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Dobeson CB, Baxter M, Rowe M, Kingdon S, Park S, Bond H, Taylor K, Islim AI, King J, Millward CP, Zakaria R, Clynch AL, Keshwara SM, Eltinay A, Kviat L, Robinson R, Haris PA, Samuel R, Venkatesh V, Derby S, Ahmad S, Smith F, Robinson S, Kathirgamakarthigeyan S, Narramneni LR, Hannan CJ, Lewis J. Management Approaches in WHO Grade III Meningioma: A National Oncology Trainees' Collaborative for Healthcare Research (NOTCH) UK Multi-Centre Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:e301-e311. [PMID: 38849235 DOI: 10.1016/j.clon.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024]
Abstract
AIMS WHO Grade 3 (G3) meningiomas are rare tumours with limited data to guide management. This retrospective study documents UK management approaches across 14 centres over 11 years. MATERIALS AND METHODS Patients with WHO G3 meningioma between 01/01/2008 and 31/12/2018 were identified. Data were collected on demographics, management strategy, adjuvant radiotherapy, approach in recurrence setting and survival. RESULTS 84 patients were identified. 21.4% transformed from lower-grade disease. 96.4% underwent primary surgical resection, with 20.8% having evidence of residual disease on their post-op MRI. 59.3% of patients underwent adjuvant radiotherapy (RT) following surgical resection. Overall median PFS and OS were 12.6 months and 28.2 months, respectively. Median OS in the group who underwent complete surgical resection was 34.9 months, compared to 27.5 months for those who had incomplete resection (HR 0.58, 95% CI 0.27-1.23, p = 0.15). Median OS was 33.1 months for those who underwent adjuvant RT and 14.0 months for those who did not (HR 0.48, 95% CI 0.27-0.84, p = 0.004). Median adjuvant RT dose delivered was 60Gy (range 12Gy-60Gy), 45.8% of adjuvant RT was delivered using IMRT. At disease relapse, 31% underwent salvage surgery and 29.3% underwent salvage RT. Of those treated with salvage RT, 64.7% were re-treats and all were treated with hypofractionated RT. CONCLUSION Surgery continues to be the preferred primary management strategy. Post-operative MRI within 48 hours is indicated to assess presence of residual disease and guide further surgical options. Adjuvant radiotherapy plays an important part of the management paradigm in these patients with the data supporting an attached survival advantage. Further surgery and re-irradiation is an option in the disease recurrence setting with radiosurgery frequently utilised in this context.
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Affiliation(s)
- C B Dobeson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, NE77DN, UK.
| | - M Baxter
- Tayside Cancer Centre, Ninewells Hospital, Dundee, NHS Tayside, Scotland, DD1 9SY, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, England, TR1 3LJ, UK
| | - S Kingdon
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - S Park
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - H Bond
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, England, PL6 8DH, UK
| | - K Taylor
- The Northern Ireland Cancer Centre, Belfast, Northern Ireland, BT12 6BA, UK
| | - A I Islim
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - J King
- The Christie NHS Foundation Trust, Manchester, England, M20 4BX, UK
| | - C P Millward
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - R Zakaria
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - A L Clynch
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - S M Keshwara
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - A Eltinay
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, England, OX3 7LE, UK
| | - L Kviat
- The Royal Marsden Hospital NHS Foundation Trust, London, England, SW3 6JJ, UK
| | - R Robinson
- The Royal Marsden Hospital NHS Foundation Trust, London, England, SW3 6JJ, UK
| | - P A Haris
- University Hospitals of Leicester NHS Trust, England, LE3 9QP, UK
| | - R Samuel
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, England, LS9 7TF, UK
| | - V Venkatesh
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, England, LS9 7TF, UK
| | - S Derby
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, G12 0YN, UK
| | - S Ahmad
- University Hospitals of Leicester NHS Trust, England, LE3 9QP, UK
| | - F Smith
- Nottingham University Hospitals NHS Trust, England, NG7 2UH, UK
| | - S Robinson
- Imperial College Healthcare NHS Trust, London, England, W2 1NY, UK
| | | | - L R Narramneni
- Aberdeen Royal Infirmary, NHS Grampian, Scotland, AB25 2ZN, UK
| | - C J Hannan
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - J Lewis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, NE77DN, UK
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Duba M, Mrlian A, Rošková I, Smrčka M, Fadrus P, Duba J, Hrdý O, Al Tukmachi D. Neurosurgical treatment and outcome patterns in patients with meningioma in South Moravian region-a population-based study. Neurol Sci 2024; 45:2311-2319. [PMID: 38151626 PMCID: PMC11021287 DOI: 10.1007/s10072-023-07244-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients. MATERIAL AND METHODS Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate. RESULTS AND CONCLUSIONS In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.
