), three patients had treatment-related temporary complaints (4.3%); two patients developed vertigo, and one had a left-sided hemihypesthesia. All complaints recovered completely after steroid medication within 2 weeks. Two patients (2.8%) developed permanent trigeminal neuralgia. Follow-up MR images showed a partial remission in 21 tumors (26.9%) and a stable tumor size in 55 cases (70.5%). Two patients with high-grade meningiomas showed a tumor progression (one WHO II and one WHO III meningioma). At the end of follow-up (July 2010), the actuarial 5- and 9-year progression-free survival after radiosurgery were 98 and 96%, respectively. There was no treatment-related mortality. CONCLUSIONS LINAC radiosurgery using a micro multi-leaf collimator for complex shaped intracranial meningiomas is effective yielding a high local tumor control, whereas the treatment-related morbidity remains low.
Collapse
Affiliation(s)
- Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Jansen M, Mohapatra G, Betensky RA, Keohane C, Louis DN. Gain of chromosome arm 1q in atypical meningioma correlates with shorter progression-free survival. Neuropathol Appl Neurobiol 2012; 38:213-9. [PMID: 21988727 PMCID: PMC3563294 DOI: 10.1111/j.1365-2990.2011.01222.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS Atypical (World Health Organization grade II) meningiomas have moderately high recurrence rates; even for completely resected tumours, approximately one-third will recur. Post-operative radiotherapy may aid local control and improve survival, but carries the risk of side effects. More accurate prediction of recurrence risk is therefore needed for patients with atypical meningioma. Previously, we used high-resolution array comparative genomic hybridization to identify genetic variations in 47 primary atypical meningiomas and found that approximately 60% of tumours show gain of 1q at 1q25.1 and 1q25.3 to 1q32.1 and that 1q gain appeared to correlate with shorter progression-free survival. This study aimed to validate and extend these findings in an independent sample. METHODS Eighty-six completely resected atypical meningiomas (with 25 recurrences) from two neurosurgical centres in Ireland were identified and clinical follow-up was obtained. Utilizing a dual-colour interphase fluorescence in situ hybridization assay, 1q gain was assessed using Bacterial Artificial Chromosome probes directed against 1q25.1 and 1q32.1. RESULTS The results confirm the high prevalence of 1q gain at these loci in atypical meningiomas. We further show that gain at 1q32.1 and age each correlate with progression-free survival in patients who have undergone complete surgical resection of atypical meningiomas. CONCLUSIONS These independent findings suggest that assessment of 1q copy number status can add clinically useful information for the management of patients with atypical meningiomas.
Collapse
Affiliation(s)
- M Jansen
- Pathology Service, Harvard Medical School, USA
| | | | | | | | | |
Collapse
|
49
|
Attia A, Chan MD, Mott RT, Russell GB, Seif D, Daniel Bourland J, Deguzman AF, Ellis TL, McMullen KP, Munley MT, Tatter SB, Shaw EG. Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol 2012; 108:179-85. [PMID: 22359231 DOI: 10.1007/s11060-012-0828-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 02/15/2012] [Indexed: 11/26/2022]
Abstract
Atypical meningiomas have poor local control with emerging literature indicating the use of radiosurgery in treatment. The purpose of this study was to evaluate clinical outcomes including local control and failure pattern after Gamma Knife radiosurgery (GKRS) and factors that may affect these outcomes. Between 1999 and 2008, 24 patients were treated with GKRS as either primary or salvage treatment for pathologically proven atypical meningiomas. Treatment failures were determined by serial magnetic resonance imaging. A median marginal dose of 14 Gy was used (range 10.5-18 Gy). Overall local control rates at 1, 2, and 5 years were 75, 51, and 44%, respectively. With median follow-up time of 42.5 months, 14 of 24 patients experienced a treatment failure at time of last follow-up. Eight recurrences were in-field, four were marginal failures, and two were distant failures. Wilcoxon analysis revealed that the conformality index (CI) was a significant predictor of local recurrence (P = 0.04). CI did not predict for distant recurrences (P = 0.16). On multivariate analysis evaluating factors predicting progression free survival, dose >14 Gy was found to be statistically significant (P = 0.01). There appears to be a dose response using GKRS beyond 14 Gy but given the suboptimal local control rates in this study, higher doses may still be needed to obtain better local control.
Collapse
Affiliation(s)
- Albert Attia
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Weber DC, Schneider R, Goitein G, Koch T, Ares C, Geismar JH, Schertler A, Bolsi A, Hug EB. Spot scanning-based proton therapy for intracranial meningioma: long-term results from the Paul Scherrer Institute. Int J Radiat Oncol Biol Phys 2011; 83:865-71. [PMID: 22138457 DOI: 10.1016/j.ijrobp.2011.08.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/28/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND To assess the long-term clinical results of spot scanning proton therapy (PT) in the treatment of intracranial meningiomas. PATIENTS AND METHODS Thirty-nine patients with meningioma (histologically proven 34/39) were treated with PT between July 1997 and January 2010. Thirty-two (82.1%) patients were treated as primary treatment (exclusive PT, n = 8; postoperative PT, n = 24). Mean age was 48.3 ± 17.9 years and 32 (82.1%) patients had skull base lesions. For patients undergoing surgery, 24 patients had a diagnosis of World Health Organization (WHO) Grade I and 10 of a WHO Grade II/III meningioma, respectively. The female-to-male ratio was 3.3. The median administered dose was 56.0 Gy (relative biologic effectiveness [RBE]) (range, 52.2-66.6) at 1.8-2.0 Gy (RBE) per fraction. Gross tumor volume (GTV) ranged from 0.76 to 546.5 cm(3) (median, 21.5). Late toxicity was assessed according to Common Terminology Criteria for Adverse Events version 3.0. Mean follow-up time was 62.0 months and all patients were followed for >6 months. RESULTS Six patients presented with tumor recurrence and 6 patients died during follow-up, of which 4 of tumor progression. Five-year actuarial local control and overall survival rates were 84.8% and 81.8%, respectively, for the entire cohort and 100% for benign histology. Cumulative 5-year Grade ≥3 late toxicity-free survival was 84.5%. On univariate analysis, LC was negatively influenced by WHO grade (p = 0.001), GTV (p = 0.013), and male gender (p = 0.058). CONCLUSIONS PT is a safe and effective treatment for patients with untreated, recurrent, or incompletely resected intracranial meningiomas. WHO grade and tumor volume was an adverse prognostic factor for local control.
Collapse
Affiliation(s)
- Damien C Weber
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|