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Carr MT, Ghadiyaram A, Krishnakumar A, Dux HM, Hall JT, Opalak CF, Sima AP, Harris TJ, Broaddus WC. Mathematical modeling of meningioma volume change after radiation treatment. Clin Neurol Neurosurg 2024; 245:108513. [PMID: 39178634 DOI: 10.1016/j.clineuro.2024.108513] [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: 05/22/2024] [Revised: 07/18/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Meningiomas are the most common primary central nervous tumor and are often treated with radiation therapy. This study examines the long-term volumetric changes of intracranial meningiomas in response to radiation therapy. The objective is to analyze and model the volumetric changes following treatment. METHODS Data from a retrospective single-institution database (2005-2015) were used, with inclusion criteria being patients with a diagnosis of meningiomas, along with additional inclusion criteria consisting of treatment with radiation, having at least three magnetic resonance imaging (MRI) scans with one or more before and after radiation treatment, and the patients following up for at least eighteen months. Exclusion criteria consisted of patients less than 18 years old, patients receiving surgery and/or adjuvant chemotherapy following radiation, and patients without any available details regarding radiation treatment parameters. Tumor volumes were measured via T1-weighted post-contrast MRI and calculated using the ABC/2 ellipsoidal approximation, a method allowing for the measurement of non-linear growth volume reduction. RESULTS Of 48 meningioma patients considered, 10 % experienced post-radiation growth, while 75 % witnessed a ≥50 % decrease in volume over a follow-up period of 0.3-14.9 years. Median decay rate was 0.81, and within 1.17 years, 90 % achieved the predicted volume reduction. Predicted vs. actual volumes showed a mean difference of 0.009 ± 0.347 cc. Initial tumor volumes strongly correlated (Pearson's R=0.98, R-squared=0.96) with final asymptotic volumes, which had a median of 1.50 cc, with interquartile range (IQR) = [0.39, 3.67]. CONCLUSION 90 % of patients achieved tumor-volume reduction at 1.17 years post-treatment, reaching a non-zero asymptote strongly correlated with initial tumor volume, and 75 % experienced at least a 50 % volume decrease. Individual volume changes for responsive meningiomas can be modeled and predicted using exponential decay curves.
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Affiliation(s)
- Matthew T Carr
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, 8th Floor Annenberg Building, New York, NY 10029, USA.
| | - Ashwin Ghadiyaram
- School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA 23298, USA.
| | - Asha Krishnakumar
- School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA 23298, USA.
| | - Hayden M Dux
- School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA 23298, USA.
| | - Jacob T Hall
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr Manning Level, Chapel Hill, NC 27514, USA.
| | - Charles F Opalak
- Southeastern Neurosurgical and Spine Institute, Prisma Health Neurosurgery, 111 Doctors Dr, Greenville, SC 29605, USA.
| | - Adam P Sima
- CorEvitas, 500 Totten Pond Rd Floor 5, Waltham, MA 02451, USA.
| | - Timothy J Harris
- Department of Radiation Oncology, Virginia Commonwealth University, 1001 E Leigh St, Richmond, VA 23219, USA.
| | - William C Broaddus
- Department of Neurosurgery, Virginia Commonwealth University, 417 N 11th St, Richmond, VA 23298, USA.
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Sanikommu S, Panchawagh S, Eatz T, Lu VM, Rodrigues PB, Abdelsalam A, Gurses ME, Cummings A, Uppalapati V, Akurati S, Kondoor V, Komotar RJ, Ivan ME. Recurrence of atypical and anaplastic intracranial Meningiomas: A meta-analysis of risk factors. Clin Neurol Neurosurg 2024; 244:108450. [PMID: 39018991 DOI: 10.1016/j.clineuro.2024.108450] [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: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The predictive role of multiple risk factors for intracranial atypical and anaplastic meningioma recurrence is convoluted. This meta-analysis assessed the predictive value of selected factors for recurrence in these Meningiomas. METHODS Studies encompassing risk factor data including gross total resection (GTR), subtotal resection (STR), post-op radiotherapy, Ki-67 % index >3 %, and location were searched for in PubMed, Embase, and Web of Science, and thereafter analyzed using robust Bayesian meta-analysis. RESULTS Eighteen observational studies involving 1589 patients met inclusion criteria for analysis. GTR was identified as a good prognostic factor for recurrence (OR = 0.212; 95 % CI (-1.972, -1.002); heterogeneity BF=0.702), and STR had a significantly higher risk of recurrence (OR = 4.43; 95 % CI 0.658-2.011; heterogeneity BF=0.724). Post-operative radiotherapy did not statistically significantly affect the recurrence process (OR = 1.02; 95 % CI (-1.848, 0.626); heterogeneity (BF=1.034)). Ki67 % index >3 % had an augmented chance of recurrence (OR = 2.38; 95 % CI (-0.220, 2.355); heterogeneity (BF=1.162)). A meta-regression analysis showed that WHO grade III Meningiomas had a higher chance of recurring than grade II Meningiomas. CONCLUSION Among the selected factors, STR and Ki67 % index > 3 % were associated with a higher risk of recurrence, with post-operative radiotherapy making no difference. GTR appeared to inversely impact recurrence. Compared to grade II, grade III Meningiomas had higher odds of recurring.
