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Kim YJ, Moon KS, Park SJ, Jung TY, Kim IY, Jung S. Gamma knife radiosurgery as primary management for intracranial meningioma identified as growing on serial imaging. Medicine (Baltimore) 2024; 103:e37082. [PMID: 38306534 PMCID: PMC10843379 DOI: 10.1097/md.0000000000037082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024] Open
Abstract
Gamma knife radiosurgery (GKRS) has emerged as a highly effective therapeutic modality for the management of intracranial meningiomas. However, the role of GKRS in treating growing meningiomas detected during active surveillance remains unclear. This study seeks to investigate the long-term outcomes of GKRS treatment for growing meningiomas. A retrospective analysis was conducted on patients who underwent GKRS as the primary treatment for growing meningiomas between 2004 and 2021. Growing meningiomas were defined as those exhibiting a > 10% increase in tumor volume (TV) compared to the previous imaging. Fifty-nine patients who received GKRS as their initial treatment were included, with a minimum follow-up period of 12 months. Comprehensive clinical, radiological, and procedural data were analyzed. Serial TV assessments were performed for all tumors before and after GKRS. Tumor progression and regression were defined as a > 10% increase or decrease in TV, respectively, compared to the pretreatment image. At a median follow-up of 41 months (range 15-197 months), TV was unchanged in 16 patients (27.1%), decreased in 41 patients (69.5%), and increased in 2 patients (3.4%). Multivariate analysis revealed that both TV (cm3) (hazard ratio [HR], 1.107; 95% confidence interval [CI], 1.002-1.222; P = .045) and volume growing rate (%/yr) (HR, 1.013; 95% CI, 1.000-1.025; P = .04) significantly correlated with tumor progression. Eleven patients (18.6%) experienced new or worsening symptoms. In multivariate analysis, factor predicting new or worsening neurological function was preexisting calcification (HR, 5.297; 95% CI, 1.328-21.124; P = .018). GKRS demonstrates a promising level of tumor control with minimal risk of neurological deterioration when applied to growing meningiomas. These findings provide compelling support for considering GKRS as a valuable therapeutic option following an initial period of active surveillance for these tumors.
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Affiliation(s)
- Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Sue Jee Park
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
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Strømsnes TA, Lund-Johansen M, Skeie GO, Eide GE, Behbahani M, Skeie BS. Growth dynamics of incidental meningiomas: A prospective long-term follow-up study. Neurooncol Pract 2023; 10:238-248. [PMID: 37188168 PMCID: PMC10180371 DOI: 10.1093/nop/npac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background There is no consensus on the management of incidental meningiomas. The literature on long-term growth dynamics is sparse and the natural history of these tumors remains to be illuminated. Methods We prospectively assessed long-term tumor growth dynamics and survival rates during active monitoring of 62 patients (45 female, mean age 63.9 years) harboring 68 tumors. Clinical and radiological data were obtained every 6 months for 2 years, annually until 5 years, then every second year. Results The natural progression of incidental meningiomas during 12 years of monitoring was growth (P < .001). However, mean growth decelerated at 1.5 years and became insignificant after 8 years. Self-limiting growth patterns were seen in 43 (63.2%) tumors, non-decelerating in 20 (29.4%) and 5 (7.4%) were inconclusive due to ≤ 2 measurements. Decelerating growth persisted once established. Within 5 years, 38 (97.4%) of 39 interventions were initiated. None developed symptoms prior to intervention. Large tumors (P < .001) involving venous sinuses (P = .039) grew most aggressively. Since inclusion 19 (30.6%) patients have died of unrelated causes and 2 (3%) from grade 2 meningiomas. Conclusion Active monitoring seems a safe and appropriate first-line management of incidental meningiomas. Intervention was avoided in > 40% with indolent tumors in this cohort. Treatment was not compromised by tumor growth. Clinical follow-up seems sufficient beyond 5 years if self-limiting growth is established. Steady or accelerating growth warrant monitoring until they reach a stable state or intervention is initiated.
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Affiliation(s)
- Torbjørn Austveg Strømsnes
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Geir Olve Skeie
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Maziar Behbahani
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
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Dincer A, Morales-Valero SF, Robert SM, Tabor JK, O'Brien J, Yalcin K, Fulbright RK, Erson-Omay Z, Dunn IF, Moliterno J. Surgical strategies for intracranial meningioma in the molecular era. J Neurooncol 2023; 162:253-265. [PMID: 37010677 PMCID: PMC10167142 DOI: 10.1007/s11060-023-04272-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/16/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Surgical resection has long been the treatment of choice for meningiomas and is considered curative in many cases. Indeed, the extent of resection (EOR) remains a significant factor in determining disease recurrence and outcome optimization for patients undergoing surgery. Although the Simpson Grading Scale continues to be widely accepted as the measure of EOR and is used to predict symptomatic recurrence, its utility is under increasing scrutiny. The influence of surgery in the definitive management of meningioma is being re-appraised considering the rapid evolution of our understanding of the biology of meningioma. DISCUSSION Although historically considered "benign" lesions, meningioma natural history can vary greatly, behaving with unexpectedly high recurrence rates and growth which do not always behave in accordance with their WHO grade. Histologically confirmed WHO grade 1 tumors may demonstrate unexpected recurrence, malignant transformation, and aggressive behavior, underscoring the molecular complexity and heterogeneity. CONCLUSION As our understanding of the clinical predictive power of genomic and epigenomic factors matures, we here discuss the importance of surgical decision-making paradigms in the context of our rapidly evolving understanding of these molecular features.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Saul F Morales-Valero
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Stephanie M Robert
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joanna K Tabor
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joseph O'Brien
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Kanat Yalcin
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Robert K Fulbright
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA.
