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Gravbrot N, Rock CB, Weil CR, Rock CB, Burt LM, DeCesaris CM, Jensen RL, Shrieve DC, Cannon DM. Gross Tumor and Intracranial Control Benefits with Fractionated Radiotherapy Compared with Stereotactic Radiosurgery for Patients with WHO Grade 2 Meningioma. World Neurosurg 2024; 188:e259-e266. [PMID: 38777319 DOI: 10.1016/j.wneu.2024.05.093] [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: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Surgical resection is the mainstay of treatment for WHO grade 2 meningioma. Fractionated radiation therapy (RT) is frequently used after surgery, though many centers utilize stereotactic radiosurgery (SRS) for recurrence or progression. Herein, we report disease control outcomes from an institutional cohort with adjuvant fractionated RT versus salvage SRS. METHODS We identified 32 patients from an institutional database with WHO grade 2 meningioma and residual/recurrent tumor treated with either SRS or fractionated RT. Patients were treated between 2007 and 2021 and had at least 1 year of follow-up. Kaplan-Meier estimators were used to determine gross tumor control (GTC) and intracranial control (IC). Univariate Cox proportional hazards models using biologically effective dose (BED) as a continuous parameter were used to assess for dose responses. RESULTS With a median follow-up of 5.5 years, 13 patients (41%) received SRS to a recurrent or progressive nodule, 2 (6%) fractionated RT to a recurrent or progressive nodule, and 17 (53%) adjuvant fractionated RT following subtotal resection. Five-year GTC was higher with fractionated RT versus SRS (82% vs. 38%, P = 0.03). Five-year IC was also better with fractionated RT versus SRS (82% vs. 11%, P < 0.001). On univariate analysis, increasing BED10 was significantly associated with better GTC (P = 0.039); increasing BED3 was not (P = 0.82). CONCLUSIONS In this patient cohort, GTC and IC were significantly higher in patients treated with adjuvant fractionated RT compared with salvage SRS. Increasing BED10 was associated with better GTC. Fractionated RT may provide a better therapeutic ratio than SRS for grade 2 meningiomas.
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Affiliation(s)
- Nicholas Gravbrot
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
| | - Calvin B Rock
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA; Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christian B Rock
- The Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Lindsay M Burt
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Cristina M DeCesaris
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Randy L Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Dennis C Shrieve
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Donald M Cannon
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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Qin JJ, Li C, Fu J, Chen XZ. Overall Survival of Primary Single Intracranial Atypical Meningioma with Different Surgical and Postoperative Treatment Options: Evidence from the SEER Database. J Multidiscip Healthc 2024; 17:2647-2658. [PMID: 38828268 PMCID: PMC11141707 DOI: 10.2147/jmdh.s461450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024] Open
Abstract
Objective The aim of this study is to evaluate the impact of different surgical and postoperative treatment options on the long-term overall survival (OS) in patients with primary single intracranial atypical meningioma. Methods In this retrospective study, participants were drawn from the Surveillance, Epidemiology, and End Results (SEER) database. Inclusion criteria comprised patients who underwent either gross total resection (GTR) or subtotal resection (STR). The inverse probability weighting (IPW) method using generalized boosted models was used to achieve balance in variables across various treatment groups. Subsequent to IPW, multivariate Cox analysis and Kaplan-Meier analysis were conducted, with OS as the endpoint. Results GTR was conducted on 1650 patients, while STR was conducted on 1109 patients. Among these, 432 patients who underwent GTR and 401 patients who underwent STR received postoperative radiotherapy (PORT). In the case of patients who were under 60 years old, PORT emerged as a significant protective factor for OS in those who underwent STR (HR 0.44; 95% CI 0.23-0.84; p = 0.013). Survival curves demonstrated that patients who underwent STR with PORT exhibited comparable OS to those who underwent GTR without PORT (p = 0.546). Conversely, for patients aged 60 years or older, PORT emerged as an independent risk factor for both GTR (HR 1.42; 95% CI 1.00-2.00; p = 0.048) and STR (HR 1.81; 95% CI 1.26-2.60; p = 0.001). Conclusion PORT may contribute to improving OS in primary single atypical meningioma patients under 60 years old who receive STR. However, in older patients who underwent either GTR or STR, the administration of PORT may be associated with a potential risk of OS. Therefore, age should be taken into account in applying PORT therapy, and the optimal treatment strategy for PORT in patients with atypical meningiomas needs to be further explored and validated.