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Affiliation(s)
- Sai Sanikommu
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA.
| | - Suhrud Panchawagh
- Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Tiffany Eatz
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | | | - Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Muhammet Enes Gurses
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | | | - Venkat Uppalapati
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Sneha Akurati
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Vishaal Kondoor
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ricardo Jorge Komotar
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA
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Kertels O, Delbridge C, Sahm F, Ehret F, Acker G, Capper D, Peeken JC, Diehl C, Griessmair M, Metz MC, Negwer C, Krieg SM, Onken J, Yakushev I, Vajkoczy P, Meyer B, Zips D, Combs SE, Zimmer C, Kaul D, Bernhardt D, Wiestler B. Imaging meningioma biology: Machine learning predicts integrated risk score in WHO grade 2/3 meningioma. Neurooncol Adv 2024; 6:vdae080. [PMID: 38957161 PMCID: PMC11217900 DOI: 10.1093/noajnl/vdae080] [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] [Indexed: 07/04/2024] Open
Abstract
Background Meningiomas are the most common primary brain tumors. While most are benign (WHO grade 1) and have a favorable prognosis, up to one-fourth are classified as higher-grade, falling into WHO grade 2 or 3 categories. Recently, an integrated risk score (IRS) pertaining to tumor biology was developed and its prognostic relevance was validated in a large, multicenter study. We hypothesized imaging data to be reflective of the IRS. Thus, we assessed the potential of a machine learning classifier for its noninvasive prediction using preoperative magnetic resonance imaging (MRI). Methods In total, 160 WHO grade 2 and 3 meningioma patients from 2 university centers were included in this study. All patients underwent surgery with histopathological workup including methylation analysis. Preoperative MRI scans were automatically segmented, and radiomic parameters were extracted. Using a random forest classifier, 3 machine learning classifiers (1 multiclass classifier for IRS and 2 binary classifiers for low-risk and high-risk prediction, respectively) were developed in a training set (120 patients) and independently tested in a hold-out test set (40 patients). Results Multiclass IRS classification had a test set area under the curve (AUC) of 0.7, mostly driven by the difficulties in clearly separating medium-risk from high-risk patients. Consequently, a classifier predicting low-risk IRS versus medium-/high-risk showed a very high test accuracy of 90% (AUC 0.88). In particular, "sphericity" was associated with low-risk IRS classification. Conclusion The IRS, in particular molecular low-risk, can be predicted from imaging data with high accuracy, making this important prognostic classification accessible by imaging.