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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Bin-Alamer O, Alnefaie N, Qedair J, Chaudhary A, Hallak H, Abdulbaki A, Mallela AN, Palmisciano P, Gersey ZC, Legarreta AD, Labib MA, Zada G, Sheehan JP, Couldwell WT, Lunsford LD, Abou-Al-Shaar H. Single session versus multisession stereotactic radiosurgery for the management of intracranial meningiomas: a systematic review and meta-analysis. J Neurooncol 2023; 161:215-224. [PMID: 35976546 DOI: 10.1007/s11060-022-04112-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare the efficacy, outcomes, and complications of single session (SS-SRS) and multisession (MS-SRS) stereotactic radiosurgery in the treatment of intracranial meningiomas. METHODS Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane. A systematic review and meta-analysis of treatment protocols and outcomes were conducted. After the selection process, 20 articles describing 1483 cases were included. RESULTS A total of 1303 patients who underwent SS-SRS and 180 patients who underwent MS-SRS for the management of their intracranial meningioma were reported in the included studies. SS-SRS and MS-SRS had comparable one-year (SS-SRS: 98% vs. MS-SRS: 100%, p > 0.99) and five-year (SS-SRS: 94% vs. MS-SRS: 93%, p = 0.71) tumor control rates. The groups also had comparable tumor volume reduction/tumor regression rates (SS-SRS: 44% vs. MS-SRS: 25%, p = 0.25), tumor volume stability rates (SS-SRS: 51% vs. MS-SRS: 75%, p = 0.12), and tumor progression rates (SS-SRS: 4% vs. MS-SRS: 4%, p = 0.89). SS-SRS and MS-SRS yielded similar complication rates (10.4% vs. 11.4%, p = 0.68) and comparable functional improvement rates (MS-SRS: 44% vs. SS-SRS: 36%, p = 0.57). However, MS-SRS was used for significantly larger tumor volumes (MS-SRS: 23.8 cm3 vs. SS-SRS: 6.1 cm3, p = 0.02). CONCLUSION SS-SRS and MS-SRS resulted in comparable tumor control, tumor volumetric change, and functional outcomes despite significant biases in selecting patients for SS- or MS-SRS.
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Affiliation(s)
- Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nada Alnefaie
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Jumanah Qedair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Adhiraj Chaudhary
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hana Hallak
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Arif Abdulbaki
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew D Legarreta
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mohamed A Labib
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Bailo M, Gagliardi F, Boari N, Spina A, Piloni M, Castellano A, Mortini P. Meningioma and Other Meningeal Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:73-97. [PMID: 37452935 DOI: 10.1007/978-3-031-23705-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Meningiomas develop from meningothelial cells and approximately account for more than 30 percent of central nervous system (CNS) tumors. They can occur anywhere in the dura, most often intracranially and at dural reflection sites. Half of the cases are usually at parasagittal/falcine and convexity locations; other common sites are sphenoid ridge, suprasellar, posterior fossa, and olfactory groove. The female-to-male ratio is approximately 2 or 3-1, and the median age at diagnosis is 65 years. Meningiomas are generally extremely slow-growing tumors; many are asymptomatic or paucisymptomatic at diagnosis and are discovered incidentally. Clinical manifestations, when present, are influenced by the tumor site and by the time course over which it develops. Meningiomas are divided into three grades. Grade I represents the vast majority of cases; they are considered typical or benign, although their CNS location can still lead to severe morbidity or mortality, resulting in a reported ten-year net survival of over 80%. Atypical (WHO grade II) meningiomas are considered "intermediate grade" malignancies and represent 5-7% of cases. They show a tendency for recurrence and malignant degeneration with a relevant increase in tumor cell migration and surrounding tissue infiltration; ten-year net survival is reported over 60%. The anaplastic subtype (WHO III) represents only 1-3% of cases, and it is characterized by a poor prognosis (ten-year net survival of 15%). The treatment of choice for these tumors stands on complete microsurgical resection in case the subsequent morbidities are assumed minimal. On the other hand, and in case the tumor is located in critical regions such as the skull base, or the patient may have accompanied comorbidities, or it is aimed to avoid intensive treatment, some other approaches, including stereotactic radiosurgery and radiotherapy, were recommended as safe and effective choices to be considered as a primary treatment option or complementary to surgery. Adjuvant radiosurgery/radiotherapy should be considered in the case of atypical and anaplastic histology, especially when a residual tumor is identifiable in postoperative imaging. A "watchful waiting" strategy appears reasonable for extremely old individuals and those with substantial comorbidities or low-performance status, while there is a reduced threshold for therapeutic intervention for relatively healthy younger individuals due to the expectation that tumor progression will inevitably necessitate proactive treatment. To treat and manage meningioma efficiently, the assessments of both neurosurgeons and radiation oncologists are essential. The possibility of other rarer tumors, including hemangiopericytomas, solitary fibrous tumors, lymphomas, metastases, melanocytic tumors, and fibrous histiocytoma, must be considered when a meningeal lesion is diagnosed, especially because the ideal diagnostic and therapeutic approaches might differ significantly in every tumor type.