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Affiliation(s)
- Miloš Duba
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Andrej Mrlian
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Ivana Rošková
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Smrčka
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavel Fadrus
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Duba
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Anaesthesia, Resuscitation and Intensive Medicine, University Hospital Brno, Brno, Czech Republic
| | - Ondřej Hrdý
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Anaesthesia, Resuscitation and Intensive Medicine, University Hospital Brno, Brno, Czech Republic
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Diagnostic and Therapeutic Strategy in Anaplastic (Malignant) Meningioma, CNS WHO Grade 3. Cancers (Basel) 2022; 14:cancers14194689. [PMID: 36230612 PMCID: PMC9562197 DOI: 10.3390/cancers14194689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Only 1% of all meningioma diagnosis is classified as malignant (anaplastic) meningioma. Due to their rarity, clinical management of these tumors presents several gaps. In this review, we investigate current knowledge of anaplastic meningioma focusing on their pathological and radiological diagnosis, molecular assessment, and loco-regional and systemic management. Despite the current marginal role of systemic therapy, it is possible that the increasing knowledge of molecular altered pathways of the disease will lead to the development of novel effective systemic treatments. Abstract Background: Meningiomas are the most common primary central nervous system malignancies accounting for 36% of all intracranial tumors. However, only 1% of meningioma is classified as malignant (anaplastic) meningioma. Due to their rarity, clinical management of these tumors presents several gaps. Methods: We carried out a narrative review aimed to investigate current knowledge of anaplastic meningioma focusing on their pathological and radiological diagnosis, molecular assessment, and loco-regional and systemic management. Results: The most frequent genetic alteration occurring in meningioma is the inactivation in the neurofibromatosis 2 genes (merlin). The accumulation of copy number losses, including 1p, 6p/q, 10q, 14q, and 18p/q, and less frequently 2p/q, 3p, 4p/q, 7p, 8p/q, and 9p, compatible with instability, is restricted to NF2 mutated meningioma. Surgery and different RT approaches represent the milestone of grade 3 meningioma management, while there is a marginal role of systemic therapy. Conclusions: Anaplastic meningiomas are rare tumors, and diagnosis should be suspected and confirmed by trained radiologists and pathologists. Despite the current marginal role of systemic therapy, it is possible that the increasing knowledge of molecular altered pathways of the disease will lead to the development of novel effective systemic treatments.
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Popadic B, Scheichel F, Pinggera D, Weber M, Ungersboeck K, Kitzwoegerer M, Roetzer T, Oberndorfer S, Sherif C, Freyschlag CF, Marhold F. The meningioma surface factor: a novel approach to quantify shape irregularity on preoperative imaging and its correlation with WHO grade. J Neurosurg 2021:1-7. [PMID: 34624861 DOI: 10.3171/2021.5.jns204223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atypical and anaplastic meningiomas account for 20% of all meningiomas. An irregular tumor shape on preoperative MRI has been associated with WHO grade II-III histology. However, this subjective allocation does not allow quantification or comparison. An objective parameter of irregularity could substantially influence resection strategy toward a more aggressive approach. Therefore, the aim of this study was to objectively quantify the level of irregularity on preoperative MRI and predict histology based on WHO grade using this novel approach. METHODS A retrospective study on meningiomas resected between January 2010 and December 2018 was conducted at two neurosurgical centers. This novel approach relies on the theory that a regularly shaped tumor has a smaller surface area than an irregularly shaped tumor with the same volume. A factor was generated using the surface area of a corresponding sphere as a reference, because for a given volume a sphere represents the shape with the smallest surface area possible. Consequently, the surface factor (SF) was calculated by dividing the surface area of a sphere with the same volume as the tumor with the surface area of the tumor. The resulting value of the SF ranges from > 0 to 1. Finally, the SF of each meningioma was then correlated with the corresponding histopathological grading. RESULTS A total of 126 patients were included in this study; 60.3% had a WHO grade I, 34.9% a WHO grade II, and 4.8% a WHO grade III meningioma. Calculation of the SF demonstrated a significant difference in SFs between WHO grade I (SF 0.851) and WHO grade II-III meningiomas (SF 0.788) (p < 0.001). Multivariate analysis identified SF as an independent prognostic factor for WHO grade (OR 0.000009, 95% CI 0.000-0.159; p = 0.020). CONCLUSIONS The SF is a proposed mathematical model for a quantitative and objective measurement of meningioma shape, instead of the present subjective assessment. This study revealed significant differences between the SFs of WHO grade I and WHO grade II-III meningiomas and demonstrated that SF is an independent prognostic factor for WHO grade.