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Affiliation(s)
- Jia-Jun Qin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Chao Li
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Jin Fu
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Xian-Zhen Chen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
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Li C, Qin J, Xue F, Shen Z, Lin Q, Xue Y, Chen X. Rethinking the effects of adjuvant beam radiation therapy on overall survival in atypical meningioma patients: age considerations. Front Neurol 2024; 15:1360741. [PMID: 38560728 PMCID: PMC10978650 DOI: 10.3389/fneur.2024.1360741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background This study aimed to investigate the effects of adjuvant beam radiation therapy (ABRT) on overall survival (OS) in patients with primary single intracranial atypical meningioma (AM), with a focus on age-related outcomes. Methods We conducted a retrospective study using data from SEER database. Our cohort consisted of patients diagnosed with a primary single intracranial AM tumor and had undergone surgery. The primary endpoint was OS. For survival analysis, univariable and multivariable Cox regression analysis were performed. A multivariable additive Cox model was used to assess the functional relationship between age and OS in patients with or without ABRT. Results Of the 2,759 patients included, 1,650 underwent gross total resection and 833 received ABRT. Multivariable Cox analysis indicated that ABRT did not significantly influence OS across the entire cohort. According to the multivariable generalized additive Cox model, the relative risk of all-cause mortality increased with advancing age in both ABRT-yes and ABRT-no group. ABRT-yes had a lower relative risk than ABRT-no when age ≤ 55 years old while a higher relative risk when age > 55 years old. Subsequent multivariable Cox analysis showed that ABRT was associated with a significant lower risk for all-cause mortality in patients with age ≤ 55 years old while a significant higher risk in patients with age > 55 years old. Conclusion Our study found that ABRT enhanced OS in younger primary single intracranial AM patients. But we also revealed a negative correlation between OS and ABRT in older patients.
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Affiliation(s)
- Chao Li
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajun Qin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Xue
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhaoli Shen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Lin
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yajun Xue
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianzhen Chen
- Department of Neurosurgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
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Song D, Zhang M, Duan C, Wei M, Xu D, An Y, Zhang L, Wang F, Feng M, Qian Z, Gao Q, Guo F. A machine learning-based integrated clinical model for predicting prognosis in atypical meningioma patients. Acta Neurochir (Wien) 2023; 165:4191-4201. [PMID: 37819396 DOI: 10.1007/s00701-023-05831-z] [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: 04/25/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Atypical meningioma (AM) recurs in up to half of patients after surgical resection and may require adjuvant therapy to improve patient prognosis. Various clinicopathological features have been shown to have prognostic implications in AM, but an integrated prediction model is lacking. Thus, in this study, we aimed to develop and validate an integrated prognostic model for AM. METHODS A retrospective cohort of 528 adult AM patients surgically treated at our institution were randomly assigned to a training or validation group in a 7:3 ratio. Sixteen baseline demographic, clinical, and pathological parameters, progression-free survival (PFS), and overall survival (OS) were analysed. Sixty-five combinations of machine learning (ML) algorithms were used for model training and validation to predict tumour recurrence and patient mortality. RESULTS The random survival forest (RSF) model was the best model for predicting recurrence and death. Primary or secondary tumour, Ki-67 index, extent of resection, tumour size, brain involvement, tumour necrosis, and age contributed significantly to the model. The C-index value of the RSF recurrence prediction model reached 0.8080. The AUCs for 1-, 3-, and 5-year PFS were 0.83, 0.82, and 0.86, respectively. The C-index value of the RSF death prediction model reached 0.8890. The AUCs for 3-year and 5-year OS were 0.88 and 0.89, respectively. CONCLUSION A high-performing integrated RSF predictive model for AM recurrence and patient mortality was proposed that may guide therapeutic decision-making and long-term monitoring.
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Affiliation(s)
- Dengpan Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Mingchu Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Chengcheng Duan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Mingkun Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Dingkang Xu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan An
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Longxiao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Mengzhao Feng
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhihong Qian
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, China
| | - Qiang Gao
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450001, Henan Province, China.