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Affiliation(s)
- Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy.
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Martina Piloni
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Antonella Castellano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
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A Pathophysiological Approach to Reduce Peritumoral Edema with Gamma Knife Radiosurgery for Large Incidental Meningiomas. Life (Basel) 2022; 12:life12111683. [DOI: 10.3390/life12111683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Peritumoral edema may be a prohibitive side effect in treating large incidental meningiomas with stereotactic radiosurgery. An approach that limits peritumoral edema and achieves tumor control with SRS would be an attractive management option for large incidental meningiomas. Methods: This is a retrospective cohort study of patients with large incidental meningiomas (≥2 mL in volume and/or 2 cm in diameter) treated with gamma knife radiosurgery (GKRS) between 2000 and 2019 in Taiwan and followed up for 5 years. The outcomes of a pathophysiological approach targeting the dural feeding artery site with a higher marginal dose (18–20 Gy) to enhance vascular damage and the parenchymal margin of the tumor with a lower dose (9–11 Gy) to reduce parenchymal damage were compared with those of a conventional approach targeting the tumor center with a higher dose and tumor margin with a lower dose (12–14 Gy). Results: A total of 53 incidental meningiomas were identified, of which 23 (43.4%) were treated with a pathophysiological approach (4 cases underwent a two-stage approach) and 30 (56.7%) were treated with a conventional approach. During a median follow-up of 3.5 (range 1–5) years, tumor control was achieved in 19 (100%) incidental meningiomas that underwent a single-stage pathophysiological approach compared with 29 (96.7%) incidental meningiomas that underwent a conventional approach (log-rank test: p = 0.426). Peritumoral edema developed in zero (0%) incidental meningiomas that underwent a single stage pathophysiological approach compared to seven (23.3%) incidental meningiomas that underwent a conventional approach (log-rank test: p = 0.023). Conclusions: Treatment of large incidental meningiomas with a pathophysiological approach with GKRS achieves similar rates of tumor control and reduces the risk of peritumoral edema. GKRS with a pathophysiological approach may be a reasonable management strategy for large incidental meningiomas.
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Yamada S, Hirayama R, Iwata T, Kuroda H, Nakagawa T, Takenaka T, Kijima N, Okita Y, Kagawa N, Kishima H. Growth risk classification and typical growth speed of convexity, parasagittal, and falx meningiomas: a retrospective cohort study. J Neurosurg 2022; 138:1235-1241. [PMID: 36115061 DOI: 10.3171/2022.8.jns221290] [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: 06/06/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas are the most common primary intracranial tumors, and their clinical and biological characteristics vary by location. Convexity, parasagittal, and falx meningiomas account for approximately 50%-65% of intracranial meningiomas. Focusing only on these locations, the aim of this study was to determine the typical speed of tumor growth, to assess the growth risk, and to show the possible tumor volume that many lesions can reach after 5 years. METHODS Patients with radiologically suspected convexity, parasagittal, or falx meningiomas at the authors' institution were studied retrospectively. The relative growth rate (RGR) and annual volume change (AVC) were calculated from MRI at more than 3-month intervals. Based on sex, age, and signal intensity on T2-weighted MRI, the cases were classified into three groups: extremely high-growth, high-growth, and low-growth groups. RESULTS The data of 313 cases were analyzed. The median RGR and AVC for this entire cohort were 6.1% (interquartile range [IQR] 2.4%-16.0%) and 0.20 (IQR 0.04-1.18) cm3/year, respectively. There were significant differences in sex (p = 0.018) and T2-weighted MRI signal intensity (p < 0.001) for RGR, and T2-weighted MRI signal intensity (p < 0.001), tumor location (p = 0.025), and initial tumor volume (p < 0.001) for AVC. The median RGR and AVC were 17.5% (IQR 8.3%-44.1%) and 1.05 (IQR 0.18-3.53) cm3/year, 8.2% (IQR 2.9%-18.6%) and 0.33 (IQR 0.06-1.66) cm3/year, and 3.4% (IQR 1.2%-5.8%) and 0.04 (IQR 0.02-0.21) cm3/year for the extremely high-growth, high-growth, and low-growth groups, respectively, with a significant difference among the groups (p < 0.001). A 2.24-times, or 5.24 cm3, increase in tumor volume over 5 years was typical in the extremely high-growth group, whereas the low-growth group showed little change in tumor volume even over a 5-year follow-up period. CONCLUSIONS For the first time, the typical speed of tumor growth was calculated, focusing only on patients with convexity, parasagittal, and falx meningiomas. In addition, the possible tumor volume that many lesions in these locations can reach after 5 years was shown based on objective indicators. These results may allow clinicians to easily detect lesions that require frequent follow-up or early treatment by determining whether they deviate from the typical range of the growth rate, similar to a growth chart for children.