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Affiliation(s)
- Branko Popadic
- 1Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems
| | - Florian Scheichel
- 1Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems
| | - Daniel Pinggera
- 2Department of Neurosurgery, Medical University of Innsbruck
| | - Michael Weber
- 3Department of Research Management, Karl Landsteiner University of Health Sciences, Krems
| | - Karl Ungersboeck
- 1Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems
| | - Melitta Kitzwoegerer
- 4Department of Pathology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems
| | - Thomas Roetzer
- 5Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna; and
| | - Stefan Oberndorfer
- 6Department of Neurology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Camillo Sherif
- 1Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems
| | | | - Franz Marhold
- 1Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems
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Wilson TA, Huang L, Ramanathan D, Lopez-Gonzalez M, Pillai P, De Los Reyes K, Kumal M, Boling W. Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management. Front Oncol 2020; 10:565582. [PMID: 33330036 PMCID: PMC7714950 DOI: 10.3389/fonc.2020.565582] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Although the majority of meningiomas are slow-growing and benign, atypical and anaplastic meningiomas behave aggressively with a penchant for recurrence. Standard of care includes surgical resection followed by adjuvant radiation in anaplastic and partially resected atypical meningiomas; however, the role of adjuvant radiation for incompletely resected atypical meningiomas remains debated. Despite maximum treatment, atypical, and anaplastic meningiomas have a strong proclivity for recurrence. Accumulating mutations over time, recurrent tumors behave more aggressively and often become refractory or no longer amenable to further surgical resection or radiation. Chemotherapy and other medical therapies are available as salvage treatment once standard options are exhausted; however, efficacy of these agents remains limited. This review discusses the risk factors, classification, and molecular biology of meningiomas as well as the current management strategies, novel therapeutic approaches, and future directions for managing atypical and anaplastic meningiomas.
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Affiliation(s)
| | - Lei Huang
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Promod Pillai
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Warren Boling
- Loma Linda University, Loma Linda, CA, United States
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Fathalla H, Tawab MGA, El-Fiki A. Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins. J Korean Neurosurg Soc 2020; 63:821-826. [PMID: 32750757 PMCID: PMC7671773 DOI: 10.3340/jkns.2020.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/23/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Hyperostosis in meningiomas can be present in 4.5% to 44% of cases. Radical resection should include aggressive removal of invaded bone. It is not clear however to what extent bone removal should be carried to achieve pathologically free margins, especially that in many cases, there is a T2 hyperintense signal that extends beyond the hyperostotic bone. In this study we try to investigate the perimeter of tumour cells outside the visible nidus of hyperostotic bone and to what extent they are present outside this nidus. This would serve as an initial step for setting guidelines on dealing with hyperostosis in meningioma surgery. METHODS This is a prospective case series that included 14 patients with convexity meningiomas and hyperostosis during the period from March 2017 to August 2018 in two university hospitals. Patients demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed. In all cases, all visible abnormal bone was excised bearing in mind to also include the hyperintense diploe in magnetic resonance imaging (MRI) T2 weighted images after careful preoperative assessment. To examine bony tumour invasion, five marked bone biopsies were taken from the craniotomy flap for histopathological examinations. These include one from the centre of hyperostotic nidus and the other four from the corners at a 2-cm distance from the margin of the nidus. RESULTS Our study included five males (35.7%) and nine females (64.3%) with a mean age of 43.75 years (33-55). Tumor site was parietal in seven cases (50%), fronto-parietal in three cases (21.4%), parieto-occipital in two cases (14.2%), frontal region in one case and bicoronal (midline) in one case. Tumour pathology revealed a World Health Organization (WHO) grade I in seven cases (50%), atypical meningioma (WHO II) in five cases (35.7%) and anaplastic meningioma (WHO III) in two cases (14.2%). In all grade I and II meningiomas, bone biopsies harvested from the nidus revealed infiltration with tumour cells while all other bone biopsies from the four corners (2 cm from nidus) were free. In cases of anaplastic meningiomas, all five biopsies were positive for tumour cells. CONCLUSION Removal of the gross epicentre of hyperostotic bone with the surrounding 2 cm is adequate to ensure radical excision and free bone margins in grade I and II meningiomas. Hyperintense signal change in MRI T2 weighted images, even beyond visible hypersototic areas, doesn't necessarily represent tumour invasion.
