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Dobeson CB, Baxter M, Rowe M, Kingdon S, Park S, Bond H, Taylor K, Islim AI, King J, Millward CP, Zakaria R, Clynch AL, Keshwara SM, Eltinay A, Kviat L, Robinson R, Haris PA, Samuel R, Venkatesh V, Derby S, Ahmad S, Smith F, Robinson S, Kathirgamakarthigeyan S, Narramneni LR, Hannan CJ, Lewis J. Management Approaches in WHO Grade III Meningioma: A National Oncology Trainees' Collaborative for Healthcare Research (NOTCH) UK Multi-Centre Retrospective Study. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00181-X. [PMID: 38849235 DOI: 10.1016/j.clon.2024.05.006] [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: 12/04/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024]
Abstract
AIMS WHO Grade 3 (G3) meningiomas are rare tumours with limited data to guide management. This retrospective study documents UK management approaches across 14 centres over 11 years. MATERIALS AND METHODS Patients with WHO G3 meningioma between 01/01/2008 and 31/12/2018 were identified. Data were collected on demographics, management strategy, adjuvant radiotherapy, approach in recurrence setting and survival. RESULTS 84 patients were identified. 21.4% transformed from lower-grade disease. 96.4% underwent primary surgical resection, with 20.8% having evidence of residual disease on their post-op MRI. 59.3% of patients underwent adjuvant radiotherapy (RT) following surgical resection. Overall median PFS and OS were 12.6 months and 28.2 months, respectively. Median OS in the group who underwent complete surgical resection was 34.9 months, compared to 27.5 months for those who had incomplete resection (HR 0.58, 95% CI 0.27-1.23, p = 0.15). Median OS was 33.1 months for those who underwent adjuvant RT and 14.0 months for those who did not (HR 0.48, 95% CI 0.27-0.84, p = 0.004). Median adjuvant RT dose delivered was 60Gy (range 12Gy-60Gy), 45.8% of adjuvant RT was delivered using IMRT. At disease relapse, 31% underwent salvage surgery and 29.3% underwent salvage RT. Of those treated with salvage RT, 64.7% were re-treats and all were treated with hypofractionated RT. CONCLUSION Surgery continues to be the preferred primary management strategy. Post-operative MRI within 48 hours is indicated to assess presence of residual disease and guide further surgical options. Adjuvant radiotherapy plays an important part of the management paradigm in these patients with the data supporting an attached survival advantage. Further surgery and re-irradiation is an option in the disease recurrence setting with radiosurgery frequently utilised in this context.
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Affiliation(s)
- C B Dobeson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, NE77DN, UK.
| | - M Baxter
- Tayside Cancer Centre, Ninewells Hospital, Dundee, NHS Tayside, Scotland, DD1 9SY, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, England, TR1 3LJ, UK
| | - S Kingdon
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - S Park
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - H Bond
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - K Taylor
- The Northern Ireland Cancer Centre, Belfast, Northern Ireland, BT12 6BA, UK
| | - A I Islim
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - J King
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - C P Millward
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - R Zakaria
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - A L Clynch
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - S M Keshwara
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - A Eltinay
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, England, OX3 7LE, UK
| | - L Kviat
- The Royal Marsden Hospital NHS Foundation Trust, London, England, SW3 6JJ, UK
| | - R Robinson
- The Royal Marsden Hospital NHS Foundation Trust, London, England, SW3 6JJ, UK
| | - P A Haris
- University Hospitals of Leicester NHS Trust, England, LE3 9QP, UK
| | - R Samuel
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, England, LS9 7TF, UK
| | - V Venkatesh
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, England, LS9 7TF, UK
| | - S Derby
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, G12 0YN, UK
| | - S Ahmad
- University Hospitals of Leicester NHS Trust, England, LE3 9QP, UK
| | - F Smith
- Nottingham University Hospitals NHS Trust, England, NG7 2UH, UK
| | - S Robinson
- Imperial College Healthcare NHS Trust, London, England, W2 1NY, UK
| | | | - L R Narramneni
- Aberdeen Royal Infirmary, NHS Grampian, Scotland, AB25 2ZN, UK
| | - C J Hannan
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - J Lewis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, NE77DN, UK