- International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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Lee G, Shih HA. The Role of Radiotherapy in the Treatment of Higher-Grade Meningioma. Neurosurg Clin N Am 2023; 34:463-478. [DOI: 10.1016/j.nec.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Ahmeti H, Caliebe A, Röcken C, Jansen O, Mehdorn MH, Synowitz M. Impact of peritumoral brain edema on pre- and postoperative clinical conditions and on long-term outcomes in patients with intracranial meningiomas. Eur J Med Res 2023; 28:40. [PMID: 36670509 PMCID: PMC9862965 DOI: 10.1186/s40001-022-00962-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Peritumoral brain edema (PTBE) is a common complication related to intracranial meningiomas. In several studies, researchers have investigated the pathogenesis of PTBE, and the factors involved in its development in patients with intracranial meningiomas have been reported. However, very little is known about the clinical effect of PTBE on patients with intracranial meningiomas; therefore, a systematic examination of this matter is necessary. METHODS In this study, we performed a systematic examination of 696 patients with primary intracranial meningiomas to assess the effect of preoperative PTBE on preoperative symptoms, neurological deficits and postoperative complications, and long-term outcomes with a follow-up period of 16.8 years. We performed a univariate analysis and multiple regression for specific outcomes and adjusted for other relevant clinical factors. RESULTS A total of 627 (90.1%) patients were symptomatic preoperatively. One hundred eighty-eight (90.8%) patients with small to moderate PTBE and 125 (98.4%) patients with severe PTBE presented with symptoms significantly more often than the 314 (86.7%) patients without PTBE (p < 0.001, univariate analysis). Cognitive deficits, palsy and seizure were significantly more present, preoperatively, in patients with PTBE than in patients without PTBE (p < 0.001, univariate analysis). Two hundred fifty-five (36.6%) patients experienced surgical and systemic complications postoperatively. The complication rate was significantly higher in patients with PTBE; 41.5% for patients with small to moderate PTBE and 52.8% for patients with severe PTBE, compared to 28.2% of patients without PTBE (p < 0.001, univariate analysis). Furthermore, pre- and postoperative KPS scores were significantly lower in patients with PTBE (p < 0.001). Patients with PTBE required additional medical support significantly more often (p < 0.001) and had a significantly longer hospital stay (p < 0.001). The mortality rate was higher in patients with PTBE immediately after surgery and in the follow-up period; however, the difference was not significant. The neurological condition of all patients improved in the follow-up and did not show significant differences between patients with and without preoperative PTBE (p = 0.6361). Multiple logistic regression analyses revealed a significant association between PTBE and the presence of preoperative cognitive deficits, the incidences of seizure and postoperative complications, and low pre- and postoperative KPS scores. CONCLUSIONS Preoperative PTBE significantly increased the incidences of specific preoperative symptoms, neurological deficits and postoperative complications in patients with intracranial meningiomas. After surgery, patients with preoperative PTBE required medical support significantly more often than patients without PTBE. However, all patients had favorable outcomes after surgery.
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Affiliation(s)
- Hajrullah Ahmeti
- grid.412468.d0000 0004 0646 2097Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Amke Caliebe
- grid.9764.c0000 0001 2153 9986Institute of Medical Informatics und Statistics, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Christoph Röcken
- grid.412468.d0000 0004 0646 2097Department of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- grid.412468.d0000 0004 0646 2097Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Maximilian H. Mehdorn
- grid.412468.d0000 0004 0646 2097Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Michael Synowitz
- grid.412468.d0000 0004 0646 2097Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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Park CJ, Choi SH, Eom J, Byun HK, Ahn SS, Chang JH, Kim SH, Lee SK, Park YW, Yoon HI. An interpretable radiomics model to select patients for radiotherapy after surgery for WHO grade 2 meningiomas. Radiat Oncol 2022; 17:147. [PMID: 35996160 PMCID: PMC9396861 DOI: 10.1186/s13014-022-02090-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives This study investigated whether radiomic features can improve the prediction accuracy for tumor recurrence over clinicopathological features and if these features can be used to identify high-risk patients requiring adjuvant radiotherapy (ART) in WHO grade 2 meningiomas.
Methods Preoperative magnetic resonance imaging (MRI) of 155 grade 2 meningioma patients with a median follow-up of 63.8 months were included and allocated to training (n = 92) and test sets (n = 63). After radiomic feature extraction (n = 200), least absolute shrinkage and selection operator feature selection with logistic regression classifier was performed to develop two models: (1) a clinicopathological model and (2) a combined clinicopathological and radiomic model. The probability of recurrence using the combined model was analyzed to identify candidates for ART. Results The combined clinicopathological and radiomics model exhibited superior performance for the prediction of recurrence compared with the clinicopathological model in the training set (area under the curve [AUC] 0.78 vs. 0.67, P = 0.042), which was also validated in the test set (AUC 0.77 vs. 0.61, P = 0.192). In patients with a high probability of recurrence by the combined model, the 5-year progression-free survival was significantly improved with ART (92% vs. 57%, P = 0.024), and the median time to recurrence was longer (54 vs. 17 months after surgery). Conclusions Radiomics significantly contributes added value in predicting recurrence when integrated with the clinicopathological features in patients with grade 2 meningiomas. Furthermore, the combined model can be applied to identify high-risk patients who require ART. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02090-7.