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Pikis S, Mantziaris G, Bunevicius A, Islim AI, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, May J, Alvarez RM, Patel DN, Kondziolka D, Bernstein K, Moreno NM, Tripathi M, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford LD, Jenkinson MD, Sheehan J. Stereotactic Radiosurgery Compared With Active Surveillance for Asymptomatic, Parafalcine, and Parasagittal Meningiomas: A Matched Cohort Analysis From the IMPASSE Study. Neurosurgery 2022; 90:750-757. [PMID: 35319529 DOI: 10.1227/neu.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The optimal management of asymptomatic, presumed WHO grade I meningiomas remains controversial. OBJECTIVE To define the safety and efficacy of stereotactic radiosurgery (SRS) compared with active surveillance for the management of patients with asymptomatic parafalcine/parasagittal (PFPS) meningiomas. METHODS Data from SRS-treated patients from 14 centers and patients managed conservatively for an asymptomatic, PFPS meningioma were compared. Local tumor control rate and new neurological deficits development were evaluated in the active surveillance and the SRS-treated cohorts. RESULTS There were 173 SRS-treated patients and 98 patients managed conservatively in the unmatched cohorts. After matching for patient age and tumor volume, there were 98 patients in each cohort. The median radiological follow-up period was 43 months for the SRS cohort and 36 months for the active surveillance cohort (P = .04). The median clinical follow-up for the SRS and active surveillance cohorts were 44 and 36 months, respectively. Meningioma control was noted in all SRS-treated patients and in 61.2% of patients managed with active surveillance (P < .001). SRS-related neurological deficits occurred in 3.1% of the patients (n = 3), which were all transient. In the active surveillance cohort, 2% of patients (n = 2) developed neurological symptoms because of tumor progression (P = 1.0), resulting in death of 1 patient (1%). CONCLUSION Up-front SRS affords superior radiological PFPS meningioma control as compared with active surveillance and may lower the risk of meningioma-related permanent neurological deficit and/or death.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Adomas Bunevicius
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Abdurrahman I Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Violaine Delabar
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | | | | | - Roman Liscak
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jaromir May
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roberto Martinez Alvarez
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dev N Patel
- Department of Neurosurgery, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth Bernstein
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Manjul Tripathi
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Herwin Speckter
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Greg N Bowden
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ronald J Benveniste
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael D Jenkinson
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
- Department of Neurosurgery and University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
- Department of Neurosurgery, Benha University, Benha, Egypt
- Ain Shams University, Cairo, Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei City, Taiwan
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
- Department of Neurosurgery, New York University, New York, New York, USA
- Department of Radiation Oncology, New York University, New York, New York, USA
- Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
- Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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9
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Pikis S, Mantziaris G, Islim AI, Peker S, Samanci Y, Nabeel AM, Reda WA, Abdelkarim K, El-Shehaby AMN, Tawadros SR, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Licsak R, Hanuska J, Alvarez RM, Patel DN, Kondziolka D, Bernstein K, Moreno NM, Tripathi M, Speckter H, Albert C, Bowden GN, Benveniste RJ, Lunsford DL, Jenkinson MD, Sheehan J. Stereotactic radiosurgery versus active surveillance for incidental, convexity meningiomas: a matched cohort analysis from the IMPASSE study. J Neurooncol 2022; 157:121-128. [DOI: 10.1007/s11060-022-03953-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
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10
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Ganz JC. Meningiomas. PROGRESS IN BRAIN RESEARCH 2022; 268:163-190. [PMID: 35074079 DOI: 10.1016/bs.pbr.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Meningiomas arise in various locations. Convexity tumors are relatively simple to remove. Skull base tumors and tumors adjacent to the major cerebral veins and venous sinuses can be very difficult to extirpate. Attempts at radical resection can lead to serious morbidity. The combination of bulk reduction using microsurgery followed by GKNS gives greatly improved survival and very low morbidity. With smaller tumors, GKNS may be used as the primary treatment. Increasing numbers of asymptomatic meningiomas are demonstrated either as an unexpected finding or as a residual or recurrent tumor after surgery. In all of these situations, GKNS gives a better result than observation or reoperation.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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11
