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Chen Z, Lin T, Liu D, Zeng Y, Zhang X, Deng B, Guo D, Shi T, Lu M. Comparison of Short-Term Surgery Outcomes and Clinical Characteristics Between Elderly and Non-Elderly Patients with Middle Third Parasagittal and Parafalcine Meningiomas. Neuropsychiatr Dis Treat 2023; 19:2331-2340. [PMID: 37928167 PMCID: PMC10624188 DOI: 10.2147/ndt.s428341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aims to compare the short-term surgery outcomes of the resection of meningiomas and clinical characteristics between elderly and non-elderly patients. Patients and Methods This retrospective study included patients who underwent a resection of middle third parasagittal and parafalcine meningiomas between January 2011 and December 2020. All lesions arise from the middle third of the parafalcine or infiltrate superior sagittal sinus (SSS). The clinical characteristics studied included neurological deficit, peritumoral brain edema (PTBE), SSS invasion, tumor size, and symptoms; perioperative complications, and short-term surgery outcomes including neurological deficit, operative blood loss, postoperative hospitalization duration, and WHO classification were compared. Results A total of 43 elderly patients and 63 non-elderly patients were included. Compared with non-elderly patients, elderly patients had larger lesions (P = 0.013) and presented with a larger PTBE (P = 0.019). SSS blockage was identified in 28.57% of elderly patients and 19.57% of non-elderly patients. Compared with non-elderly patients, elderly patients tended to suffer from more aggressive lesions (WHO II/III meningioma 6 vs 3, P = 0.154) and presented with longer postoperative hospital stays (17.25 ± 5.8 vs 13.50 ± 3.8, P = 0.009); conversely, while the non-elderly patients experienced more blood loss (P = 0.022) and had more perioperative reoperations (3 vs 1). No significant difference in neurological deficit was detected between the two groups (P = 0.97). After total tumor resection, patients with neurological deficits in both groups can recover during the follow-up period. Conclusion Among the 106 patients with middle third parasagittal and falx meningiomas in our hospital, elderly patients had larger lesions, presented with more severe PTBE, and had longer postoperative hospital stays than younger patients. Conversely, younger patients had more blood loss and serious complications than elderly patients. Postoperative neurological dysfunction in elderly patients was similar to that in middle-aged and young patients.
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Affiliation(s)
- Zhijie Chen
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Lin
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Da Liu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Yongqin Zeng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Xubiao Zhang
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Bin Deng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Dongliang Guo
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Shi
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Ming Lu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
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Giraud N, Jecko V, Le Petit L, Sans C, Wavasseur T, Huchet A, Roblot P. Spontaneous resolution of intracranial hypertension following radiotherapy for posterior parasagittal meningioma: About two cases and review of the literature. Cancer Radiother 2023; 27:421-424. [PMID: 37479558 DOI: 10.1016/j.canrad.2023.06.005] [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: 03/30/2023] [Revised: 06/04/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023]
Abstract
We report the cases of two patients who underwent normofractionated radiotherapy for evolutive asymptomatic parasagittal meningiomas. After completion of radiotherapy, both patients presented severe headache and vomiting episodes without papillar edema. We then decided a "wait-and-scan" strategy because of the slit-ventricles, and symptoms regressed spontaneously. MRI showed significant tumor regression a year after radiotherapy with a newly developed collateral venous drainage system in the first patient and a left, unusually large, superior anastomotic vein in the second. These clinical presentation and radiological evolution are compatible with venous stenosis caused by radiation-induced symptomatic edema, fading after the development of a collateral venous drainage system. The relation between pressure-related headaches and venous anatomy remains unclear in parasagittal meningiomas. These observations underline the importance of the study of venous anatomy when pressure-related headaches are suspected. Further clinical descriptions might help the clinicians to treat these patients' symptoms.