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Affiliation(s)
- Chae Jung Park
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihwan Eom
- Department of Computer Science, Yonsei University, Seoul, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sung Soo Ahn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yae Won Park
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Corniola MV, Meling TR. Management of Recurrent Meningiomas: State of the Art and Perspectives. Cancers (Basel) 2022; 14:cancers14163995. [PMID: 36010988 PMCID: PMC9406695 DOI: 10.3390/cancers14163995] [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: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Intracranial meningiomas account for 30% to 40% of the primary lesions of the central nervous system. Surgery is the mainstay treatment whenever symptoms related to an intra-cranial meningioma are encountered. However, the management of recurrences after initial surgery, which are not uncommon, is still a matter of debate. Here, we present the alternatives described in the management of meningioma recurrence (radiotherapy, stereotaxic radiosurgery, protontherapy, and chemotherapy, among others). Their overall results are compared to surgery and future perspectives are presented. Abstract Background: While meningiomas often recur over time, the natural history of repeated recurrences and their management are not well described. Should recurrence occur, repeat surgery and/or use of adjuvant therapeutic options may be necessary. Here, we summarize current practice when it comes to meningioma recurrence after initial surgical management. Methods: A total of N = 89 articles were screened. N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review. Results: The articles were distributed as follows: studies on chemotherapy (N = 14), radiotherapy, protontherapy, and stereotaxic radiosurgery (N = 6), boron-neutron capture therapy (N = 2) and surgery (N = 3). No study seems to provide serious alternatives to surgery in terms of progression-free and overall survival. Recurrence can occur long after the initial surgery and also affects WHO grade 1 meningiomas, even after initial gross total resection at first surgery, emphasizing the need for a long-term and comprehensive follow-up. Conclusions: Surgery still seems to be the state-of-the-art management when it comes to meningioma recurrence, since none of the non-surgical alternatives show promising results in terms of progression-free and overall survival.
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Affiliation(s)
- Marco Vincenzo Corniola
- Service de Neurochirurgie, Pôle des Neurosciences, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France
- Faculté de Médecine, Université de Rennes 1, 35000 Rennes, France
- Faculté de Médecine, Université de Genève, 1205 Geneve, Switzerland
- Laboratoire du Traitement de Signal, Unité Médicis, INSERM UMR 1099 LTSI, Université de Rennes 1, 35000 Rennes, France
| | - Torstein R. Meling
- Faculté de Médecine, Université de Genève, 1205 Geneve, Switzerland
- Department of Neurosurgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Besta NeuroSim Center, Fondazione IRCCS, Istituto Neurologico Carlo Basta, 20133 Milano, Italy
- Correspondence:
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Zeng Q, Tian Z, Gao Q, Xu P, Shi F, Zhang J, Guo Z. Effectiveness of postoperative radiotherapy on atypical meningiomas patients after gross-total resection: analysis of 260 cases. World Neurosurg 2022; 162:e580-e586. [DOI: 10.1016/j.wneu.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
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10
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Kim MS, Chun SW, Dho YS, Seo Y, Lee JH, Won JK, Kim JW, Park CK, Park SH, Kim YH. Histopathological predictors of progression-free survival in atypical meningioma: a single-center retrospective cohort and meta-analysis. Brain Tumor Pathol 2022; 39:99-110. [PMID: 35031884 DOI: 10.1007/s10014-021-00419-w] [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: 09/08/2021] [Accepted: 11/22/2021] [Indexed: 11/02/2022]
Abstract
To determine the prognostic significance of histopathological features included in the diagnostic criteria of atypical meningioma for progression-free survival (PFS). We performed a retrospective cohort study and meta-analysis. Brain invasion, mitotic index, spontaneous necrosis, sheeting, prominent nucleoli, high cellularity, and small cells were the histopathological features of interest. The data from 25 studies involving 3590 patients including our cohort (n = 262) were included. The pooled HR of mitotic index at a cutoff value of 4 showed no statical significance in the gross analysis (pooled HR, 1.09; 95% CI 0.61-1.96; p = 0.7699). Furthermore, it failed to prognosticate PFS in other pooled analyses. For brain invasion, no consistent association with the progression was found in each pooled analysis according to the included studies. Among the remaining five atypical features, spontaneous necrosis, sheeting, and prominent nucleoli showed a significant correlation with PFS in the gross analysis. In the analysis that pooled the HRs from the multivariate analyses, only spontaneous necrosis had significant association with PFS. The available evidence supports that the current cutoff value of mitotic index for diagnosing atypical meningioma might be improper to have prognostic value. The prognostic significance of brain invasion also needs further evaluation.
