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Zhang H, Wu H, Lu J, Shao W, Yu L. Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report. Front Oncol 2023; 13:1273465. [PMID: 37886178 PMCID: PMC10599143 DOI: 10.3389/fonc.2023.1273465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Orbital meningioma is a rare type of orbital tumor with high invasiveness and recurrence rates, making it extremely challenging to treat. Due to the special location of the disease, surgery often cannot completely remove the tumor, requiring postoperative radiation therapy. Here, we report a case of an elderly male patient with right-sided proptosis, visual impairment, and diplopia. Imaging diagnosis revealed a space-occupying lesion in the extraconal space of the right orbit. Pathological and immunohistochemical examination of the resected tumor confirmed it as a grade 3 anaplastic meningioma. Two months after surgery, the patient complained of right eye swelling and a magnetic resonance imaging (MRI) scan showed a recurrence of the tumor. The patient received helical tomotherapy (TOMO) in the postoperative tumor bed and high-risk areas within the orbit with a total dose of 48Gy. However, there was no significant improvement in the patient's right eye swelling, and the size of the recurrent lesion showed no significant change on imaging. Gamma knife multifractionated stereotactic radiosurgery (MF-SRS) was then given to the recurrent lesion with 50% prescription dose 13.5Gy/3f, once every other day. An imaging diagnosis performed 45 days later showed that the tumor had disappeared completely. The patient's vision remained unchanged, but diplopia was significantly relieved after MF-SRS. We propose a new hybrid treatment model for recurrent orbital meningioma, where conventional radiation therapy ensures local control of high-risk areas around the postoperative cavity, and MF-SRS maximizes the radiation dose to recurrent lesion areas while protecting surrounding tissues and organs.
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Affiliation(s)
- Haomiao Zhang
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hanfeng Wu
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
| | - Jianjie Lu
- Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wencheng Shao
- Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lili Yu
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
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Alvaro-Heredia JA, Salazar Felix NA, López-Valencia G, Moncada-Habib T, Castro-Vega JI, Rodríguez-Hernández LA, Mondragón-Soto M, Muñuzuri-Camacho MA, Alvaro-Heredia I, González-Aguilar A. Epidemiology of Intracranial Meningiomas in Mexico: Cohort of the National Institute of Neurology and Neurosurgery During the Last Decade. Cureus 2023; 15:e40046. [PMID: 37425507 PMCID: PMC10324624 DOI: 10.7759/cureus.40046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Meningiomas have been described as slow-growing neoplasms with benign behavior derived from the connective tissue surrounding the brain and spinal cord. Meningiomas represent one-third of primary central nervous system (CNS) tumors. The World Health Organization (WHO) initially classified them into three groups based on their histopathological characteristics, recently incorporating molecular patterns. Small cohorts have been reported in Latin America compared to the international literature. Ignoring the epidemiology of meningiomas in this region and considering this limitation, we aim to study the epidemiology of meningiomas in our country, Mexico. Material and methods A historical cohort was carried out on 916 patients diagnosed with intracranial meningiomas from January 2008 to January 2021, considering sociodemographic, topographic, and histopathological characteristics. Results In this study, 69.4% (n=636) of patients were women with a mean overall age of 47.53 (SD=14.85) years; 79.6% (n=729) of the lesions were supratentorial with convexity meningiomas being the most prevalent at 32.6% (n=299). Histopathologically, transitional (45.7%) (n=419), meningothelial (22.1%) (n=202), and fibroblastic (16.7%) (n=153) meningiomas were the most frequent. We found significant differences between men and women in age (p=0.01), infra or supratentorial presentation (p<0.001), location of the lesion (p<0.001), and histopathological characteristics (p<0.001). Conclusions Our results are consistent with what has been reported; however, until now, it appears as the largest series reported in our country and Latin America.
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Affiliation(s)
| | | | - German López-Valencia
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Tomas Moncada-Habib
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Jorge Ivan Castro-Vega
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Michel Mondragón-Soto
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Isidro Alvaro-Heredia
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Alberto González-Aguilar
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Cai L, Yang Z, Song D, Luo M. Nomogram Model for Predicting the Overall Survival of Patients With Meningiomas: a Retrospective Cohort Study. World Neurosurg 2023; 171:e309-e322. [PMID: 36513299 DOI: 10.1016/j.wneu.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify the significant prognostic factors of overall survival (OS) for patients living with meningiomas (MMs), and establish a novel graphical nomogram and an online dynamic nomogram. METHODS Patients diagnosed with MMs were identified retrospectively from the SEER database. The cohort was split into training (70%) and test (30%) groups randomly. Univariable and multivariable Cox models were successively used to screen the significant prognostic factors. Subsequently, the independent predictors were used as items to establish the graphic and dynamic nomogram model. To assess the accuracy of the model, a calibration curve was plotted. To assess the discrimination performance, C-index and time-dependent area under the receiver operator characteristic curve (AUC) were selected. Additionally, the decision curve was generated to evaluate the clinical net benefit of the model. RESULTS A total of 899 patients were involved, of which 629 and 270 were split into training group and test group, respectively. Age, sex, radiotherapy, tumor size, and tumor histology were identified as the significant prognostic factors. Based on these factors, a graphical nomogram and online nomogram (Web site: https://helloshinyweb.shinyapps.io/dynamic_nomogram/) were developed. The calibration curve showed favorable consistence between predicted and actual survival rate. C-index and time-dependent AUC showed good discrimination ability, and the decision curve analysis showed positive net benefit of the model in clinical practice. CONCLUSIONS Age of diagnosis, sex, tumor size, tumor histology, and radiotherapy were independent predictors for OS, while extent of resection had a borderline significant. A nomogram model was successfully developed and validated to dynamically predict the long-term OS for MM patients, expecting to help neurosurgeons optimize clinical management and treatment strategies.