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Affiliation(s)
- N Giraud
- Service de radiothérapie, hôpital Haut Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France.
| | - V Jecko
- Service de Neurochirurgie, hôpital Pellegrin, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - L Le Petit
- Service de Neurochirurgie, hôpital Pellegrin, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - C Sans
- Service de radiothérapie, hôpital Haut Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France
| | - T Wavasseur
- Service de Neurochirurgie, hôpital Pellegrin, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - A Huchet
- Service de radiothérapie, hôpital Haut Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France
| | - P Roblot
- Service de Neurochirurgie, hôpital Pellegrin, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
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Schmutzer M, Skrap B, Thorsteinsdottir J, Fürweger C, Muacevic A, Schichor C. Meningioma involving the superior sagittal sinus: long-term outcome after robotic radiosurgery in primary and recurrent situation. Front Oncol 2023; 13:1206059. [PMID: 37496660 PMCID: PMC10367096 DOI: 10.3389/fonc.2023.1206059] [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: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
Objective Treatment for meningiomas involving the superior sagittal sinus (SSS) is challenging and proved to be associated with higher risks compared to other brain locations. Therapeutical strategies may be either microsurgical (sub-)total resection or adjuvant radiation, or a combination of both. Thrombosis or SSS occlusion following resection or radiosurgery needs to be further elucidated to assess whether single or combined treatment is superior. We here present tumor control and side effect data of robotic radiosurgery (RRS) in combination with or without microsurgery. Methods From our prospective database, we identified 137 patients with WHO grade I meningioma involving the SSS consecutively treated between 2005 and 2020. Treatment decisions were interdisciplinary. Patients underwent RRS as initial/solitary treatment (group 1), as adjuvant treatment after subtotal resection (group 2), or due to recurrent tumor growth after preceding microsurgery (group 3). Positive tumor response was assessed by MRI and defined as reduction of more than 50% of volume. Study endpoints were time to recurrence (TTR), time to RRS, risk factors for decreased survival, and side effects. Overall and specific recurrence rates for treatment groups were analyzed. Side effect data included therapy-related morbidity during follow-up (FU). Results A total of 137 patients (median age, 58.3 years) with SSS meningiomas WHO grade I were analyzed: 51 patients (37.2%) in group 1, 15 patients (11.0%) in group 2, and 71 patients (51.8%) in group 3. Positive MR (morphological response) to therapy was achieved in 50 patients (36.4%), no response was observed in 25 patients (18.2%), and radiological tumor progression was detected in 8 patients (5.8%). Overall 5-year probability of tumor recurrence was 15.8% (median TTR, 41.6 months). Five-year probabilities of recurrence were 0%, 8.3.%, and 21.5% for groups 1-3 (p = 0.06). In multivariate analysis, tumor volume was significantly associated with extent of SSS occlusion (p = 0.026) and sex (p = 0.011). Tumor volume significantly correlated with TTR (p = 0.0046). Acute sinus venous thrombosis or venous congestion-associated bleedings did not occur in any of the groups. Conclusion RRS for grade I meningiomas with SSS involvement represents a good option as first-line treatment, occasionally also in recurrent and adjuvant scenarios as part of a multimodal treatment strategy.
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Affiliation(s)
- Michael Schmutzer
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Benjamin Skrap
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jun Thorsteinsdottir
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Christian Schichor
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
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Martz N, Salleron J, Dhermain F, Vogin G, Daisne JF, Mouttet-Audouard R, Tanguy R, Noel G, Peyre M, Lecouillard I, Jacob J, Attal J, Charissoux M, Veresezan O, Hanzen C, Huchet A, Latorzeff I, Coutte A, Doyen J, Stefan D, Feuvret L, Garcia GCTE, Royer P. Target volume delineation for radiotherapy of meningiomas: an ANOCEF consensus guideline. Radiat Oncol 2023; 18:113. [PMID: 37408055 DOI: 10.1186/s13014-023-02300-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: 02/13/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE Radiotherapy is, with surgery, one of the main therapeutic treatment strategies for meningiomas. No prospective study has defined a consensus for the delineation of target volumes for meningioma radiotherapy. Therefore, target volume definition is mainly based on information from retrospective studies that include heterogeneous patient populations. The aim is to describe delineation guidelines for meningioma radiotherapy as an adjuvant or definitive treatment with intensity-modulated radiation therapy and stereotactic radiation therapy techniques. This guideline is based on a consensus endorsed by a multidisciplinary group of brain tumor experts, members of the Association of French-speaking Neuro-oncologists (ANOCEF). MATERIALS AND METHODS A 3-step procedure was used. First, the steering group carried out a comprehensive review to identify divergent issues on meningiomas target volume delineation. Second, an 84-item web-questionnaire has been developed to precisely define meningioma target volume delineation in the most common clinical situations. Third, experts members of the ANOCEF were requested to answer. The first two rounds were completed online. A third round was carried out by videoconference to allow experts to debate and discuss the remaining uncertain questions. All questions remained in a consensus. RESULTS Limits of the target volume were defined using visible landmarks on computed tomography and magnetic resonance imaging, considering the pathways of tumor extension. The purpose was to develop clear and precise recommendations on meningiomas target volumes. CONCLUSION New recommendations for meningiomas delineation based on simple anatomic boundaries are proposed by the ANOCEF. Improvement in uniformity in target volume definition is expected.