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Mantziaris G, Pikis S, Samanci Y, Peker S, Nabeel AM, Reda WA, Tawadros SR, El-Shehaby AMN, Abdelkarim K, Emad RM, Delabar V, Mathieu D, Lee CC, Yang HC, Liscak R, Hanuska J, Alvarez RM, Moreno NM, Tripathi M, Speckter H, Albert C, Benveniste RJ, Bowden GN, Patel DN, Kondziolka D, Bernstein K, Lunsford LD, Jenkinson MD, Islim AI, Sheehan J. Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas: an international, multicenter matched cohort study. J Neurooncol 2022; 156:509-518. [DOI: 10.1007/s11060-021-03923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
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12
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Yamada S, Kijima N, Nakagawa T, Hirayama R, Kinoshita M, Kagawa N, Kishima H. How Much Tumor Volume Is Responsible for Development of Clinical Symptoms in Patients With Convexity, Parasagittal, and Falx Meningiomas? Front Neurol 2021; 12:769656. [PMID: 34867757 PMCID: PMC8635518 DOI: 10.3389/fneur.2021.769656] [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: 09/02/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: Meningiomas are the most common primary intracranial neoplasms and clinical symptom appearance depends on their volume and location. This study aimed to identify factors that influence clinical symptoms and to determine a specific threshold tumor volume for the prediction of symptomatic progression in patients with convexity, parasagittal, and falx meningiomas. Materials and Methods: We retrospectively studied patients with radiologically suspected convexity, parasagittal, or falx meningiomas at our institution. Results: The data of three hundred thirty-three patients were analyzed. We further divided patients into two groups based on clinical symptoms: an asymptomatic group (250 cases) and a symptomatic group (83 cases). Univariate analysis revealed significant differences between the groups in terms of sex (p = 0.002), age at the time of volumetric analysis (p < 0.001), hyperintense lesions on T2-weighted images (p = 0.029), peritumoral edema (p < 0.001), maximum tumor diameter (p < 0.001), and tumor volume (p < 0.001). Further multivariate analysis revealed significant differences between the groups in terms of age at the time of volumetric analysis (p = 0.002), peritumoral edema (p < 0.001), and tumor volume (p < 0.001). The receiver operating characteristic curve revealed a threshold tumor volume of 21.1 ml for predicting whether a patient would develop symptoms (sensitivity 0.843, specificity 0.880, an area under the curve 0.919 [95% confidence interval: 0.887–0.951]). Conclusion: We identified factors predictive of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas and determined the first-ever threshold tumor volume for predicting symptomatic progression in such patients.
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Affiliation(s)
- Shuhei Yamada
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoyoshi Nakagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryuichi Hirayama
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
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13
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Collin A, Copol C, Pianet V, Colin T, Engelhardt J, Kantor G, Loiseau H, Saut O, Taton B. Spatial mechanistic modeling for prediction of the growth of asymptomatic meningiomas. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105829. [PMID: 33348072 DOI: 10.1016/j.cmpb.2020.105829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Mathematical modeling of tumor growth draws interest from the medical community as they have the potential to improve patients' care and the use of public health resources. The main objectives of this work are to model the growth of meningiomas - slow-growing benign tumors requiring extended imaging follow-up - and to predict tumor volume and shape at a later desired time using only two times examinations. METHODS We develop two variants of a 3D partial differential system of equations (PDE) which yield after a spatial integration systems of ordinary differential equations (ODE) that relate tumor volume with time. Estimation of models parameters is a crucial step to obtain a personalized model for a patient that can be used for descriptive or predictive purposes. As PDE and ODE systems share the same parameters, they are both estimated by fitting the ODE systems to the tumor volumes obtained from MRI examinations acquired at different times. A population approach allows to compensate for sparse sampling times and measurement uncertainties by constraining the variability of the parameters in the population. RESULTS Description capabilities of the models are investigated in 39 patients with benign asymptomatic meningiomas who had had at least three surveillance MRI examinations. The two models can fit to the data accurately and more realistically than a naive linear regression. Prediction performances are validated for 33 patients using a population approach. Mean relative errors in volume predictions are less than 10% with ODE systems versus 12.5% with the naive linear model using only two times examinations. Concerning the shape, the mean Sørensen-Dice coefficients are 85% with the PDE systems in a subset of 10 representative patients. CONCLUSIONS Our strategy - based on personalization of mathematical model - provides a good insight on meningioma growth and may help decide whether to extend the follow-up or to treat the tumor.
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Affiliation(s)
- Annabelle Collin
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence, F-33400, France.