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Affiliation(s)
- Linqiang Cai
- Department of Neurosurgery, the Central Hospital Affiliated to Shaoxing University, Shaoxing City, China
| | - Zhihao Yang
- Department of Neurosurgery, the Central Hospital Affiliated to Shaoxing University, Shaoxing City, China
| | - Dagang Song
- Department of Neurosurgery, the Central Hospital Affiliated to Shaoxing University, Shaoxing City, China
| | - Ming Luo
- Department of Neurosurgery, the Central Hospital Affiliated to Shaoxing University, Shaoxing City, China.
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Paths of Evolution of Progressive Anaplastic Meningiomas: A Clinical and Molecular Pathology Study. J Pers Med 2023; 13:jpm13020206. [PMID: 36836440 PMCID: PMC9965923 DOI: 10.3390/jpm13020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Grade 3 meningiomas are rare malignant tumors that can originate de novo or from the progression of lower grade meningiomas. The molecular bases of anaplasia and progression are poorly known. We aimed to report an institutional series of grade 3 anaplastic meningiomas and to investigate the evolution of molecular profile in progressive cases. Clinical data and pathologic samples were retrospectively collected. VEGF, EGFR, EGFRvIII, PD-L1; and Sox2 expression; MGMT methylation status; and TERT promoter mutation were assessed in paired meningioma samples collected from the same patient before and after progression using immunohistochemistry and PCR. Young age, de novo cases, origin from grade 2 in progressive cases, good clinical status, and unilateral side, were associated with more favorable outcomes. In ten progressive meningiomas, by comparing molecular profile before and after progression, we identified two subgroups of patients, one defined by Sox2 increase, suggesting a stem-like, mesenchymal phenotype, and another defined by EGFRvIII gain, suggesting a committed progenitor, epithelial phenotype. Interestingly, cases with Sox2 increase had a significantly shortened survival compared to those with EGFRvIII gain. PD-L1 increase at progression was also associated with worse prognosis, portending immune escape. We thus identified the key drivers of meningioma progression, which can be exploited for personalized treatments.
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5
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Maier AD. Malignant meningioma. APMIS 2022; 130 Suppl 145:1-58. [DOI: 10.1111/apm.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Daniela Maier
- Department of Neurosurgery, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Pathology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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Maier AD, Mirian C, Haslund-Vinding J, Bartek J, Guldager R, Møller S, Munch TN, Fugleholm K, Poulsgaard L, Skjøth-Rasmussen J, Ziebell M, Eriksson LE, Scheie D, Poulsen FR, Mathiesen T. Granular clinical history and outcome in 51 patients with primary and secondary malignant meningioma. J Neurosurg 2022; 137:1347-1357. [PMID: 35276654 DOI: 10.3171/2022.1.jns212723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE WHO grade III meningiomas, also known as malignant meningiomas (MMs), are rare, and the heterogenous clinical course in patients with MM is not well described. To characterize the clinical course of patients with MM, granular clinical data were gathered from 51 patients treated at the Department of Neurosurgery and Radiation Oncology, Rigshospitalet, in Copenhagen, Denmark, between 2000 and 2020. METHODS The authors investigated outcome and timing in terms of 1) tumor progression and grade transformation in patients previously diagnosed with WHO grade I or II meningiomas (patients with a secondary MM [sMM]); 2) performance status and complications following surgery; and 3) transition to noncurative treatment and ultimately death. Complications, time between recurrences, and outcome (modified Rankin Scale [mRS] score) for every surgery were analyzed, both malignant and premalignant. RESULTS Of the 51 patients, 24 (47%) had an sMM. The time to WHO grade III transformation in the sMM group varied widely (median 5.5 years, range 0.5-22 years), but after transformation to a WHO grade III tumor, patients with an sMM and those with a primary MM (pMM) did not differ significantly in overall survival and cumulative risk of progression. Median overall survival for all 51 patients was 4.2 years (95% CI 2.6-7.2 years). Time from the decision to shift from curative to noncurative treatment until death was 3.8 months and the 30-day mortality rate following surgery was 11.8%. From a cumulative number of 151 surgeries, 10 surgeries were followed by improvement on the mRS, mRS score was unchanged in 70, and it worsened in 71. The MM was the underlying cause of death in 30 of 31 patients who had died at the end of follow-up. CONCLUSIONS Together, these findings clearly show a significant morbidity and mortality from the disease itself and from the treatment. These findings warrant studies of prognostic factors for earlier support and adjuvant measures in MM and identify a need for better palliative strategies in this patient group.