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Affiliation(s)
- Nicolas Martz
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France.
| | - Julia Salleron
- Cellule Data-biostatistiques, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lés-Nancy, France
| | - Frédéric Dhermain
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - Guillaume Vogin
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France
- Department of Radiation Therapy, Baclesse Radiation Therapy Centre, Esch/Alzette, Luxembourg
| | - Jean-François Daisne
- Department of Radiation Oncology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | | | - Ronan Tanguy
- Department of Radiotherapy, Léon Bérard Cancer Centre, Lyon, France
| | - Georges Noel
- Radiation Oncology Department, Paul Strauss Cancer Centre, Strasbourg, France
| | - Matthieu Peyre
- Department of Neurosurgery, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Julian Jacob
- Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France
| | - Justine Attal
- Radiotherapy Department, Institut Claudius Regaud, Toulouse University Institute for Cancer (IUCT-Oncopole), Toulouse, France
| | - Marie Charissoux
- Radiation Oncology Department, Centre Val d'Aurelle, Montpellier, France
| | - Ovidiu Veresezan
- Department of Radiation Oncology, Cancer Centre Henri Becquerel, Rouen, France
| | - Chantal Hanzen
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Aymeri Huchet
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD Garonne and Clinique Pasteur, Toulouse, France
| | | | - Jérôme Doyen
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice- Sophia, Nice, France
| | - Dinu Stefan
- Department of Radiation Oncology, François Baclesse Cancer Centre, Caen, France
| | - Loic Feuvret
- Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France
| | | | - Philippe Royer
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France
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Hypofractionated Radiosurgery for Large or in Critical-Site Intracranial Meningioma: Results of a Phase 2 Prospective Study. Int J Radiat Oncol Biol Phys 2023; 115:153-163. [PMID: 36075299 DOI: 10.1016/j.ijrobp.2022.08.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Radiosurgery is a well-known, safe, and effective technique used in the treatment of intracranial meningiomas. However, single-fraction radiosurgery can lead to high toxicity rates when large-volume or critically located lesions are targeted. Multisession-also called hypofractionated-radiosurgery (hypo-RS) might overcome these limitations. Accordingly, we carried out a prospective phase 2 trial, aiming to establish whether a fractionated RS schedule of 25 Gy in 5 fractions would be safe and effective in treating large (≥ 3 cm) and/or critically located (<3 mm from critical structures) grade 1 intracranial meningiomas. The main aim was to evaluate the safety of hypo-RS in terms of absence of adverse events. The secondary aim was to evaluate tumor response in terms of local control, defined as stability or reduction of lesion volume. METHODS AND MATERIALS We prospectively enrolled patients with diagnoses of grade 1 meningiomas, large size and/or critically located lesions, either histologically diagnosed or imaging defined. Additional inclusion criteria were signed informed consent, an age of ≥18 years, and Karnofsky Performance Status ≥70. RESULTS Between 2011 and 2016, 178 patients were consecutively enrolled. The median follow-up was 53 months (range, 4-101 months). Overall, the toxicity rate was 12.7% (21 of 166 patients). At a 5-year minimum follow-up, the patients' toxicity rates were 11.7 % (9 of 77 patients). Symptom evaluation at both 3-year and last follow-up showed an improvement in most of the patients. Five-year local tumor control was 97% (95% confidence interval, 92%-99%). CONCLUSIONS Hypo-RS schedule of 25 Gy in 5 fractions is a well-tolerated option in the treatment of large-volume and/or critically located benign meningiomas. Early results suggest favorable local control, although longer-term follow-up is needed.