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Affiliation(s)
- Olivia Kertels
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claire Delbridge
- Department of Neuropathology, School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Ehret
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Güliz Acker
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Capper
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Institut für Innovative Radiotherapy (iRT), Munich, Germany
| | - Christian Diehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Institut für Innovative Radiotherapy (iRT), Munich, Germany
| | - Michael Griessmair
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marie-Christin Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chiara Negwer
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, München, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Institut für Innovative Radiotherapy (iRT), Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - David Kaul
- Faculty of Medicine, HMU Health and Medical University, Potsdam, Germany
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Institut für Innovative Radiotherapy (iRT), Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
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El-Hajj VG, Ghaith AK, Nguyen RH, Al-Saidi NN, Hoang H, Graepel SP, Elmi-Terander A, Lehrer EJ, Brown P, Bydon M. Analysis of demographics and the impact of adjuvant radiotherapy on a nationwide cohort of patients with high-grade spinal meningiomas. Neurooncol Adv 2024; 6:vdae018. [PMID: 38410135 PMCID: PMC10896623 DOI: 10.1093/noajnl/vdae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Background Although typically benign, 5% of spinal meningiomas (SMs) present with higher-grade features (World Health Organization grades 2 and 3). High-grade SMs are poorly studied and the role of adjuvant radiotherapy in their management remains controversial. We hence aimed to study the demographic characteristics of this rare tumor and investigate the outcomes associated with the use of surgery with adjuvant therapy in contrast to surgery alone. Methods The National Cancer Database was queried for patients with SMs from 2004 to 2017. Basic statistics were used to identify differences between low- and high-grade tumors in terms of baseline characteristics. Surgery with and without adjuvant radiotherapy were compared after (1:1) propensity-score matching. Kaplan-Meier survival analysis was conducted to study overall survival. All analyses were performed on R. Results A total of 13 184 patients diagnosed with SMs were included, of whom only 5% (n = 669) had high-grade SMs. Patients with high-grade SMs presented at a younger median age (57 years [IQR: 44-68] versus 65 years [54-75]; P < .001) and were more commonly males (33% vs 20%; P < .001). After propensity-score matching, survival analysis revealed similar overall survival outcomes in patients with high-grade SM undergoing both surgery and radiotherapy as compared to those only receiving surgery (P = .19). Conclusions This study reveals major demographic differences between high- and low-grade SMs. There were no benefits associated with the use of adjuvant radiotherapy. However, due to confounding, overall survival outcomes between patients receiving surgery alone and those receiving surgery with adjuvant radiotherapy are not causally interpretable.
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Affiliation(s)
- Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan H Nguyen
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil Nazar Al-Saidi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry Hoang
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen P Graepel
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
| | - Eric J Lehrer
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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5
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Frances SM, Murray L, Nicklin E, Velikova G, Boele F. Long-term health-related quality of life in meningioma survivors: A mixed-methods systematic review. Neurooncol Adv 2024; 6:vdae007. [PMID: 38375359 PMCID: PMC10876080 DOI: 10.1093/noajnl/vdae007] [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] [Indexed: 02/21/2024] Open
Abstract
Background Meningiomas account for ~25% of all primary brain tumors. These tumors have a relatively favorable prognosis with ~92% of meningioma patients surviving >5 years after diagnosis. Yet, patients can report high disease burden and survivorship issues even years after treatment, affecting health-related quality of life (HRQOL). We aimed to systematically review the literature and synthesize evidence on HRQOL in meningioma patients across long-term survival, defined as ≥2 years post-diagnosis. Methods Systematic literature searches were carried out using Medline, EMBASE, CINAHL, PsycINFO, and Web of Science Core Collection. Any published, peer-reviewed articles with primary quantitative, qualitative, or mixed-methods data covering the physical, mental, and/or social aspects of HRQOL of meningioma survivors were included. A narrative synthesis method was used to interpret the findings. Results Searches returned 2253 unique publications, of which 21 were included. Of these, N = 15 involved quantitative methodology, N = 4 mixed methods, and N = 2 were qualitative reports. Patient sample survival ranged from 2.75 to 13 years. HRQOL impairment was seen across all domains. Physical issues included persevering symptoms (eg, headaches, fatigue, vision problems); mental issues comprised emotional burden (eg, high prevalence of depressive symptoms and anxiety) and cognitive complaints; social issues included role limitations, social isolation, and affected work productivity. Due to study heterogeneity, the impact of treatment on long-term HRQOL remains unclear. Conclusions The findings from this review highlight the areas of HRQOL that can be impacted in long-term survivorship for patients with meningioma. These findings could help raise awareness among clinicians and patients, facilitating support provision.