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Affiliation(s)
| | | | | | - Jiri Bartek
- 1Departments of Neurosurgery
- 3Department of Neurosurgery, Karolinska University Hospital, Solna, Stockholm, Sweden
- 4Department of Clinical Neuroscience, Karolinska Institutet, Solna, Stockholm, Sweden
| | | | - Søren Møller
- 5Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tina N Munch
- 1Departments of Neurosurgery
- 6Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- 7Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Kåre Fugleholm
- 1Departments of Neurosurgery
- 7Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | - Jane Skjøth-Rasmussen
- 1Departments of Neurosurgery
- 7Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Morten Ziebell
- 1Departments of Neurosurgery
- 7Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars E Eriksson
- 8Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- 9School of Health Sciences, City, University of London, United Kingdom
- 10Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | | | - Frantz R Poulsen
- 11Odense University Hospital, Department of Neurosurgery, Odense, Denmark; and
- 12University of Southern Denmark and BRIDGE, Clinical Institute, Odense, Denmark
| | - Tiit Mathiesen
- 1Departments of Neurosurgery
- 7Department of Clinical Medicine, University of Copenhagen, Denmark
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Survival Benefit of Prognostic Factors and Treatment in Adult Patients with Recurrent Anaplastic Meningioma: A Retrospective Case Series and Systematic Literature Review. World Neurosurg 2022; 166:e758-e769. [PMID: 35944862 DOI: 10.1016/j.wneu.2022.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrence rates of anaplastic meningioma (AM) are high even after a complete resection with postoperative radiotherapy. OBJECTIVE This study aimed to evaluate predictors and treatment affecting survival of recurrent AM based on our series and a systematic literature review (SLR). METHODS Our single-institute (SI) data enrolled patients with first recurrent AM, treated in our hospital from 2012 to 2018. We retrieved eligible cases from SLR from 1966 to 2020. Our SI data and pooled data, integrating SI and SLR data, were subject to Cox proportional hazard regression analysis. RESULTS Analysis from SI data (n = 38) showed that second recurrence-free survival (RFS) was associated with intervals (HR [hazard ratio], 0.263; P = 0.002), preoperative Karnofsky Performance Status (KPS) (HR, 0.450; P = 0.043), radiotherapy (HR, 0.395; P = 0.047), whereas overall survival (OS) was related to preoperative KPS (HR, 0.411; P = 0.037) and tumor size (HR, 3.429; P = 0.007). The pooled data (n = 60) indicated that short intervals (HR, 0.370; P = 0.002) and the use of radiotherapy (HR, 0.318; P = 0.003) improved second RFS and number of resections ≥3 (HR, 0.210; P = 0.002) and radiotherapy (HR, 0.209; P = 0.002) prolonged OS. Furthermore, the overall second RFS (P = 0.024) and OS (P = 0.031) stratified by 4 treatment protocols differed significantly. CONCLUSIONS Early managements of patients with AM, before presence of poor preoperative KPS and large tumor size, are critical for survival. For patients with recurrent AM, survival benefits could be obtained from radiotherapy and multiple resections.
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Diagnostic and Therapeutic Strategy in Anaplastic (Malignant) Meningioma, CNS WHO Grade 3. Cancers (Basel) 2022; 14:cancers14194689. [PMID: 36230612 PMCID: PMC9562197 DOI: 10.3390/cancers14194689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Only 1% of all meningioma diagnosis is classified as malignant (anaplastic) meningioma. Due to their rarity, clinical management of these tumors presents several gaps. In this review, we investigate current knowledge of anaplastic meningioma focusing on their pathological and radiological diagnosis, molecular assessment, and loco-regional and systemic management. Despite the current marginal role of systemic therapy, it is possible that the increasing knowledge of molecular altered pathways of the disease will lead to the development of novel effective systemic treatments. Abstract Background: Meningiomas are the most common primary central nervous system malignancies accounting for 36% of all intracranial tumors. However, only 1% of meningioma is classified as malignant (anaplastic) meningioma. Due to their rarity, clinical management of these tumors presents several gaps. Methods: We carried out a narrative review aimed to investigate current knowledge of anaplastic meningioma focusing on their pathological and radiological diagnosis, molecular assessment, and loco-regional and systemic management. Results: The most frequent genetic alteration occurring in meningioma is the inactivation in the neurofibromatosis 2 genes (merlin). The accumulation of copy number losses, including 1p, 6p/q, 10q, 14q, and 18p/q, and less frequently 2p/q, 3p, 4p/q, 7p, 8p/q, and 9p, compatible with instability, is restricted to NF2 mutated meningioma. Surgery and different RT approaches represent the milestone of grade 3 meningioma management, while there is a marginal role of systemic therapy. Conclusions: Anaplastic meningiomas are rare tumors, and diagnosis should be suspected and confirmed by trained radiologists and pathologists. Despite the current marginal role of systemic therapy, it is possible that the increasing knowledge of molecular altered pathways of the disease will lead to the development of novel effective systemic treatments.
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Belanger K, Ung TH, Damek D, Lillehei KO, Ormond DR. Concomitant Temozolomide plus radiotherapy for high-grade and recurrent meningioma: a retrospective chart review. BMC Cancer 2022; 22:367. [PMID: 35392834 PMCID: PMC8988385 DOI: 10.1186/s12885-022-09340-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background High-grade and recurrent meningiomas are often treatment resistant and pose a therapeutic challenge after surgical and radiation therapy (RT) failure. Temozolomide (TMZ) is a DNA alkylating agent that appears to have a radiosensitizing effect when used in combination with RT and may be worthwhile in meningioma treatment. Thus, we investigated the potential efficacy of concomitant RT plus TMZ compared to historical controls of just RT used in the treatment of high-grade and recurrent meningiomas. Methods We performed a retrospective analysis of patients with meningioma treated at the University of Colorado with TMZ chemoradiation. Progression free survival (PFS) and overall survival (OS) were calculated from the start of chemoradiation to local recurrence or death, respectively. Results Eleven patients (12 tumors) were treated with chemoradiation with a median follow-up of 41.5 months. There were two WHO grade 1, eight grade 2 and two grade 3 meningiomas. Three patients died during the follow-up period—one being disease related (11.1%). Two patients had meningioma recurrence—at 2.3 months (WHO grade 3), and 5.4 years (WHO grade 2). Three-year OS and PFS for grade 2 meningiomas were each 88%. Historical controls demonstrate a 3-year median OS and PFS of 83% and 75.8%, respectively. Conclusions Treatment options are limited for meningiomas after local failure. In this study, TMZ chemoradiation demonstrated no significant difference in PFS and OS in the treatment of grade 2 meningiomas compared to historic controls. Further study is warranted to find novel methods for the treatment of malignant and recurrent meningiomas.
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Affiliation(s)
- Katherine Belanger
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy H Ung
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Denise Damek
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA.