| | - Cédrick Copol
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence, F-33400, France
| | - Vivien Pianet
- Sophia Genetics, Cité de la Photonique, Pessac, F-33600, France
| | - Thierry Colin
- Sophia Genetics, Cité de la Photonique, Pessac, F-33600, France
| | - Julien Engelhardt
- Service de Neurochirurgie B, Groupe Hospitalier Pellegrin, CHU Bordeaux, Bordeaux, F-33000, France
| | - Guy Kantor
- Département de Radiothérapie, Institut Bergonié, Bordeaux F-33076, France
| | - Hugues Loiseau
- Service de Neurochirurgie B, Groupe Hospitalier Pellegrin, CHU Bordeaux, Bordeaux, F-33000, France; EA 7435 - IMOTION, Univ. Bordeaux, Bordeaux, F-33076, France
| | - Olivier Saut
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence, F-33400, France
| | - Benjamin Taton
- Univ. Bordeaux, Inria Bordeaux-Sud-Ouest, Bordeaux INP, CNRS, IMB, UMR 5251, Talence, F-33400, France; Service de Néphrologie - Transplantation - Dialyse - Aphérèses, Groupe Hospitalier Pellegrin, CHU Bordeaux, Bordeaux, F-33000, France
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14
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Pikis S, Bunevicius A, Sheehan J. Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery. Acta Neurochir (Wien) 2021; 163:83-88. [PMID: 33211178 DOI: 10.1007/s00701-020-04648-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Optimal management of asymptomatic skull base meningiomas is controversial. We evaluated the safety and efficiency of Gamma Knife radiosurgery (GKRS) for the management of asymptomatic skull base meningiomas. METHODS This retrospective study involved patients managed with GKRS for asymptomatic, skull base meningiomas from 1997 to 2019. Patient clinico-radiologic data, tumor characteristics, and procedural details were analyzed. Favorable outcome was defined as lack of procedure-related mortality or permanent neurologic morbidity and radiologic evidence of tumor control. Tumor progression and regression were defined as an increase or decrease of > 20% in volume from baseline to the last neuroimaging study respectively. Tumor volumes within ± 20% of baseline volume were considered stable. RESULTS Thirty-seven patients (30 women), median age 68 years old (range 42-83 months) were managed with a single-session GKRS for 40 asymptomatic, skull base meningiomas. At a median clinical follow-up of 58.5 months (range 14-150 months), no mortality associated with the procedure or the treated tumor was noted. Permanent neurologic morbidity was 2.75%. There was a statistically significant decrease in mean tumor volume (p < 0.001) from 4.04 cc (SD 3.09 cc) prior to radiosurgery to 2.73 cc (SD 2.24 cc) at last follow-up. Higher margin dose was associated with tumor regression at last follow-up (HR = 1.351; 95%CI [1.094-1.669]; p = 0.05). CONCLUSION As compared to natural history studies, GKRS affords long-standing tumor control and neurologic preservation in the vast majority of patients treated for asymptomatic, skull base meningiomas. Further study is necessary to identify the optimal management of asymptomatic skull base meningiomas.
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15
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Fu J, Wu L, Peng C, Yang X, You H, Cao L, Deng Y, Yu J. Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience. Front Oncol 2020; 10:598582. [PMID: 33330094 PMCID: PMC7732633 DOI: 10.3389/fonc.2020.598582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/20/2020] [Indexed: 12/04/2022] Open
Abstract
Objective The aims of this study were to investigate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for large (≥20 mm) or documented growth asymptomatic meningiomas. Design and Methods This was a single-center retrospective study. Fifty-nine patients with large (≥20 mm) or documented growth asymptomatic meningiomas undergoing initial GKRS were enrolled. The median age was 56 (range, 27–83) years. The median time of follow-up was 66.8 (range, 24.6–245.6) months, and the median tumor margin dose was 13.0 Gy (range, 11.6–22.0 Gy). Results Tumors shrunk in 35 patients (59.3%) and remained stable in 23 (39.0%). One patient (1.7%) experienced radiological progression at 54 months after GKRS. The PFS was 100%, 97%, and 97% at 3, 5, and 10 years, respectively. Nine patients (15.3%) occurred new neurological symptoms or signs at a median time of 8.1 (range, 3.0–81.6) months. The symptom PFS was 90% and 78% at 5 and 10 years, respectively. Fifteen patients (25.4%) occurred peritumoral edema (PTE) at a median time of 7.2 (range, 2.0–81.6) months. One patient underwent surgical resection for severe PTE. In univariate and multivariate analysis, Only tumor size (≥25 mm) and maximum dose (≥34 Gy) were significantly associated with PTE [hazard ratio (HR)= 3.461, 95% confidence interval (CI)=1.157-10.356, p=0.026 and HR=3.067, 95% CI=1.068-8.809, P=0.037, respectively]. Conclusions In this study, initial GKRS can provide a high tumor control rate as well as an acceptable rate of complications in large or documented growth asymptomatic meningiomas. GKRS may be an alternative initial treatment for asymptomatic meningiomas.
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Affiliation(s)
- Junyi Fu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lisha Wu
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chao Peng
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongji You
- Department of Nuclear Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Linhui Cao
- Department of Traditional Chinese Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinhui Deng
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinxiu Yu
- Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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16
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Bu J, Pan P, Yao H, Gong W, Liu Y, Yu Z, Wang Z, Wu J, Chen G. Small Cerebellopontine Angle Meningioma-Surgical Experience of 162 Patients and Literature Review. Front Oncol 2020; 10:558548. [PMID: 33163399 PMCID: PMC7581792 DOI: 10.3389/fonc.2020.558548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Objective To retrospective analyze the clinical data of 162 patients with small cerebellopontine angle meningiomas. To compare with the nature of tumors, symptoms pre- and post-treatments, neurological deficit, and prognosis in literatures. To explore the surgical outcomes of small cerebellopontine angle meningiomas and summarize the surgical experience. Methods All of 162 patients with small cerebellopontine angle meningiomas underwent surgery between January 2010 and December 2019 in the neurosurgery department of the First Affiliated Hospital of Soochow University. This cohort of eight literatures reported about stereotactic radiotherapy of small cerebellopontine angle meningiomas between January 2010 and December 2019. All clinical data were obtained for analysis. Results Compared with stereotactic radiotherapy, surgical treatment for small cerebellopontine angle meningiomas lead to the better results in relieving symptoms and inhibiting tumor progression. Surgical treatment can obtain the exact pathological examination results to guide the further treatment. Conclusions Surgical treatment should be the first choice for small cerebellopontine angle meningiomas.