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Affiliation(s)
- Sé Maria Frances
- Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
| | - Louise Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Emma Nicklin
- Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
| | - Galina Velikova
- Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Florien Boele
- Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, UK
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Toader C, Bratu BG, Covache-Busuioc RA, Dumitrascu DI, Glavan LA, Ciurea AV. Giant Extracranial Meningioma Associated With Hormonal Imbalances Due to Thyroidectomy: Case Report and Literature Review. Cureus 2023; 15:e51376. [PMID: 38293000 PMCID: PMC10825725 DOI: 10.7759/cureus.51376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Meningiomas represent a prevalent class of primary brain tumors, with malignancies such as World Health Organization grade III meningiomas posing significant clinical challenges due to their aggressive nature and potential for recurrence. This case report showcases the clinical journey of a 67-year-old female patient presenting with a giant malignant meningioma post-thyroidectomy, who unfortunately succumbed to postoperative complications. The report offers a comprehensive analysis of the tumor's clinical presentation, including its substantial size, which qualifies it as a 'giant' meningioma, and explores the patient's endocrine dysfunction as a possible contributing factor to her neurological pathology. In the broader context of meningioma management, the report synthesizes data from multiple studies, underscoring the higher incidence of such malignancies in post-pubertal women and the complexity of treatment modalities. Surgical resection remains the cornerstone of treatment, especially when combined with adjuvant therapies. The report concludes with a discussion on the persistent gaps in knowledge regarding the pathogenesis of giant malignant meningiomas and the need for further research, particularly concerning the role of endocrine dysregulation in their development. This case underscores the imperative for multidisciplinary approaches and individualized treatment strategies in the management of malignant meningiomas, with an emphasis on the intricate interplay between endocrine factors and tumor progression.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, Bucharest, ROU
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | | | - David-Ioan Dumitrascu
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Luca-Andrei Glavan
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Alexandru Vladimir Ciurea
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Neurosurgery, Sanador Clinical Hospital, Bucharest, ROU
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Migliorati K, Spatola G, Giudice L, de Graaf N, Bassetti C, Giorgi C, Fontanella M, Vivaldi O, Bignardi M, Franzin A. Post Surgical Management of WHO Grade II Meningiomas: Our Experience, the Role of Gamma Knife and a Literature Review. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010037. [PMID: 36675987 PMCID: PMC9865644 DOI: 10.3390/life13010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
Purpose: Grade II meningiomas are rarer than Grade I, and when operated on, bear a higher risk of local recurrence, with a 5-year progression free survival (PFS) ranging from 59 to 90%. Radiotherapy (RT) or radiosurgery, such as Gamma Knife radiosurgery (GKRS) can reduce the risk of relapse in patients with residual disease, even if their role, particularly after gross total resection (GTR), is still under debate. Main goal of this study was to compare the outcomes of different post-surgical management of grade II meningiomas, grouped by degree of surgical removal (Simpson Grade); next in order we wanted to define the role of GKRS for the treatment of residual disease or relapse. Methods: from November 2016 to November 2020 all patients harboring grade II meningiomas, were divided into three groups, based on post-surgical management: (1) wait and see, (2) conventional adjuvant radiotherapy and (3) stereotactic GKRS radiosurgery. Relapse rate and PFS were registered at the time of last follow up and results were classified as stable, recurrence next to or distant from the surgical cavity. In the second part of the study we collected data of all patients who underwent GKRS in our Centers from November 2017 to November 2020. Results: A total of 37 patients were recruited, including seven patients with multiple meningiomas. Out of 47 meningiomas, 33 (70.2%) were followed with a wait and see strategy, six (12.7%) were treated with adjuvant radiotherapy, and 8 patients (17.0%) with adjuvant GKRS. Follow up data were available for 43 (91.4%) meningiomas. Within the wait and see group, recurrence rates differed based on Simpson grades, lower recurrence rates being observed in three Simpson I cases (30%) compared to twelve relapses (60%) in patients with Simpson grade II/III. Finally, out of the 24 meningiomas undergoing GKRS (8 residual and 16 recurrence), 21 remained stable at follow up. Conclusions: Gross total resection (GTR) Simpson II and III have a significantly worse outcome as compared to Simpson I. The absence of adjuvant treatment leads to significant worsening of the disease progression curve. Adjuvant radiotherapy, especially GKRS, provides good local control of the disease and should be considered as an adjuvant treatment in all cases where Simpson I resection is not possible.
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Affiliation(s)
- Karol Migliorati
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Giorgio Spatola
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Lodoviga Giudice
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Nine de Graaf
- Department of General Surgery, Fondazione Poliambulanza, 25124 Brescia, Italy
- Cancer Center Amsterdam, Department of Surgery, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Chiara Bassetti
- Medical Physics Unit, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Cesare Giorgi
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Marco Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25124 Brescia, Italy
| | - Oscar Vivaldi
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Mario Bignardi
- Department of Radiation Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Alberto Franzin
- Department of Neurosurgery, Fondazione Poliambulanza, 25124 Brescia, Italy
- Correspondence:
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