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de Oliveira Silva CB, Araújo B, Ongaratti BR, dos Santos TM, Rech CGSL, Coutinho LB, Ferreira NP, da Costa Oliveira M, Pereira-Lima JFS. Preoperative hematological inflammatory markers associated with grade and survival in Meningiomas. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [DOI: 10.1186/s42047-022-00106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractMeningiomas represent the most frequently diagnosed intracranial tumors. Inflammatory cells present in the tumor can modulate both antitumor and protumor functions, and modify the therapeutic response. Hematological inflammatory parameters have provided prognostic information useful in the treatment and clinical evaluation of several tumors. The aim of this study was to evaluate preoperative hematological markers of patients with meningiomas and to relate them to clinical variables and recurrence-regrowth free survival. Eighty-nine patients without corticosteroid therapy were included. Blood test results and tumor characteristics were collected from medical records. Associations between clinical characteristics and the recurrence-regrowth free survival (RFS) were evaluated using Cox proportional hazard analysis and Kaplan-Meier curves. The receiver operating characteristic (ROC) curves were constructed. Of the 89 cases, 73 (82%) were grade I and 16 (18%) grade II. The mean age was 53 ± 13.9 years, with higher frequency in women. Anemia was observed in 23.6% and neutrophilia in 42% of the patients. In univariate analysis, anemia (p = 0.04), neutrophilia (p = 0.02) and neutrophil/lymphocyt ratio (NLR) (p = 0.02) were associated with an increased risk of recurrence-regrowth and shorter RFS. In multivariate analysis, anemia and NLR > 4.1 represented a higher risk of recurrence-regrowth (p = 0.003). The ROC curve analysis showed that only the lymphocyte/monocyte (L/M) > 2.5 was able to predict the tumor grade. The preoperative presence of anemia, neutrophilia, NLR > 4.1 and L/M > 2.5 were associated with a worse prognosis in meningiomas. The use of preoperative hematological inflammatory parameters as prognostic factors can be promissing for evaluation and follow-up of meningiomas.
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Sá-Marta E, Alves JL, Rebelo O, Barbosa M. World Health Organization Grade III Meningiomas: A Retrospective Study at an Academic Medical Center. World Neurosurg 2021; 149:e877-e893. [PMID: 33516862 DOI: 10.1016/j.wneu.2021.01.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Meningiomas are the most common primary brain tumors and are generally considered benign. However, a rare subgroup of meningiomas, classified as World Health Organization (WHO) grade III meningiomas, can show extremely aggressive behavior and high rates of recurrence. Despite ongoing research, data on the clinical outcome of this subgroup of meningiomas are still limited. METHODS Medical records of patients with WHO grade III meningiomas diagnosed between 2000 and 2018 at the Coimbra University Hospital Center were retrospectively reviewed and several variables of interest and their relation to patients' survival were analyzed. RESULTS Of the 26 patients included in the final analysis, 23 had anaplastic meningiomas, 2 had papillary meningiomas, and 1 had a rhabdoid meningioma. Median overall survival and median progression-free survival were 2.45 and 1.22 years, respectively. Overall survival at 1, 2 and 5 years was 73%, 57%, and 35%, respectively. Adjuvant radiotherapy correlated with improved survival for subtotally resected meningiomas but not for gross totally resected meningiomas. There was a trend toward improved overall survival with gross total resection versus subtotal resection, but this difference failed to reach statistical significance. CONCLUSIONS This study provides insight into the clinical outcomes of WHO grade III meningiomas and suggests that adjuvant radiotherapy may not be beneficial for patients who underwent gross total resection. This rare subset of meningiomas still portends a devastating prognosis and the impact of extent of resection and adjuvant therapies in these patients needs further clarification.
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Affiliation(s)
- Eduarda Sá-Marta
- Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - José Luís Alves
- Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Olinda Rebelo
- Neuropathology Laboratory, Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marcos Barbosa
- Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
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Tian W, Liu J, Zhao K, Wang J, Jiang W, Shu K, Lei T. Analysis of Prognostic Factors of World Health Organization Grade Ⅲ Meningiomas. Front Oncol 2020; 10:593073. [PMID: 33425743 PMCID: PMC7793968 DOI: 10.3389/fonc.2020.593073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Objective WHO grade III meningiomas are highly aggressive and lethal. However, there is a paucity of clinical information because of a low incidence rate, and little is known for prognostic factors. The aim of this work is to analyze clinical characteristics and prognosis in patients diagnosed as WHO grade III meningiomas. Methods 36 patients with WHO grade III meningiomas were enrolled in this study. Data on gender, age, clinical presentation, preoperative Karnofsky Performance Status (KPS), histopathologic features, tumor size, location, radiologic findings, postoperative radiotherapy (RT), surgical treatment, and prognosis were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method. Univariate and multivariate analysis were conducted by the Cox regression model. Results Median PFS is 20 months and median OS is 36 months in 36 patients with WHO grade III meningiomas. Patients with secondary tumors which transformed from low grade meningomas had lower PFS (p=0.0014) compared with primary group. Multivariate analysis revealed that tumors location (PFS, p=0.016; OS, p=0.013), Ki-67 index (PFS, p=0.004; OS, p<0.001) and postoperative radiotherapy (PFS, p=0.006; OS, p<0.001) were associated with prognosis. Conclusion WHO grade III meningiomas which progressed from low grade meningiomas were more prone to have recurrences or progression. Tumors location and Ki-67 index can be employed to predict patient outcomes. Adjuvant radiotherapy after surgery can significantly improve patient prognosis.