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Affiliation(s)
- Hussein Fathalla
- Division of Neurosurgery, Cairo University Hospitals, Cairo, Egypt
| | | | - Ahmed El-Fiki
- Division of Neurosurgery, Cairo University Hospitals, Cairo, Egypt
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König M, Osnes T, Bruland Ø, Sundby Hall K, Bratland Å, Meling TR. The Role of Adjuvant Treatment in Craniofacial Malignancy: A Critical Review. Front Oncol 2020; 10:1402. [PMID: 32850452 PMCID: PMC7426725 DOI: 10.3389/fonc.2020.01402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Tumors originating from the craniofacial region usually present in a locally advanced stage with frequent involvement of adjacent sites and have a strong tendency for local recurrence in the absence of adjuvant therapy, even when the original surgical resection was presumed to be radical. In the past decades, several advances in the radiological diagnosis and treatment of craniofacial malignancies have been introduced. There are, however, no randomized trials that define the optimal multimodal treatment of these tumors because of their rarity as well as heterogeneity in both histology and site of origin. The aim of this study was to conduct a critical review of the role of adjuvant therapy in the treatment of craniofacial malignancy. Method: We conducted a critical review of the past and contemporary literature available, focusing on adjuvant oncological treatments of the most common craniofacial malignancies. Results: Preoperative radiotherapy can have a documented role in the treatment of olfactory neuroblastoma and soft tissue sarcoma, while preoperative chemotherapy can be advocated in the treatment of sinonasal undifferentiated carcinoma, neuroendocrine carcinoma, olfactory neuroblastoma, and craniofacial sarcoma (both soft-tissue and high-grade osteosarcoma). Postoperative radiotherapy has a well-established role in the treatment of most craniofacial malignancies. The role of postoperative chemotherapy is unclear in most histologies, but is commonly used during the treatment of well-selected cases of paranasal sinus carcinoma, olfactory neuroblastoma, mucosal melanoma, soft tissue sarcoma and high-grade craniofacial osteosarcoma. Discussion: Alongside developments in surgery, there have also been improvements in diagnostics, radiotherapy, and chemotherapy. Implementation of novel radiation techniques allows delivery of higher radiation doses while minimizing irradiation-related morbidity. Better understanding of tumor biology allows the construction of more complex treatment strategies, incorporating adjuvant chemotherapy either pre- or postoperatively. In the era of personalized targeted therapy, rapid strides are being made to identify specific tumor-targets for use of novel biologic agents, with the potential to change current management paradigms.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terje Osnes
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Øyvind Bruland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torstein R. Meling
- Service de Neurochirurgie, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Long-Term Outcomes of Newly Diagnosed Resected Atypical Meningiomas and the Role of Adjuvant Radiotherapy. World Neurosurg 2019; 122:e1153-e1161. [DOI: 10.1016/j.wneu.2018.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/22/2022]
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Abstract
The epochal developments in the treatment of meningioma—microsurgery, skull base techniques, and radiation therapy—will be appended to include the rational application of targeted and immune therapeutics, previously ill-fitting concepts for a tumor that has traditionally been a regarded as a surgical disease. The genomic and immunological architecture of these tumors continues to be defined in ever-greater detail. Grade I meningiomas are driven by NF2 alterations or mutations in AKT1, SMO, TRAF7, PIK3CA, KLF4, POLR2A, SUFU, and SMARCB1. Higher-grade tumors, however, are driven nearly exclusively by NF2/chr22 loss and are marked by infrequent targetable mutations, although they may harbor a greater mutation burden overall. TERT mutations may be more common in tumors that progress in histological grade; SMARCE1 alteration has become a signature of the clear cell subtype; and BAP1 in rhabdoid variants may confer sensitivity to pharmacological inhibition. Compared with grade I meningiomas, the most prominent alteration in grade II and III meningiomas is a significant increase in chromosomal gains and losses, or copy number alterations, which may have behavioral implications. Furthermore, integrated genomic analyses suggest phenotypic subgrouping by methylation profile and a specific role for PRC2 complex activation. Lastly, there exists a complex phylogenetic relationship among recurrent high-grade tumors, which continues to underscore a role for the most traditional therapy in our arsenal: surgery.