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Affiliation(s)
- Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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11
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Radiation therapy for atypical and anaplastic meningiomas: an overview of current results and controversial issues. Neurosurg Rev 2022; 45:3019-3033. [PMID: 35665867 PMCID: PMC9492595 DOI: 10.1007/s10143-022-01806-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 02/03/2023]
Abstract
Meningiomas are the most common intracranial tumors. Most meningiomas are WHO grade 1 tumors whereas less than one-quarter of all meningiomas are classified as atypical (WHO grade 2) and anaplastic (WHO grade 3) tumors, based on local invasiveness and cellular features of atypia. Surgical resection remains the cornerstone of meningioma therapy and represents the definitive treatment for the majority of patients; however, grade 2 and grade 3 meningiomas display more aggressive behavior and are difficult to treat. Several retrospective series have shown the efficacy and safety of postoperative adjuvant external beam radiation therapy (RT) for patients with atypical and anaplastic meningiomas. More recently, two phase II prospective trials by the Radiation Therapy Oncology Group (RTOG 0539) and the European Organisation for Research and Treatment of Cancer (EORTC 2042) have confirmed the potential benefits of fractionated RT for patients with intermediate and high-risk meningiomas; however, several issues remain a matter of debate. Controversial topics include the timing of radiation treatment in patients with totally resected atypical meningiomas, the optimal radiation technique, dose and fractionation, and treatment planning/target delineation. Ongoing randomized trials are evaluating the efficacy of early adjuvant RT over observation in patients undergoing gross total resection.
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12
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Jia Z, Yan Y, Wang J, Yang H, Zhan H, Chen Q, He Y, Hu Y. Development and Validation of Prognostic Nomogram in Patients With WHO Grade III Meningioma: A Retrospective Cohort Study Based on SEER Database. Front Oncol 2021; 11:719974. [PMID: 34926244 PMCID: PMC8671456 DOI: 10.3389/fonc.2021.719974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction World Health Organization (WHO) Grade III meningioma is a central nervous system tumor with a poor prognosis. In this retrospective cohort study, the authors constructed a nomogram for predicting the prognosis of WHO Grade III meningioma. Methods The patients of this nomogram were based on the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018. All patients were randomly divided into a development cohort (964 patients) and a validation cohort (410 patients) in a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression was used to screen the predictors. The Cox hazards regression model was constructed and the prognosis was visualized by nomogram. The performance of the prognostic nomogram was determined by consistency index (C-index), clinical net benefit, and calibration. Results Eight variables were included in the nomogram: gender, race, age at diagnosis, histology, tumor site, tumor size, laterality, and surgical method. The C-index of the training set and verification set were 0.654 and 0.628. The calibration plots showed that the nomogram was in good agreement with the actual observation. The clinical decision curve indicates that the nomogram has a good clinical net benefit in WHO Grade III meningioma. Conclusions A prognostic nomogram of a large cohort of WHO Grade III meningioma was established and verified based on the SEER database. The nomogram we established may help clinicians provide personalized treatment services and clinical decisions for patients.
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Affiliation(s)
- Zetian Jia
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaqi Yan
- Department of Cardiology, The First Hospital of Handan of Hebei Province, Handan, China
| | - Jiuxin Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - He Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haihua Zhan
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Chen
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yawei He
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhua Hu
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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13
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Song D, Xu D, Han H, Gao Q, Zhang M, Wang F, Wang G, Guo F. Postoperative Adjuvant Radiotherapy in Atypical Meningioma Patients: A Meta-Analysis Study. Front Oncol 2021; 11:787962. [PMID: 34926303 PMCID: PMC8674463 DOI: 10.3389/fonc.2021.787962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023] Open
Abstract
Background and Purpose Consensus regarding the need for adjuvant radiotherapy (RT) in patients with atypical meningiomas (AMs) is lacking. We compared the effects of adjuvant RT after surgery, gross total resection (GTR), and subtotal resection (STR) on progression-free survival (PFS) and overall survival (OS) in patients with AMs, respectively. Methods We performed a systematic review and meta-analysis of the literature published in PubMed, Embase, and the Cochrane Library from inception to February 1, 2021, to identify articles comparing the PFS and OS of patients receiving postoperative RT after surgery, GTR and STR. Results We identified 2307 unique studies; 24 articles including 3078 patients met the inclusion criteria. The sensitivity analysis results showed that for patients undergoing undifferentiated surgical resection, adjuvant RT reduced tumor recurrence (HR=0.70, p<0.0001) with no significant effect on survival (HR=0.89, p=0.49). Postoperative RT significantly increased PFS (HR=0.69, p=0.01) and OS (HR=0.55, p=0.007) in patients undergoing GTR. The same improvement was observed in patients undergoing STR plus RT (PFS: HR=0.41, p<0.00001; OS: HR=0.47, p=0.01). A subgroup analysis of RT in patients undergoing GTR showed no change in PFS in patients undergoing Simpson grade I and II resection (HR=1.82, p=0.22) but significant improvement in patients undergoing Simpson grade III resection (HR=0.64, p=0.02). Conclusion Regardless of whether GTR or STR was performed, postoperative RT improved PFS and OS to varying degrees. Especially for patients undergoing Simpson grade III or IV resection, postoperative RT confers the benefits for recurrence and survival.