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Cesme DH, Alkan A, Sari L, Yabul F, Temur HO, Aykan ME, Seyithanoglu MH, Hatiboglu MA. Importance of Pre-treatment Fractional Anisotropy Value in Predicting Volumetric Response in Patients with Meningioma Treated with Gamma Knife Radiosurgery. Curr Med Imaging 2021; 17:871-877. [PMID: 33511956 PMCID: PMC8811611 DOI: 10.2174/2213335608999210128182047] [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: 10/07/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/22/2022]
Abstract
Background The importance of pre-treatment Diffusion Tensor Imaging (DTI) parameters in determining the response to treatment after radiosurgery in patients with meningioma has not yet been clearly revealed. Objective This study was conducted to determine tumor volume changes in terms of radiological response in patients with meningioma treated with Gamma Knife Radiosurgery (GKR) and to analyze the relationship between Total Tumor Volume (TTV) and Diffusion Tensor Imaging (DTI) parameters. In addition, we investigated whether the response to treatment can be predicted by pre-radiosurgery DTI findings. Methods Fifty-four patients were assessed using MRI and DTI before and after GKR. Mean Diffusivity (MD), Fractional Anisotropy (FA), Radial Diffusivity (RD), and TTV of tumour were determined. Patients with 10% or more decrease in TTV after GKR were classified as group 1 and those with less than 10% decrease in volume or increase in volume were considered group 2. The relationships between MD, RD, and FA values and TTV were investigated. Results A decrease of 46.34% in TTV was detected in group 1 after GKR, while TTV increased by 42.91% in group 2. The lowest pre-treatment FA value was detected in group 1. In addition, after GKR, FA values showed a significant increase in group 1. MD and RD values increased in both groups after radiosurgery. There was a negative correlation between pre-treatment FA, RD, and MD values after radiosurgery. Conclusion Detection of low FA values due to the poor fiber content in meningioma before radiosurgery may be a guide in predicting the response to treatment. Further studies are required to have a better understanding of the relationship between pre- and post-treatment follow-up FA values and tumor volume in determining the efficacy of GKR in patients with meningioma.
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Affiliation(s)
- Dilek H Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Yabul
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize O Temur
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mahmut E Aykan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet H Seyithanoglu
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa A Hatiboglu
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Long-term outcomes of multimodality management for parasagittal meningiomas. J Neurooncol 2020; 147:441-450. [PMID: 32088814 DOI: 10.1007/s11060-020-03440-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to systematically analyze the clinical characteristics of a large cohort of parasagittal meningioma (PM) and to evaluate the patients' outcomes and best treatment strategies based on tumor features. METHODS To minimize selection bias we performed a single-institutional review of PM with restricted criteria. One hundred and ninety-two consecutive patients who met criteria for inclusion were reviewed from 2003 to 2011 in our general hospital. RESULTS A total of 131 cases (68.2%) were with WHO grade I, while grade II and grade III PMs constituted 40 (20.8%) and 21 cases (10.9%). Higher histological grade was associated with loss of trimethylation of H3K27 (P = 0.000). For WHO grade I PMs, GTR was significantly associated with a better PFS (P = 0.023); however, adjuvant radiotherapy did not benefit patients with STR (P = 0.215). For de novo high-grade (WHO grade II and III) PMs (n = 37), adjuvant radiotherapy was associated with a significantly longer OS (P = 0.013), while no difference was observed between GTR and STR (P = 0.654). In recurrent high-grade PM patients (n = 24), GTR combined with adjuvant radiotherapy increased PFS (P = 0.005). CONCLUSIONS This study demonstrated that PMs were a heterogeneous group of tumors with a high proportion of high-grade tumors that often displayed aggressive clinical behaviors. Low-grade PM benefited from radical resection, whereas high-grade de novo PM did not. Adjuvant radiotherapy significantly prolonged OS for high-grade primary PM, but did not impact survival of patients with subtotally resected low-grade tumors. Long-term outcome of high-grade recurrent PMs was dismal. We thus show that extent of tumor resection, tumor grade and tumor recurrent status inform therapeutic decisions for PMs.
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