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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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Graillon T, Boissonneau S, Appay R, Boucekine M, Peyrière H, Meyer M, Farah K, Albarel F, Morange I, Castinetti F, Brue T, Fuentes S, Figarella-Branger D, Cuny T, Dufour H. Meningiomas in patients with long-term exposition to progestins: Characteristics and outcome. Neurochirurgie 2021; 67:556-563. [PMID: 33989642 DOI: 10.1016/j.neuchi.2021.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe progestin-associated meningiomas' characteristics, outcome and management. MATERIAL AND METHODS We included 53 patients operated on and/or followed in the department for meningioma with progestin intake longer than one year and with recent drug discontinuation. RESULTS Cyproterone acetate (CPA), nomegestrol acetate (NomA), and chlormadinone acetate (ChlA) were involved in most cases. Mean duration of progestin drugs intake was 17.5 years. Tumors were multiple in 66% of cases and were located in the anterior and the medial skull base in 71% of cases. Transitional subtype represented 16/25 tumors; 19 meningiomas were WHO grade I and 6 were grade II. The rate of transitional subtype and skull base location was significantly higher compared to matched operated meningioma general population. No difference was observed given WHO classification. But Ki67 proliferation index tends to be lower and 5/6 of the WHO grade II meningiomas were classified as WHO grade II because of brain invasion. Strong progesterone receptors expression was observed in most cases. After progestin discontinuation, a spontaneous visual recovery was observed in 6/10 patients. Under CPA (n=24) and ChlA/NomA (n=11), tumor volume decreased in 71% and 18% of patients, was stabilized in 25% and 64% of patients, and increased in 4% and 18% of patients, respectively. Volume outcome was related to meningioma location. CONCLUSIONS Outcome at progestins discontinuation is favorable but different comparing CPA versus ChlA-NomA and comparing tumor location. Long-term follow-up is required. In most cases, simple observation is recommended and surgery should be avoided.
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Affiliation(s)
- T Graillon
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Neursurgery, CHU Timone, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - S Boissonneau
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neuro-chirurgie, Marseille, France
| | - R Appay
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - M Boucekine
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, 27, bd Jean Moulin cedex 05, 13385 Marseille, France
| | - H Peyrière
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - M Meyer
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - K Farah
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - F Albarel
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - I Morange
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - F Castinetti
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - T Brue
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - S Fuentes
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - D Figarella-Branger
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - T Cuny
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - H Dufour
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Neursurgery, CHU Timone, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
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