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Affiliation(s)
- Wenya Linda Bi
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Vikram C. Prabhu
- 2Departments of Neurological Surgery and Radiation Oncology, Loyola University Medical Center, Chicago, Illinois
| | - Ian F. Dunn
- 1Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
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Lam Shin Cheung V, Kim A, Sahgal A, Das S. Meningioma recurrence rates following treatment: a systematic analysis. J Neurooncol 2017; 136:351-361. [DOI: 10.1007/s11060-017-2659-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Bi WL, Wu WW, Santagata S, Reardon DA, Dunn IF. Checkpoint inhibition in meningiomas. Immunotherapy 2017; 8:721-31. [PMID: 27197540 DOI: 10.2217/imt-2016-0017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Meningiomas are increasingly appreciated to share similar features with other intra-axial central nervous system neoplasms as well as systemic cancers. Immune checkpoint inhibition has emerged as a promising therapy in a number of cancers, with durable responses of years in a subset of patients. Several lines of evidence support a role for immune-based therapeutic strategies in the management of meningiomas, especially high-grade subtypes. Meningiomas frequently originate juxtaposed to venous sinuses, where an anatomic conduit for lymphatic drainage resides. Multiple populations of immune cells have been observed in meningiomas. PD-1/PD-L1 mediated immunosuppression has been implicated in high-grade meningiomas, with association between PD-L1 expression with negative prognostic outcome. These data point to the promise of future combinatorial therapeutic strategies in meningioma.
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Affiliation(s)
- Wenya Linda Bi
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Winona W Wu
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Division of Neuropathology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ian F Dunn
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Bagshaw HP, Burt LM, Jensen RL, Suneja G, Palmer CA, Couldwell WT, Shrieve DC. Adjuvant radiotherapy for atypical meningiomas. J Neurosurg 2016; 126:1822-1828. [DOI: 10.3171/2016.5.jns152809] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this paper was to evaluate outcomes in patients with atypical meningiomas (AMs) treated with surgery alone compared with surgery and radiotherapy at initial diagnosis, or at the time of first recurrence.METHODSPatients with pathologically confirmed AMs treated at the University of Utah from 1991 to 2014 were retrospectively reviewed. Local control (LC), overall survival (OS), Karnofsky Performance Status (KPS), and toxicity were assessed. Outcomes for patients receiving adjuvant radiotherapy were compared with those for patients treated with surgery alone. Kaplan-Meier and the log-rank test for significance were used for LC and OS analyses.RESULTSFifty-nine patients with 63 tumors were reviewed. Fifty-two patients were alive at the time of analysis with a median follow-up of 42 months. LC for all tumors was 57% with a median time to local failure (TTLF) of 48 months. The median TTLF following surgery and radiotherapy was 180 months, compared with 46 months following surgery alone (p = 0.02). Excluding Simpson Grade IV (subtotal) resections, there remained an LC benefit with the addition of radiotherapy for Simpson Grade I, II, and III resected tumors (median TTLF 180 months after surgery and radiotherapy compared with 46 months with surgery alone [p = 0.002]). Patients treated at first recurrence following any initial therapy (either surgery alone or surgery and adjuvant radiotherapy) had a median TTLF of 26 months compared with 48 months for tumors treated at first diagnosis (p = 0.007). There were 2 Grade 3 toxicities and 1 Grade 4 toxicity associated with radiotherapy.CONCLUSIONSAdjuvant radiotherapy improves LC for AMs. The addition of adjuvant radiotherapy following even a Simpson Grade I, II, or III resection was found to confer an LC benefit. Recurrent disease is difficult to control, underscoring the importance of aggressive initial treatment.