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Affiliation(s)
- Dengpan Song
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingkang Xu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongjie Han
- Department of Neurosurgery, Pingdingshan Second People's Hospital, Pingdingshan, China
| | - Qiang Gao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingchu Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoqing Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Treatment and follow-up results of WHO grade II meningiomas. J Clin Neurosci 2021; 91:354-364. [PMID: 34373052 DOI: 10.1016/j.jocn.2021.07.022] [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: 03/16/2021] [Revised: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
Meningiomas are the most common primary intracranial tumors. They have three pathologic grades. Surgical resection aiming Simpson I resection is the standard treatment for meningiomas. Radiotherapy and Gamma Knife radiosurgery are the main adjuvant and salvage treatments. Chemotherapy has limited use. Grade II, and III meningiomas have a higher recurrence rate, and adjuvant radiotherapy is usually the standard treatment for grade III meningiomas but there is not a consensus regarding grade II meningiomas. In this paper, we analyzed our meningioma series of 1401 patients and presented the treatment and follow-up results of 170 grade II meningioma cases. The median follow-up of grade II meningiomas was 61 (range = 1-231) months. The mean age of patients was 52.5 ± 15.0 years, 102 of them were female and 68 were male (female/male ratio = 1.5). The median progression-free survival (PFS) of them was 109 months, and the cumulative overall survival (OS) rate was 85% at 10 years. Meningiomas with gross total resection, non-skull base meningiomas, and primary grade II meningiomas had longer PFS with statistical significance, while non-skull base meningiomas, younger group of patients, and primary grade II meningiomas had longer OS with a statistical significance.
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15
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Zhang GJ, Liu XY, You C. Clinical Factors and Outcomes of Atypical Meningioma: A Population-Based Study. Front Oncol 2021; 11:676683. [PMID: 34123845 PMCID: PMC8187879 DOI: 10.3389/fonc.2021.676683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Atypical meningioma is a non-benign tumor, and its prognostic factors and treatment strategies are unclear. Methods Patients with atypical meningioma, between 2004 and 2016, were collected from the Surveillance, Epidemiology, and End Results database. Then, we randomly divided patients into a training set and a validation set at a ratio of 8:2. The nomogram was constructed based on the multivariate Cox regression analyses. And the concordance index, calibration curves, and receiver operating character were used to assess the predictive ability of the nomogram. We divided the patient scores into three groups and constructed a survival curve using Kaplan–Meier analysis. Results After our inclusion and exclusion criteria, 2358 patients were histologically diagnosed of atypical meningioma. The prognostic nomogram comprised factors of overall survival, including age, tumor size and surgery. The concordance index was 0.715 (95%CI=0.688-0.742) for overall survival in the training set and 0.688 (95%CI=0.629-0.747) for overall survival in the validation set. The calibration curves and receiver operating character also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the three groups of patients according to quartiles of risk score. Conclusion Gross total resection is an independent factor for survival, and radiation after non-gross total resection potentially confers a survival advantage for patients with atypical meningioma.
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Affiliation(s)
- Gui-Jun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Yin Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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16
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Unteroberdörster M, Michel A, Darkwah Oppong M, Jabbarli R, Hindy NE, Wrede KH, Sure U, Pierscianek D. The 2016 Edition of the WHO Classification of Primary Brain Tumors: Applicable to Assess Individual Risk of Recurrence in Atypical Meningioma? A Single-Center Experience. J Neurol Surg A Cent Eur Neurosurg 2021; 82:417-423. [PMID: 33845510 DOI: 10.1055/s-0040-1720987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS/OBJECT Despite the relevance of molecular criteria for brain tumor diagnosis and prognosis, meningioma grading is still solely based on histologic features. Atypical meningiomas (AMs; WHO grade II) display a great histologic heterogeneity and individual courses of disease can differ significantly. This study aimed to identify clinically aggressive AMs that are prone to early recurrence after gross total resection (GTR) by assessing a specific histologic score. PATIENTS AND METHODS A retrospective analysis of 28 consecutive patients (17 females and 11 males; mean age of 62 years [range: 35-88 years]) treated in our institution between January 2006 and December 2015 was performed. Basic demographic and clinical characteristics were assessed. A scoring scale was designed to address the histologic diversity by summing up the individual histologic features in every tumor sample. According to that, points were awarded as follows: major AM defining criterion (3 points) and minor criterion (1 point). RESULTS The subclassification based on our specific histologic score revealed no significant difference in frequency of one (46.4%) or two (42.9%) AM defining features; three criteria were less frequently seen (10.7%). Mean follow-up was 61.89 ± 9.03 months. Local recurrence occurred in 35.7% after a mean time of 37.4 ± 22.6 months after primary surgery. Age > 60 years was significantly associated with a shorter progression-free survival (PFS). There was a trend toward shorter PFS with increasing scores, tantamount with the presence of several AM defining histologic criteria in one sample. No tumor relapse was seen when diagnosis was based only on minor criteria. CONCLUSION AMs display a histologic diversity. There is a trend toward shorter PFS with increasing numbers of AM defining histologic features. The inclusion of this score in the decision algorithm regarding further treatment for patients >60 years after GTR might be helpful and should be evaluated in further studies.