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Affiliation(s)
- Weidong Tian
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jingdian Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gauchotte G, Peyre M, Pouget C, Cazals-Hatem D, Polivka M, Rech F, Varlet P, Loiseau H, Lacomme S, Mokhtari K, Kalamarides M, Bielle F. Prognostic Value of Histopathological Features and Loss of H3K27me3 Immunolabeling in Anaplastic Meningioma: A Multicenter Retrospective Study. J Neuropathol Exp Neurol 2020; 79:754-762. [PMID: 32447376 DOI: 10.1093/jnen/nlaa038] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022] Open
Abstract
The diagnosis of anaplastic meningioma (AM) (WHO grade III) is based on the presence of a high mitotic index (MI) and/or overt anaplasia. Only few data exist about the reproducibility and prognostic value of overt anaplasia. Additionally, the prognostic value of H3K27me3 loss in AM has not yet been demonstrated. Our objectives were to evaluate the reproducibility and prognostic value of WHO criteria and H3K27me3 loss in a multicenter series of 66 AM. Interobserver reproducibility was good for the determination of WHO grade (Kappa = 0.671) and MI (intraclass correlation coefficient [ICC] = 0.649), and fair for assessment of overt anaplasia (Kappa = 0.366). Patients with meningiomas showing high MI had significantly shorter overall survival (OS) than patients with meningiomas showing overt anaplasia without high MI (p = 0.009). OS was significantly lower in case of overt anaplasia with low MI (<20/1.6 mm2) than in atypical meningiomas (p = 0.008). H3K27me3 loss was present in 10/47 (21%) of AM and independently associated with shorter OS (p = 0.036; Cox multivariate analysis), with a good reproducibility (Kappa = 0.643). In conclusion, the presence of overt anaplasia could give additional prognostic information in tumors lacking high MI. Finally, loss of H3K27me3 is an easy-to-use and reproducible marker of poorer prognosis.
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Affiliation(s)
- Guillaume Gauchotte
- INSERM U1256, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy.,Department of Pathology, CHRU, Nancy, France.,Centre de Ressources Biologiques, BB-0033-00035 (GG, SL), CHRU, Nancy, France
| | - Matthieu Peyre
- Sorbonne Universités, INSERM, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Department of Neurosurgery, Groupe Hospitalier Pitié Salpêtrière, AP-HP (MP, MK), Paris, France.,Department of Pathology, Hôpital Lariboisière, AP-HP, Paris, France
| | - Celso Pouget
- INSERM U1256, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy.,Department of Pathology, CHRU, Nancy, France
| | | | | | - Fabien Rech
- Department of Neurosurgery, CHRU, Nancy, France.,Institut des Neurosciences, INSERM U1051, Montpellier, France
| | - Pascale Varlet
- Department of Neuropathology, Centre Hospitalier Saint-Anne, Paris, France
| | - Hugues Loiseau
- Department of Neurosurgery, CEREPEG, Hôpital Pellegrin Tripode, Bordeaux, France.,EA 7435 - IMOTION University of Bordeaux (HL), Bordeaux
| | - Stéphanie Lacomme
- Centre de Ressources Biologiques, BB-0033-00035 (GG, SL), CHRU, Nancy, France
| | - Karima Mokhtari
- Sorbonne Universités, INSERM, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, Paris, France.,AP-HP, Department of Neuropathology, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Michel Kalamarides
- Sorbonne Universités, INSERM, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Department of Neurosurgery, Groupe Hospitalier Pitié Salpêtrière, AP-HP (MP, MK), Paris, France
| | - Franck Bielle
- Sorbonne Universités, INSERM, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, Paris, France.,AP-HP, Department of Neuropathology, Hôpital de la Pitié Salpêtrière, Paris, France.,SiRIC CURAMUS (Cancer United Research Associating Medicine, University & Society), Site de Recherche Intégrée sur le Cancer IUC, APHP.6, Sorbonne Université (FB), Paris, France
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14
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Kuranari Y, Tamura R, Tsuda N, Kosugi K, Morimoto Y, Yoshida K, Toda M. Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Patients With Meningiomas. Front Oncol 2020; 10:592470. [PMID: 33330078 PMCID: PMC7732694 DOI: 10.3389/fonc.2020.592470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Meningiomas are the most common benign intracranial tumors. However, even WHO grade I meningiomas occasionally show local tumor recurrence. Prognostic factors for meningiomas have not been fully established. Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic factor for several solid tumors. The prognostic value of NLR in meningiomas has been analyzed in few studies. Materials and Methods This retrospective study included 160 patients who underwent surgery for meningiomas between October 2010 and September 2017. We analyzed the associations between patients’ clinical data (sex, age, primary/recurrent, WHO grade, extent of removal, tumor location, peritumoral brain edema, and preoperative laboratory data) and clinical outcomes, including recurrence and progression-free survival (PFS). Results Forty-four meningiomas recurred within the follow-up period of 3.8 years. WHO grade II, III, subtotal removal, history of recurrence, Ki-67 labeling index ≥3.0, and preoperative NLR value ≥2.6 were significantly associated with shorter PFS (P < 0.001, < 0.001, 0.002, < 0.001, and 0.015, respectively). Furthermore, NLR ≥ 2.6 was also significantly associated with shorter PFS in a subgroup analysis of WHO grade I meningiomas (P = 0.003). In univariate and multivariate analyses, NLR ≥2.6 remained as a significant predictive factor for shorter PFS in patients with meningioma (P = 0.014). Conclusions NLR may be a cost-effective and novel preoperatively usable biomarker in patients with meningiomas.