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Affiliation(s)
- Jiyuan Bu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pengjie Pan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Yao
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiyi Gong
- Department of Neurosurgery, First People's Hospital of Kunshan, Suzhou, China
| | - Yuan Liu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhengquan Yu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Abstract
Observation has been a mainstay in asymptomatic meningiomas, but it may increase the risk associated with treatment due to tumor enlargement and the aging of patients. Understanding the natural course of meningiomas is important to provide appropriate treatment. The majority of previous studies investigated factors related to their growth, but failed to demonstrate their relationship with symptomatic progression (sympP) because of its rarity. We reviewed and meta-analyzed 27 studies that investigated natural courses in asymptomatic or untreated meningiomas to find clinico-radiological factors predictive of radiological progression (radioP), growth speed, and sympP. In results of time-growth analysis, two-thirds of meningiomas showed radioP defined by a volume criterion and the rate approached a plateau at 4-5 years. In growth curve analyses, about half of incidental meningiomas presented decelerating or no growth, while less than one-quarter of them grew exponentially. RadioP, growth speed [annual volume change (AVC) or relative growth rate], and sympP each had different factors related to them. Younger age, non-calcification, and high intensity on T2-weighted image were related to radioP and rapid growth speed, but not to sympP. Tumors in males and those of larger size were likely to be symptomatic in the meta-analysis. AVC (≥2.1 cm3/year) was the strongest indicator of sympP. Apart from perifocal edema, radiological features at up-front imaging may not be useful for predicting sympP. This may be due to dynamic changes of those radiological markers in the long term. Quantified tumor size and growth speed, especially AVC, are important markers for deciding on treatment.
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Affiliation(s)
| | - Yoko Nakasu
- Department of Neurosurgery, Shiga University of Medical Science
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18
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Kim SK, Yoon HI, Yoon WS, Cho JM, Moon J, Kim KH, Kim SH, Kim YI, Kim YZ, Kim HS, Dho YS, Park JS, Park JE, Seo Y, Sung KS, Song JH, Wee CW, Lee SH, Lim DH, Im JH, Chang JH, Han MH, Hong JB, Hwang K, Park CK, Lee YS, Gwak HS. A National Consensus Survey for Current Practice in Brain Tumor Management II: Diffuse Midline Glioma and Meningioma. Brain Tumor Res Treat 2020; 8:11-19. [PMID: 32390349 PMCID: PMC7221470 DOI: 10.14791/btrt.2020.8.e6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background The Guideline Working Group of the Korean Society for Neuro-Oncology (KSNO) conducted a nationwide questionnaire survey for diverse queries faced in the treatment of brain tumors. As part II of the survey, the aim of this study is to evaluate the national patterns of clinical practice for patients with diffuse midline glioma and meningioma. Methods A web-based survey was sent to all members of the KSNO by email. The survey included 4 questions of diffuse midline glioma and 6 questions of meningioma (including 2 case scenarios). All questions were developed by consensus of the Guideline Working Group. Results In the survey about diffuse midline glioma, 76% respondents performed histologic confirmation to identify H3K27M mutation on immunohistochemical staining or sequencing methods. For treatment of diffuse midline glioma, respondents preferred concurrent chemoradiotherapy with temozolomide (TMZ) and adjuvant TMZ (63.8%) than radiotherapy alone (34.0%). In the survey about meningioma, respondents prefer wait-and-see policy for the asymptomatic small meningioma without peritumoral edema. However, a greater number of respondents had chosen surgical resection as the first choice for all large size meningiomas without exception, and small size meningiomas with either peritumoral edema or eloquent location. There was no single opinion with major consensus on long-term follow-up plans for asymptomatic meningioma with observation policy. As many as 68.1% of respondents answered that they would not add any adjuvant therapies for World Health Organization grade II meningiomas if the tumor was totally resected including dura. Conclusion The survey demonstrates the prevailing clinical practice patterns for patients with diffuse midline glioma and meningioma among members of the KSNO. This information provides a point of reference for establishing a practical guideline in the management of diffuse midline glioma and meningioma.