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Affiliation(s)
| | | | | | | | - Cheryl A. Palmer
- 3Pathology, University of Utah School of Medicine, Salt Lake City, Utah
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Bi WL, Abedalthagafi M, Horowitz P, Agarwalla PK, Mei Y, Aizer AA, Brewster R, Dunn GP, Al-Mefty O, Alexander BM, Santagata S, Beroukhim R, Dunn IF. Genomic landscape of intracranial meningiomas. J Neurosurg 2016; 125:525-35. [DOI: 10.3171/2015.6.jns15591] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meningiomas are the most common primary intracranial neoplasms in adults. Current histopathological grading schemes do not consistently predict their natural history. Classic cytogenetic studies have disclosed a progressive course of chromosomal aberrations, especially in high-grade meningiomas. Furthermore, the recent application of unbiased next-generation sequencing approaches has implicated several novel genes whose mutations underlie a substantial percentage of meningiomas. These insights may serve to craft a molecular taxonomy for meningiomas and highlight putative therapeutic targets in a new era of rational biology-informed precision medicine.
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Affiliation(s)
- Wenya Linda Bi
- 1Department of Neurosurgery, Brigham and Women's Hospital
- 4Department of Cancer Biology, Dana-Farber Cancer Institute; and
| | - Malak Abedalthagafi
- 2Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital,
| | - Peleg Horowitz
- 1Department of Neurosurgery, Brigham and Women's Hospital
| | - Pankaj K. Agarwalla
- 3Department of Neurosurgery, Massachusetts General Hospital
- 4Department of Cancer Biology, Dana-Farber Cancer Institute; and
| | - Yu Mei
- 1Department of Neurosurgery, Brigham and Women's Hospital
| | - Ayal A. Aizer
- 5Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Ryan Brewster
- 2Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital,
| | - Gavin P. Dunn
- 6Department of Neurosurgery, Pathology, and Immunology, Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri
| | | | - Brian M. Alexander
- 5Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Sandro Santagata
- 2Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital,
| | - Rameen Beroukhim
- 4Department of Cancer Biology, Dana-Farber Cancer Institute; and
| | - Ian F. Dunn
- 1Department of Neurosurgery, Brigham and Women's Hospital
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15
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Hasan S, Young M, Albert T, Shah AH, Okoye C, Bregy A, Lo SS, Ishkanian F, Komotar RJ. The Role of Adjuvant Radiotherapy After Gross Total Resection of Atypical Meningiomas. World Neurosurg 2015; 83:808-15. [DOI: 10.1016/j.wneu.2014.12.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
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Zaher A, Abdelbari Mattar M, Zayed DH, Ellatif RA, Ashamallah SA. Atypical Meningioma: A Study of Prognostic Factors. World Neurosurg 2013; 80:549-53. [DOI: 10.1016/j.wneu.2013.07.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 07/04/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022]
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Combs SE, Debus J. Treatment with heavy charged particles: systematic review of clinical data and current clinical (comparative) trials. Acta Oncol 2013; 52:1272-86. [PMID: 23964656 DOI: 10.3109/0284186x.2013.818254] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND To analyze relevant data on carbon ion radiotherapy for different tumor indications and to review current clinical trials. MATERIAL AND METHODS All published data on carbon ion radiotherapy were searched for with specific criteria in PUBMED. The terms for search were 'carbon ion and (radiotherapy OR radiation therapy) and (nirs OR chiba OR japan OR itep OR st. petersburg OR PSI OR dubna OR uppsala OR clatterbridge OR loma linda OR nice OR orsay OR itemba OR mpri OR himac OR triumf OR GSI OR HMI OR NCC OR ibmc OR pmrc OR MGH OR infn-lns OR shizuoka OR werc OR zibo OR md anderson OR fpti OR ncc ilsan OR boston OR heidelberg OR tsukuba) NOT in vitro NOT cell culture NOT review[Publication Type] Filters: Humans, English'. The search delivered 273 hits, of which only articles in English including 20 or more patients were included. Case reports were not considered. We subdivided into disease- and site-specific groups. RESULTS AND CONCLUSION To date, several studies have been performed, however, no randomized trials have been conducted. Therefore, carbon ion radiotherapy must be considered an experimental treatment, and randomized trials comparing modern photon as well as proton treatments are necessary.