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Affiliation(s)
- Yuki Kuranari
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Tsuda
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yukina Morimoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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15
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Wang D, Sun S, Hua L, Deng J, Luan S, Cheng H, Xie Q, Wakimoto H, Zhu H, Gong Y. Prognostic Model That Predicts Benefits of Adjuvant Radiotherapy in Patients With High Grade Meningioma. Front Oncol 2020; 10:568079. [PMID: 33240812 PMCID: PMC7683714 DOI: 10.3389/fonc.2020.568079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Adjuvant radiotherapy is the main treatment modality for high grade meningioma after surgical resection; however, recurrence and survival outcomes vary. The aim of this study was to create a new “prognostic score” that allows personalized recommendations for post-operative adjuvant radiotherapy in patients with high grade meningioma. Methods Clinical data were collected from 115 patients with high grade meningioma treated with surgical resection and adjuvant radiotherapy. A prognostic model was built based on the hazards ratios of independent prognostic factors yielded by multivariate cox proportional analysis. Calibration and discrimination of the prognostic score was evaluated using good of fit test and Harrel’s C index, respectively. Results A total of 115 high grade meningioma patients (72 atypical and 43 anaplastic meningiomas) were enrolled. Three factors were independently associated with progression-free survival (PFS): extent of resection (GTR vs. STR), recurrent status (de novo vs. recurrent), and Ki-67 labeling index (<5% vs. ≥ 5%). The respective β-coefficients were used to generate the “prognostic score”. The cohort was divided into low-risk and high-risk groups based on the median prognostic score. Good of fit test showed strong calibration (P = 0.7133) and Harrel’s C index 0.766 indicated a strong discrimination capability of the prognostic score. The Harrel’s C index for OS was 0.60. Conclusions Our prognostic model using three basic clinical parameters robustly separated high grade meningioma patients who benefit vs. do not benefit from adjuvant radiotherapy. External validation of our model is warranted to help improve patient selection suitable for adjuvant radiotherapy.
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Affiliation(s)
- Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuchen Sun
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaojiao Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihai Luan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haixia Cheng
- Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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16
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Hua L, Juratli TA, Zhu H, Deng J, Wang D, Sun S, Xie Q, Wakimoto H, Gong Y. High Tumor Mitochondrial DNA Content Correlates With an Improved Patient's Outcome in WHO Grade III Meningioma. Front Oncol 2020; 10:542294. [PMID: 33072573 PMCID: PMC7530740 DOI: 10.3389/fonc.2020.542294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Studies have shown mitochondrial genome content (mtDNA content) varies in many malignancies. However, its distribution and prognostic values in high-grade meningioma remain largely unknown. In this retrospective study, we sought to assess a putative correlation between the mtDNA content and clinical characteristics. Methods: Mitochondrial DNA was extracted from 87 World Health Organization grade III meningioma samples using a qPCR method. The distribution of mtDNA content in WHO grade III meningioma and its correlations with clinical variables were assessed. Furthermore, we prognostic values were also determined. Results: Mean mtDNA content was 617.7 (range, 0.8-3000). There was no mtDNA distribution difference based on the histological subtypes (P = 0.07). Tumors with preoperative radiation were associated with lower mtDNA content (P = 0.041), whereas no correlations with other clinical variables were observed. A high mtDNA content was associated with significantly better PFS (P = 0.044) and OS (P = 0.019). However, in patients who received postoperative radiotherapy, low mtDNA content was associated with better PFS (P = 0.028), while no difference in OS was observed (P = 0.272). Low mtDNA content was also associated with better OS and PFS in subgroups of patients with ER negative status (PFS, P = 0.002; OS, P = 0.002). Conclusions: Consistent with other tumors, high mtDNA content was associated with better outcome in WHO grade III meningioma in our cohort. However, for patients who received post-operative radiation therapy, low mtDNA content was associated with better PFS. These findings suggest that mtDNA content may further be explored as a potential biomarker for high-grade meningioma patients and for those who received postoperative radiation therapy.
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Affiliation(s)
- Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tareq A. Juratli
- Department of Neurosurgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaojiao Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuchen Sun
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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17
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Champeaux C, Jecko V, Houston D, Thorne L, Dunn L, Fersht N, Khan AA, Resche-Rigon M. Malignant Meningioma: An International Multicentre Retrospective Study. Neurosurgery 2020; 85:E461-E469. [PMID: 30566646 DOI: 10.1093/neuros/nyy610] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In contrast to benign meningiomas, malignant meningiomas (MM) are rare and associated with an unfavourable prognosis. Reports on MM concern fairly small cohorts, often comprising less than 30 cases. OBJECTIVE To describe the outcome MM and identify factors that may influence survival. METHODS Pathology reports and clinical data of 178 patients treated between 1989 and 2017 for a MM at 6 different international institutions were retrospectively reviewed. Seventy-six patients (42.7%) had a previous history of grade I or grade II meningioma. The patients underwent a total of 380 surgical resections and 72.5% received radiotherapy. Median follow-up was 4.5 yr. RESULTS At data collection, 111 patients were deceased (63.4%) and only 23 patients (13.7%) were alive without any residual tumor on the most recent scan. Median overall survival was 2.9 yr, 95% confidence interval [CI; 2.4, 4.5]. Overall survival rates at 1, 5, and 10 yr, respectively, were: 77.7%, 95% CI [71.6, 84.3], 40%, 95% CI [32.7, 49], and 27.9%, 95% CI [20.9, 37.3]. In the multivariable analysis, age at MM surgery <65 yr (hazard ratio [HR] = 0.44, 95% CI [0.29, 0.67], P < .001), previous benign or atypical meningioma surgery (HR = 1.9, 95% CI [1.23, 2.92], P = .004), completeness of resection (HR = 0.51, 95% CI [0.34, 0.78], P = .002), and adjuvant radiotherapy (HR = 0.64, 95% CI [0.42, 0.98], P = .039) were established as independent prognostic factors for survival. CONCLUSION This large series confirms the poor prognosis associated with MM, the treatment of which remains challenging. Patients under 65-yr-old with primary MM may live longer after complete resection and postoperative radiotherapy. Even with aggressive treatments, local control remains difficult to achieve.