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Affiliation(s)
- Meike Unteroberdörster
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany.,Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Michel
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | | | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany.,Werne Spine Center, Hospital Lünen/Werne GmbH - St. Christophorus Hospital, Werne, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
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17
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Chun SW, Kim KM, Kim MS, Kang H, Dho YS, Seo Y, Kim JW, Kim YH, Park CK. Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis. Radiat Oncol 2021; 16:34. [PMID: 33596974 PMCID: PMC7890913 DOI: 10.1186/s13014-021-01759-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background The impact of adjuvant radiotherapy (RT) on atypical meningioma (AM) underwent a gross total resection (GTR) remains unclear, showing conflicting results from various studies. The objective of this study was to perform an updated meta-analysis for observational studies to determine the effect of adjuvant RT after GTR on local recurrence and survival outcomes compared to observation after GTR. Methods PubMed, Embase, and Web of Science were searched to identify comparative studies that reported outcomes of adjuvant RT versus observation for AM patients after GTR. Local recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicities related to RT were considered as outcomes of interest. Differences between two cohorts were estimated by calculating odds ratios (OR) for LR rate and hazard ratios (HR) for survival outcomes with 95% confidence intervals (CIs) for meta-analysis, using R version 4.0.3 software. Included studies were appraised with the Risk of Bias Assessment tool for Non-Randomized Studies. Outcome ratios were combined with the Mantel–Haenszel method and the inverse variance-weighted method, appropriately. Results Data from 30 studies involving 2904 patients (adjuvant RT: n = 737; observation: n = 2167) were eventually included. Significant reduction of local recurrence rate was seen in the adjuvant RT cohort compare to that in the observation cohort (OR 0.50; 95% CI 0.36–0.68; p < 0.0001). Pooled HRs of PFS at 1-year, 3-year, 5-year, and > 5-year revealed that adjuvant RT was superior to observation. There was no significant difference in OS between the two cohorts during any period. Most toxicities were tolerable with grade 1 or 2. There was no documented grade 5 toxicity. Conclusions For AM patients who underwent GTR, evidence suggested that adjuvant RT could potentially decrease local recurrence and improve PFS better than observation.
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Affiliation(s)
- Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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18
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Prognostic significance of brain invasion in meningiomas: systematic review and meta-analysis. Brain Tumor Pathol 2021; 38:81-95. [PMID: 33403457 DOI: 10.1007/s10014-020-00390-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022]
Abstract
The WHO 2016 classification introduced brain invasion as a standalone criterion for grade II meningioma (GIIM). We systematically reviewed studies published after 2000 and performed a PRISMA-compliant meta-analysis of the hazard ratios (HRs) for progression-free survival (PFS) between brain-invasive and noninvasive meningiomas. In five studies that included both benign and higher-grade meningiomas, brain invasion was a significant risk factor for recurrence (HR = 2.45, p = 0.0004). However, in 3 studies comparing "brain-invasive meningioma with otherwise benign histology (BIOB)" with grade I meningioma, brain invasion was not a significant predictor of PFS (HR = 1.49, p = 0.23). Among GIIM per the WHO 2000 criteria, brain invasion was a significant predictor of shorter PFS than noninvasive GIIM (HR = 3.40, p = 0.001) but not per the WHO 2016 criteria (HR 1.13, p = 0.54), as the latter includes BIOB. Meta-regression analysis of seven studies of grade II meningioma showed that more frequent BIOB was associated with lower HRs (p < 0.0001). Hence, there is no rationale for brain invasion as a standalone criterion for grade II meningioma, although almost all studies were retrospective and exhibited highly heterogeneous HRs due to differences in brain-tumor interface data availability.
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19
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Nazem AA, Ruzevick J, Ferreira MJ. Advances in meningioma genomics, proteomics, and epigenetics: insights into biomarker identification and targeted therapies. Oncotarget 2020; 11:4544-4553. [PMID: 33346248 PMCID: PMC7733625 DOI: 10.18632/oncotarget.27841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 01/25/2023] Open
Abstract
Meningiomas are a heterogeneous group of tumors, defined histo-pathologically by World Health Organization (WHO) grading. The WHO grade of meningiomas does not always correlate with clinical aggressiveness. Despite maximal surgical resection and adjuvant radiation, a subset of tumors are clinically aggressive; displaying early recurrence and invasion. Current methods for identifying aggressive meningiomas solely focus on genomics, proteomics, or epigenetics and not a combination of all for developing a real-time clinical biomarker. Improved methods for the identification of these outlying tumors can facilitate better classification and potentially adjuvant treatment planning. Understanding the pathways of oncogenesis using multiple markers driving aggressive meningiomas can provide a foundation for targeted therapies, which currently do not exist.