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Affiliation(s)
- Stephanie E Combs
- University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany
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Thuijs NB, Uitdehaag BMJ, Van Ouwerkerk WJR, van der Valk P, Vandertop WP, Peerdeman SM. Pediatric meningiomas in The Netherlands 1974-2010: a descriptive epidemiological case study. Childs Nerv Syst 2012; 28:1009-15. [PMID: 22543431 PMCID: PMC3376254 DOI: 10.1007/s00381-012-1759-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/03/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to review the epidemiology and the clinical, radiological, pathological, and follow-up data of all surgically treated pediatric meningiomas during the last 35 years in The Netherlands. METHODS Patients were identified in the Pathological and Anatomical Nationwide Computerized Archive database, the nationwide network and registry of histopathology and cytopathology in The Netherlands. Pediatric patients of 18 years or younger at first operation in 1974-2009 with the diagnosis meningioma were included. Clinical records, follow-up data, radiological findings, operative reports, and pathological examinations were reviewed. RESULTS In total, 72 patients (39 boys) were identified. The incidence of operated meningiomas in the Dutch pediatric population is 1:1,767,715 children per year. Median age at diagnosis was 13 years (range 0-18 years). Raised intracranial pressure and seizures were the most frequent signs at presentation. Thirteen (18 %) patients had neurofibromatosis type 2 (NF2). Fifty-three (74 %) patients had a meningioma World Health Organization grade I. Total resection was achieved in 35 of 64 patients. Fifteen patients received radiotherapy postoperatively. Mean follow-up was 4.8 years (range 0-27.8 years). Three patients died as a direct result of their meningioma within 3 years. Four patients with NF2 died as a result of multiple tumors. Nineteen patients had disease progression, requiring additional treatment. CONCLUSION Meningiomas are extremely rare in the pediatric population; 25 % of all described meningiomas show biological aggressive behavior in terms of disease progression, requiring additional treatment. The 5-year survival is 83.9 %, suggesting that the biological behavior of pediatric menigiomas is more aggressive than that of its adult counterparts.
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Affiliation(s)
- Nikki B. Thuijs
- Neurosurgical Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Bernard M. J. Uitdehaag
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Willem J. R. Van Ouwerkerk
- Meningioma Group Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Neurosurgical Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Paul van der Valk
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - W. Peter Vandertop
- Meningioma Group Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Neurosurgical Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Saskia M. Peerdeman
- Meningioma Group Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands ,Neurosurgical Center Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Combs SE, Edler L, Burkholder I, Rieken S, Habermehl D, Jäkel O, Haberer T, Unterberg A, Wick W, Debus J, Haselmann R. Treatment of patients with atypical meningiomas Simpson grade 4 and 5 with a carbon ion boost in combination with postoperative photon radiotherapy: the MARCIE trial. BMC Cancer 2010; 10:615. [PMID: 21062428 PMCID: PMC2996393 DOI: 10.1186/1471-2407-10-615] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 11/09/2010] [Indexed: 12/25/2022] Open
Abstract
Background Treatment standard for patients with atypical or anaplastic meningioma is neurosurgical resection. With this approach, local control ranges between 50% and 70%, depending on resection status. A series or smaller studies has shown that postoperative radiotherapy in this patient population can increase progression-free survival, which translates into increased overall survival. However, meningiomas are known to be radioresistant tumors, and radiation doses of 60 Gy or higher have been shown to be necessary for tumor control. Carbon ions offer physical and biological characteristics. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increased relative biological effectiveness (RBE), which can be calculated between 2 and 5 depending on the cell line as well as the endpoint analyzed. First data obtained within the Phase I/II trial performed at GSI in Darmstadt on carbon ion radiotherapy for patients with high-risk meningiomas has shown safety, and treatment results are promising. Methods/design The Phase II-MARCIE-Study will evaluate a carbon ion boost applied to the macroscopic tumor in conjunction with photon radiotherapy in patients with atypical menigiomas after incomplete resection or biopsy. Primary endpoint is progression-free survival, secondary endpoints are overall survival, safety and toxicity. Discussion Based on published data on the treatment of atypical meningiomas with carbon ions at GSI, the present study will evaluate this treatment concept in a larger patient population and will compare outcome to current standard photon treatment. Trial registration NCT01166321