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Affiliation(s)
- Charles Champeaux
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA team, Université Diderot - Paris 7, USPC, Paris, France.,Department of Neurosurgery, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Neurosurgery, Pellegrin Hospital, Bordeaux, France.,Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Vincent Jecko
- Department of Neurosurgery, Pellegrin Hospital, Bordeaux, France
| | - Deborah Houston
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Lewis Thorne
- Department of Neurosurgery, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Laurence Dunn
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Naomi Fersht
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Akbar Ali Khan
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Matthieu Resche-Rigon
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA team, Université Diderot - Paris 7, USPC, Paris, France
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18
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Rogers CL, Won M, Vogelbaum MA, Perry A, Ashby LS, Modi JM, Alleman AM, Galvin J, Fogh SE, Youssef E, Deb N, Kwok Y, Robinson CG, Shu HK, Fisher BJ, Panet-Raymond V, McMillan WG, de Groot JF, Zhang P, Mehta MP. High-risk Meningioma: Initial Outcomes From NRG Oncology/RTOG 0539. Int J Radiat Oncol Biol Phys 2019; 106:790-799. [PMID: 31786276 DOI: 10.1016/j.ijrobp.2019.11.028] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phase 2 cooperative group meningioma trial assessing the safety and efficacy of risk-adaptive management strategies. This is the initial analysis of the high-risk cohort. METHODS AND MATERIALS High-risk patients were those with a new or recurrent World Health Organization (WHO) grade III meningioma of any resection extent, recurrent WHO grade II of any resection extent, or new WHO grade II after subtotal resection. Patients received intensity-modulated radiotherapy (IMRT) using a simultaneous integrated boost technique (60 Gy high dose and 54 Gy low dose in 30 fractions). Three-year progression-free survival (PFS) was the primary endpoint. Adverse events (AEs) were scored per NCI Common Terminology Criteria for Adverse Events version 3. RESULTS Of 57 enrolled patients, 53 received protocol treatment. Median follow-up was 4.0 years (4.8 years for living patients). Two patients withdrew without progression before year 3; for the remaining 51 patients, 3-year PFS was 58.8%. Among all 53 protocol-treated patients, 3-year PFS was 59.2%. Three-year local control was 68.9%, and overall survival was 78.6%. Of 51 patients, 1 patient (1.9%) experienced a late grade-5 necrosis-related AE. All other acute (23 of 53 patients) and late (21 of 51 patients) AEs were grades 1 to 3. CONCLUSIONS Patients with high-risk meningioma treated with IMRT (60 Gy/30) experienced 3-year PFS of 58.8%. Combined acute and late AEs were limited to grades 1 to 3, except for a single necrosis-related grade 5 event. These results support postoperative IMRT for high-risk meningioma and invite ongoing investigations to improve outcomes further.
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Affiliation(s)
- C Leland Rogers
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | | | - Arie Perry
- University of California-San Francisco, San Francisco, California
| | - Lynn S Ashby
- Saint Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Anthony M Alleman
- The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Shannon E Fogh
- University of California-San Francisco, San Francisco, California
| | - Emad Youssef
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nimisha Deb
- Department of Radiation Oncology, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Young Kwok
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | | | | | | | - William G McMillan
- Juravinski Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John F de Groot
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
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19
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Masalha W, Heiland DH, Delev D, Fennell JT, Franco P, Scheiwe C, Mercas BI, Mader I, Schnell O, Grauvogel J. Survival and Prognostic Predictors of Anaplastic Meningiomas. World Neurosurg 2019; 131:e321-e328. [DOI: 10.1016/j.wneu.2019.07.148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/26/2022]
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20
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Survival Benefit of Adjuvant Radiotherapy in Elderly Patients with WHO Grade III Meningioma. World Neurosurg 2019; 131:e303-e311. [DOI: 10.1016/j.wneu.2019.07.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023]
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21
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Peyre M, Gauchotte G, Giry M, Froehlich S, Pallud J, Graillon T, Bielle F, Cazals-Hatem D, Varlet P, Figarella-Branger D, Loiseau H, Kalamarides M. De novo and secondary anaplastic meningiomas: a study of clinical and histomolecular prognostic factors. Neuro Oncol 2019; 20:1113-1121. [PMID: 29216385 DOI: 10.1093/neuonc/nox231] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Following recent studies underlining the differences between de novo and secondary anaplastic meningiomas and the prognostic value of telomerase reverse transcriptase (TERT) promoter mutation, we decided to conduct a multicenter retrospective study to address these questions and determine specific prognostic factors in each of these 2 anaplastic meningioma subgroups. Methods Among the 68 meningioma cases initially selected, only 57 were confirmed as anaplastic meningiomas after centralized pathological review. TERT promoter mutation analysis was performed in all cases. Results Median overall survival was 2.6 years and 5-year survival rate was 10%. This study confirmed the better prognosis of de novo anaplastic meningiomas (28 tumors) compared with secondary anaplastic meningiomas (29 tumors) (P = 0.02). In the "de novo" group, meningiomas diagnosed on histological anaplasia alone had a better prognosis than those in patients with a high number of mitoses with or without anaplasia (P = 0.01). In the "secondary" group, tumors demonstrate very heterogeneous clinical courses leading to malignant transformation, and time to first relapse as a low-grade tumor was a strong predictor of overall survival (P = 0.0007). TERT promoter mutation in anaplastic meningiomas was rare (14%) and did not influence overall survival but was associated with a shorter recurrence-free survival in the secondary anaplastic meningioma subgroup (P = 0.02). The absence of TERT promoter methylation, although rare (3/33 cases), may be associated with prolonged overall survival (P = 0.02). Conclusion This study highlights the different prognoses of de novo and secondary anaplastic meningiomas with specific prognostic factors in each subgroup. The analysis of TERT mutation and methylation could provide additional prognostic insights.