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Yokogami K, Watanabe T, Yamashita S, Mizuguchi A, Takeshima H. Inhibition of BMP signaling pathway induced senescence and calcification in anaplastic meningioma. J Neurooncol 2024; 167:455-465. [PMID: 38446374 PMCID: PMC11096233 DOI: 10.1007/s11060-024-04625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Meningiomas are the most common type of brain tumors and are generally benign, but malignant atypical meningiomas and anaplastic meningiomas frequently recur with poor prognosis. The metabolism of meningiomas is little known, so few effective treatment options other than surgery and radiation are available, and the targets for treatment of recurrence are not well defined. The Aim of this paper is to find the therapeutic target. METHODS The effects of bone morphogenetic protein (BMP) signal inhibitor (K02288) and upstream regulator Gremlin2 (GREM2) on meningioma's growth and senescence were examined. In brief, we examined as follows: 1) Proliferation assay by inhibiting BMP signaling. 2) Comprehensive analysis of forced expression GREM2.3) Correlation between GREM2 mRNA expression and proliferation marker in 87 of our clinical samples. 4) Enrichment analysis between GREM2 high/low expressed groups using RNA-seq data (42 cases) from the public database GREIN. 5) Changes in metabolites and senescence markers associated with BMP signal suppression. RESULTS Inhibitors of BMP receptor (BMPR1A) and forced expression of GREM2 shifted tryptophan metabolism from kynurenine/quinolinic acid production to serotonin production in malignant meningiomas, reduced NAD + /NADH production, decreased gene cluster expression involved in oxidative phosphorylation, and caused decrease in ATP. Finally, malignant meningiomas underwent cellular senescence, decreased proliferation, and eventually formed psammoma bodies. Reanalyzed RNA-seq data of clinical samples obtained from GREIN showed that increased expression of GREM2 decreased the expression of genes involved in oxidative phosphorylation, similar to our experimental results. CONCLUSIONS The GREM2-BMPR1A-tryptophan metabolic pathway in meningiomas is a potential new therapeutic target.
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Affiliation(s)
- Kiyotaka Yokogami
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan.
| | - Takashi Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Shinji Yamashita
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Asako Mizuguchi
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
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Früh A, Bodnar B, Nachbar M, Gradhand J, Kalinauskaite G, Rubarth K, Truckenmueller P, Kaul D, Zips D, Vajkoczy P, Senger C, Acker G. Robotic stereotactic radiosurgery for intracranial meningiomas in elderly patients: assessment of treatment efficacy and safety. Front Oncol 2024; 14:1329696. [PMID: 38347835 PMCID: PMC10860398 DOI: 10.3389/fonc.2024.1329696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) has been increasingly used to treat intracranial pathologies in elderly patients. The treatment efficiency of SRS has been demonstrated in meningiomas, with excellent local control. We aimed to analyze the safety of robotic SRS in elderly patients with meningiomas. Methods We searched for patients with suspected WHO °I meningioma ≥ 60 years old, who underwent CyberKnife (CK) SRS from January 2011 to December 2021. Tumor localization was categorized using the "CLASS" algorithmic scale. Tumor response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria for meningiomas. Adverse effects were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and a cox regression was performed to investigate possible predictors. Results We identified 82 patients with 102 CK-treated lesions that matched the criteria for the first SRS. The median age was 70 [IQR 64-75] years, and 24.3% of the patients were aged > 75 years. Multiple lesions (up to six) were treated in 14.1% of the SRS-sessions. A previous surgery was performed in 57.3% of lesions, with a median time interval of 41 [IQR 10 - 58] months between the initial surgical procedure and the SRS treatment. In 47.9% of cases, CLASS 3 meningiomas at high-risk locations were irradiated. Single fraction radiosurgery was applied to 62.5% of the lesions, while in the remaining cases multi-session SRS with three to five fractions was used. During the median follow-up period of 15.9 months, lesion size progression was observed in 3 cases. Karnofsky Performance Status (KPS) declined by ≥ 20 points in four patients. Adverse effects occurred in 13 patients, while only four patients had CTCAE ≥2 toxicities. Hereby only one of these toxicities was persistent. The occurrence of complications was independent of age, planned target volume (PTV), high-risk localization, and surgery before SRS. Conclusion The data indicates that SRS is a safe, efficient, and convenient treatment modality for elderly patients with meningioma, even at high-risk locations.
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Affiliation(s)
- Anton Früh
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health Biomedical Innovation Academy, Berlin, Germany
| | - Bohdan Bodnar
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcel Nachbar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julia Gradhand
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kerstin Rubarth
- Insitute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Insitute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Truckenmueller
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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