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Affiliation(s)
- Sung Kwon Kim
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Soo Yoon
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jin Mo Cho
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Jangsup Moon
- Department of Neurology, Rare Disease Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young Zoon Kim
- Division of Neurooncology and Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hoon Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Im
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chul Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Youn Soo Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Ho Shin Gwak
- Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Bailo M, Gagliardi F, Boari N, Castellano A, Spina A, Mortini P. The Role of Surgery in Meningiomas. Curr Treat Options Neurol 2019; 21:51. [PMID: 31560106 DOI: 10.1007/s11940-019-0587-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review presents the most recent evidences and recommendations in the pre-, intra-, and post-surgical management of patients harboring meningiomas. Due to the increasing relevance of multimodal approaches, in order to preserve patients' neurological function and quality of life (QoL), the role of observation and radiation treatments (as either primary or adjuvant therapy) has also been discussed. RECENT FINDINGS Multiple advances in neurosurgery, including the use of the microscope and endoscope, improved preoperative neuroimaging, intraoperative image-guided approaches, and intraoperative neurophysiological monitoring, have extended the neurosurgeon's ability to remove lesions that were previously considered only partially resectable or unresectable, while minimizing morbidity. On the other hand, the preservation of patients' neurological integrity and QoL are increasingly important issues, more than complete tumor resection, for both patients and neurosurgeons. In this setting, stereotactic radiosurgery (SRS) and radiotherapy (RT) may be considered safe and effective alternatives for asymptomatic small- to moderate-sized tumors that demonstrate growth on serial imaging, or in combination with planned subtotal resection (STR) for tumors in critical locations. Data supporting the use of pharmacotherapy in meningiomas are, to date, weak, but the strength of the evidence might improve in the next future with the identification of targetable mutations. Complete microsurgical resection remains the standard of care if it can be achieved with minimal or no morbidity. However, many studies have reported SRS/RT as safe and effective treatments, either as primary approach or as complementary to surgery, especially when dealing with critically located meningiomas (e.g., cranial base) or in patients with comorbidity or wishing to avoid invasive treatments. The management of meningiomas is a field of complementary disciplines: neurosurgeon needs to work closely with radiation oncologists while tailoring the optimal treatment for these patients in order to achieve the best results.
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Affiliation(s)
- Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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20
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Behbahani M, Skeie GO, Eide GE, Hausken A, Lund-Johansen M, Skeie BS. A prospective study of the natural history of incidental meningioma-Hold your horses! Neurooncol Pract 2019; 6:438-450. [PMID: 31832214 DOI: 10.1093/nop/npz011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The number of incidental meningiomas has increased because of the increased availability of neuroimaging. Lack of prospective data on the natural history makes the optimal management unclear. We conducted a 5-year prospective study of incidental meningiomas to identify risk factors for tumor growth. Methods Sixty-four of 70 consecutive patients with incidental meningioma were included. Clinical and radiological status was obtained at 0, 0.5, 1, 1.5, 2, 3, 4, and 5 years. GammaPlan and mixed linear regression modeling were utilized for volumetric analysis with primary endpoint tumor growth. Results None of the patients developed tumor-related symptoms during the study period, although 48 (75%) tumors increased (>15%), 13 (20.3%) remained unchanged, and 3 (4.7%) decreased (>15%) in volume. Mean time to growth was 2.2 years (range, 0.5-5.0 years).The growth pattern was quasi-exponential in 26%, linear in 17%, sigmoidal in 35%, parabolic in 17%, and continuous reduction in 5%. There was significant correlation among growth rate, larger baseline tumor volume (P < .001), and age in years (<55 y: 0.10 cm3/y, 55-75 y: 0.24 cm3/y, and >75 y: 0.85 cm3/y). Conclusion The majority of meningiomas will eventually grow. However, more than 60% display a self-limiting growth pattern. Our study provides level-2 evidence that asymptomatic tumors can be safely managed utilizing serial imaging until persistent radiological and/or symptomatic growth.
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Affiliation(s)
- Maziar Behbahani
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
- Department of Neurosurgery, Stavanger University Hospital, Norway
| | - Geir Olve Skeie
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Annbjørg Hausken
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
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Garcia CR, Slone SA, Chau M, Neltner JH, Pittman T, Villano JL. Initial management of meningiomas: Analysis of the National Cancer Database. Cancer Epidemiol 2019; 60:16-22. [PMID: 30878798 DOI: 10.1016/j.canep.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States. METHODS We analyzed the National Cancer Database from 2004 to 2014, for all patients with diagnosis of meningioma. RESULTS 201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher in histologically confirmed cases (13.1 years). Older patients, Blacks, males, those that received radiation plus surgery, and were treated in community facilities had an increased risk of mortality. CONCLUSIONS Over half of patients were diagnosed by imaging, suggesting a higher role of clinical determinants over histological confirmation in treatment decisions. Watchful waiting as initial management is increasing. Our survival analysis favored histological confirmation. Patients receiving radiation and surgery had an increased risk of mortality.
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Affiliation(s)
- Catherine R Garcia
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Stacey A Slone
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Monica Chau
- Department of Neurology, University of Kentucky, Lexington, KY, United States
| | - Janna H Neltner
- Departments of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States
| | - Thomas Pittman
- Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States
| | - John L Villano
- Department of Medicine, University of Kentucky, Lexington, KY, United States; Department of Neurology, University of Kentucky, Lexington, KY, United States; Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States.
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