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Affiliation(s)
- Matthieu Peyre
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.,Université Paris VI-Pierre et Marie Curie, Paris, France.,Inserm 1127 Unit-Institut du Cerveau et de la Moelle Epinière, Paris, France
| | | | - Marine Giry
- Inserm 1127 Unit-Institut du Cerveau et de la Moelle Epinière, Paris, France
| | | | - Johan Pallud
- Department of Neurosurgery, Hôpital Sainte-Anne, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Thomas Graillon
- Department of Neurosurgery, Hôpital la Timone, Marseille, France
| | - Franck Bielle
- Department of Neuropathology, Hopital Pitié-Salpêtrière, APHP, Paris, France
| | | | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France.,Department of Neuropathology, Hopital Sainte-Anne, Paris, France
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, INSERM, CRO2, La Timone Hospital, Department of Pathology and Neuropathology, Marseille, France
| | - Hugues Loiseau
- Department of Neurosurgery, Hopital Pellegrin, Bordeaux, France
| | - Michel Kalamarides
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.,Université Paris VI-Pierre et Marie Curie, Paris, France.,Inserm 1127 Unit-Institut du Cerveau et de la Moelle Epinière, Paris, France
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22
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Garcia CR, Slone SA, Chau M, Neltner JH, Pittman T, Villano JL. Initial management of meningiomas: Analysis of the National Cancer Database. Cancer Epidemiol 2019; 60:16-22. [PMID: 30878798 PMCID: PMC6527450 DOI: 10.1016/j.canep.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States. METHODS We analyzed the National Cancer Database from 2004 to 2014, for all patients with diagnosis of meningioma. RESULTS 201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher in histologically confirmed cases (13.1 years). Older patients, Blacks, males, those that received radiation plus surgery, and were treated in community facilities had an increased risk of mortality. CONCLUSIONS Over half of patients were diagnosed by imaging, suggesting a higher role of clinical determinants over histological confirmation in treatment decisions. Watchful waiting as initial management is increasing. Our survival analysis favored histological confirmation. Patients receiving radiation and surgery had an increased risk of mortality.
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Affiliation(s)
- Catherine R Garcia
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Stacey A Slone
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Monica Chau
- Department of Neurology, University of Kentucky, Lexington, KY, United States
| | - Janna H Neltner
- Departments of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States
| | - Thomas Pittman
- Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States
| | - John L Villano
- Department of Medicine, University of Kentucky, Lexington, KY, United States; Department of Neurology, University of Kentucky, Lexington, KY, United States; Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States.
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Maier AD, Bartek J, Eriksson F, Ugleholdt H, Juhler M, Broholm H, Mathiesen TI. Clinical and histopathological predictors of outcome in malignant meningioma. Neurosurg Rev 2019; 43:643-653. [DOI: 10.1007/s10143-019-01093-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/10/2019] [Accepted: 03/03/2019] [Indexed: 02/01/2023]
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Chen H, Lai R, Tang X, Liu Z, Xu J. Lateral Intraventricular Anaplastic Meningioma: A Series of 5 Patients at a Single Institution and Literature Review. World Neurosurg 2018; 131:e1-e11. [PMID: 30500581 DOI: 10.1016/j.wneu.2018.11.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lateral intraventricular anaplastic meningiomas (LIAMs) are rare lesions. The aim of this study is to clarify clinical and radiologic characteristics and the optimal treatment strategies of LIAMs with long-term follow-up. METHODS From September 2008 to September 2017, 5 patients with LIAM were enrolled in our study. The clinical profiles, radiologic features, treatment strategies, and outcomes were retrospectively analyzed. RESULTS Five patients (all female; mean age, 48.8 years; range, 33-61 years) were included in this study. The most frequent symptoms were those related to increased intracranial pressure. Mean duration of symptoms was 6.7 months (range, 2 weeks-2 years). The average tumor size was 4.98 cm at the maximal diameter (range, 3.0-6.2 cm). All were confirmed with a diagnosis of anaplastic meningioma. Gross total resection was achieved in all 5 patients. All patients experienced improvement of symptoms. Recurrence and progression were identified in only 2 patients. At the last follow-up, the mean recurrence-free survival was 13 months (range, 7-21 months) and the mean overall survival was 16.25 months (range, 8-21 months). One patient was lost to follow-up. CONCLUSIONS Female and right trigone area predominance were found in our case series. Shorter duration of symptoms, irregular tumor shape, peritumoral edema, and heterogeneous enhancement may indicate an aggressive feature. Maximal safe resection followed by radiation therapy may be the best strategy for patients with LIAM. Long-term clinical follow-up and serial imaging are recommended.
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Affiliation(s)
- Hongxu Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Rui Lai
- Department of Anesthesiology, People's Hospital of Deyang City, Deyang, Sichuan, P.R. China
| | - Xinpu Tang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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Zhang GJ, Zhang YS, Zhang GB, Li D, Zhang LW, Wu Z, Zhang JT. Prognostic factors and the management of anaplastic meningioma. Clin Neurol Neurosurg 2018; 170:13-19. [DOI: 10.1016/j.clineuro.2018.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/17/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
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Shan B, Zhang J, Song Y, Xu J. Prognostic factors for patients with World Health Organization grade III meningiomas treated at a single center. Medicine (Baltimore) 2017; 96:e7385. [PMID: 28658170 PMCID: PMC5500092 DOI: 10.1097/md.0000000000007385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
| | | | - Yanlin Song
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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