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Affiliation(s)
- Ahmad A Nazem
- Department of Neurosurgery, University of Washington School of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.,These authors contributed equally to this work
| | - Jacob Ruzevick
- Department of Neurosurgery, University of Washington School of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.,These authors contributed equally to this work
| | - Manuel J Ferreira
- Department of Neurosurgery, University of Washington School of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA
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20
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Delgado-López PD, Corrales-García EM. Role of adjuvant radiotherapy in atypical (WHO grade II) and anaplastic (WHO grade III) meningiomas: a systematic review. Clin Transl Oncol 2020; 23:205-221. [DOI: 10.1007/s12094-020-02434-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
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21
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Roux A, Tauziede-Espariat A, Zanello M, Gareton A, Malaize H, Benzakoun J, Zah-Bi G, Oppenheim C, Plu-Bureau G, Chretien F, Pallud J. Symptomatic progestin-associated atypical grade II meningioma. A first case report. Neurochirurgie 2020; 66:174-178. [PMID: 32277999 DOI: 10.1016/j.neuchi.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/24/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Long-term use of high-dose progestin is known to promote the development of meningioma. Atypical meningioma in a patient under progestin has not previously been reported. CASE REPORT A 53-year-old right-handed woman presented with focal onset seizures, without impaired consciousness. Medical history featured endometriosis, treated successively by cyproterone acetate 25mg/day for 2 months then 50mg/day for 101 months, and chlormadinone acetate 5mg/day for 68 months then 10mg/day for 83 months. Brain MRI revealed multiple extra-axial lesions suggestive of left central meningioma associated with anterior skull base meningiomatosis. Surgical resection of the left central meningioma was achieved and progestin was withdrawn. Neuropathology diagnosed grade II atypical meningioma. Close clinical and imaging monitoring was implemented without adjuvant oncological treatment. At 25 months, imaging follow-up showed no recurrence of the left central meningioma and a significant regression of all other lesions, except for the right frontal lesion. CONCLUSIONS Neurosurgeons should be aware of the possible aggressiveness of meningioma in patients under progestin, and particularly those treated by different types of progestin over a long period of time without interruption. This may require systematic close monitoring, to adapt neurosurgical management.
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Affiliation(s)
- A Roux
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - A Tauziede-Espariat
- Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - M Zanello
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - A Gareton
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - H Malaize
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - J Benzakoun
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - G Zah-Bi
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - C Oppenheim
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuroradiology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - G Plu-Bureau
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, AP-HP, Paris, France
| | - F Chretien
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - J Pallud
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
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22
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Clinical, radiological, and histopathological predictors for long-term prognosis after surgery for atypical meningiomas. Acta Neurochir (Wien) 2019; 161:1647-1656. [PMID: 31147831 DOI: 10.1007/s00701-019-03956-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite considerable rates of recurrence and mortality in atypical meningiomas, reliable predictors for estimating postoperative long-term prognosis remain elusive. METHODS Clinical, histopathological, and radiological variables from 138 patients, including 64 females and 74 males (46% and 54%, median age 62 years), who underwent surgery for intracranial atypical meningioma were retrospectively analyzed. Associations between variables and recurrence and mortality were investigated using uni- and multivariate analyses. RESULTS Gross total (GTR) and subtotal resection (STR) was achieved in 81% and 19% of cases, respectively. Within a median follow-up of 62 months, recurrence occurred in 52 (38%) and mortality in 22 (16%) cases. In patients who did not receive adjuvant irradiation, recurrence rates were higher after STR than after GTR (32% vs 63%, p = 0.025). In univariate analyses, only intratumoral calcifications on preoperative MRI (p = 0.012) and the presence of brain invasion in the absence of other histological grading criteria (p = 0.010) were correlated with longer progression-free intervals (PFI). In multivariate analyses, patient age was positively (HR 1.03, 95%CI 1.04-1.05; p = 0.018) and the presence of brain invasion as the only grading criterion (HR 0.37, 95%CI 0.19-0.74; p = 0.005) was negatively related with progression, while rising age at the time of surgery (HR 1.07, 95%CI 1.03-1.12; p = 0.001) was prognostic for mortality. CONCLUSIONS PFI was longer in brain invasive but otherwise histological benign meningiomas and in tumors displaying calcifications on preoperative MRI. Advancing patient age and lower Karnofsky Performance Score were associated with higher overall mortality.
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