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Combs SE, Hartmann C, Nikoghosyan A, Jäkel O, Karger CP, Haberer T, von Deimling A, Münter MW, Huber PE, Debus J, Schulz-Ertner D. Carbon ion radiation therapy for high-risk meningiomas. Radiother Oncol 2010; 95:54-9. [DOI: 10.1016/j.radonc.2009.12.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 11/28/2022]
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Durand A, Labrousse F, Jouvet A, Bauchet L, Kalamaridès M, Menei P, Deruty R, Moreau JJ, Fèvre-Montange M, Guyotat J. WHO grade II and III meningiomas: a study of prognostic factors. J Neurooncol 2009; 95:367-375. [PMID: 19562258 DOI: 10.1007/s11060-009-9934-0] [Citation(s) in RCA: 222] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 06/01/2009] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE Meningiomas that occur over the convexity of the brain are the most common meningiomas, but little has been published about their contemporary management. We aimed to analyze a large series of convexity meningiomas with respect to surgical technique, complication rates, and pathological factors leading to recurrence. METHODS We retrospectively reviewed 163 cases of convexity meningiomas operated on in our institution by the senior author (PMB) between 1986 and 2005. The median follow-up time was 2.3 years (range, 1-13 yr). RESULTS Convexity tumors represented 22% of all meningiomas operated on. There was a female:male ratio of 2.7:1. Median age was 57 years (range, 20-89 yr). Image-guided surgery was used on all cases in the last 5 years. The 30-day mortality rate was 0%. The incidence of new neurological deficits was 1.7%, and the overall complication rate was 9.4%. The pathology of the tumors was benign in 144 (88.3%), atypical in 16 (9.8%), and anaplastic/malignant in 3 (1.8%). In six of the cases designated "benign," there were borderline atypical features. The 5-year recurrence rate for benign meningiomas was 1.8%, atypical meningiomas 27.2%, and anaplastic meningiomas 50%. The two cases of benign tumor recurrences involved tumors with borderline atypia and high MIB-1 indices. The borderline atypical cases had a 5-year recurrence-free survival rate of only 55.9%, more closely approximating that of tumors designated "atypical." CONCLUSION Convexity meningiomas can be safely removed using modern image-guided minimally invasive surgical techniques with a very low operative mortality. Benign convexity meningiomas having a Simpson Grade I complete excision have a very low recurrence rate. The recurrence rates of atypical and malignant tumors are significantly higher, and borderline atypical tumors should be considered to behave more like atypical rather than benign lesions. Longer-term follow-up data are needed to more accurately determine the recurrence rates of benign meningiomas.
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Affiliation(s)
- Andrew P Morokoff
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Mattozo CA, De Salles AAF, Klement IA, Gorgulho A, McArthur D, Ford JM, Agazaryan N, Kelly DF, Selch MT. Stereotactic radiation treatment for recurrent nonbenign meningiomas. J Neurosurg 2007; 106:846-54. [PMID: 17542529 DOI: 10.3171/jns.2007.106.5.846] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors analyzed the results of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) for the treatment of recurrent meningiomas that were described at initial resection as showing aggressive, atypical, or malignant features (nonbenign).
Methods
Twenty-five patients who underwent SRS and/or SRT for nonbenign meningiomas between December 1992 and August 2004 were included. Thirteen of these patients underwent treatment for multiple primary or recurrent lesions. In all, 52 tumors were treated. All histological sections were reviewed and reclassified according to World Health Organization (WHO) 2000 guidelines as benign (Grade I), atypical (Grade II), or anaplastic (Grade III) meningiomas. The median follow-up period was 42 months.
Seventeen (68%) of the cases were reclassified as follows: WHO Grade I (five cases), Grade II (11 cases), and Grade III (one case). Malignant progression occurred in eight cases (32%) during the follow-up period; these cases were considered as a separate group. The 3-year progression-free survival (PFS) rates for the Grades I, II, and III, and malignant progression groups were 100, 83, 0, and 11%, respectively (p < 0.001). In the Grade II group, the 3-year PFS rates for patients treated with SRS and SRT were 100 and 33%, respectively (p = 0.1). After initial treatment, 22 new tumors required treatment using SRS or SRT; 17 (77%) of them occurred inside the original resection cavity. Symptomatic edema developed in one patient (4%).
Conclusions
Stereotactic radiation treatment provided effective local control of “aggressive” Grade I and Grade II meningiomas, whereas Grade III lesions were associated with poor outcome. The outcome of cases in the malignant progression group was intermediate between that of the Grade II and Grade III groups, with the lesions showing a tendency toward malignancy.
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Affiliation(s)
- Carlos A Mattozo
- Division of Neurosurgery, University of California at Los Angeles School of Medicine, Los Angeles, California 90095, USA
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