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Joy Trybula S, Nandoliya KR, Youngblood MW, Karras CL, Fernandez LG, Oyon DE, Texakalidis P, Khan OH, Lesniak MS, Tate MC, Rosenow JM, Hill VB, Hijaz TA, Russell EJ, Sachdev S, Kalapurakal JA, Horbinski CM, Magill ST, Chandler JP. Predictors of salvage therapy for parasagittal meningiomas treated with primary surgery, radiosurgery, or surgery plus adjuvant radiotherapy. J Clin Neurosci 2024; 124:102-108. [PMID: 38685181 DOI: 10.1016/j.jocn.2024.04.024] [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: 02/25/2024] [Revised: 04/07/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Parasagittal meningiomas (PM) are treated with primary microsurgery, radiosurgery (SRS), or surgery with adjuvant radiation. We investigated predictors of tumor progression requiring salvage surgery or radiation treatment. We sought to determine whether primary treatment modality, or radiologic, histologic, and clinical variables were associated with tumor progression requiring salvage treatment. METHODS Retrospective study of 109 consecutive patients with PMs treated with primary surgery, radiation (RT), or surgery plus adjuvant RT (2000-2017) and minimum 5 years follow-up. Patient, radiologic, histologic, and treatment data were analyzed using standard statistical methods. RESULTS Median follow up was 8.5 years. Primary treatment for PM was surgery in 76 patients, radiation in 16 patients, and surgery plus adjuvant radiation in 17 patients. Forty percent of parasagittal meningiomas in our cohort required some form of salvage treatment. On univariate analysis, brain invasion (OR: 6.93, p < 0.01), WHO grade 2/3 (OR: 4.54, p < 0.01), peritumoral edema (OR: 2.81, p = 0.01), sagittal sinus invasion (OR: 6.36, p < 0.01), sagittal sinus occlusion (OR: 4.86, p < 0.01), and non-spherical shape (OR: 3.89, p < 0.01) were significantly associated with receiving salvage treatment. On multivariate analysis, superior sagittal sinus invasion (OR: 8.22, p = 0.01) and WHO grade 2&3 (OR: 7.58, p < 0.01) were independently associated with receiving salvage treatment. There was no difference in time to salvage therapy (p = 0.11) or time to progression (p = 0.43) between patients receiving primary surgery alone, RT alone, or surgery plus adjuvant RT. Patients who had initial surgery were more likely to have peritumoral edema on preoperative imaging (p = 0.01). Median tumor volume was 19.0 cm3 in patients receiving primary surgery, 5.3 cm3 for RT, and 24.4 cm3 for surgery plus adjuvant RT (p < 0.01). CONCLUSION Superior sagittal sinus invasion and WHO grade 2/3 are independently associated with PM progression requiring salvage therapy regardless of extent of resection or primary treatment modality. Parasagittal meningiomas have a high rate of recurrence with 80.0% of patients with WHO grade 2/3 tumors with sinus invasion requiring salvage treatment whereas only 13.6% of the WHO grade 1 tumors without sinus invasion required salvage treatment. This information is useful when counseling patients about disease management and setting expectations.
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Affiliation(s)
- S Joy Trybula
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Constantine L Karras
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis G Fernandez
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel E Oyon
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pavlos Texakalidis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Osaama H Khan
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maciej S Lesniak
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Virginia B Hill
- Department of Radiology, Division of Neuroradiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tarek A Hijaz
- Department of Radiology, Division of Neuroradiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric J Russell
- Department of Radiology, Division of Neuroradiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Craig M Horbinski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Pathology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - James P Chandler
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cucu AI, Costea CF, Macovei G, Dumitrescu GF, Sava A, Blaj LA, Prutianu I, Porumb-Andrese E, Dascălu CG, Coşman M, Poeată I, Turliuc Ş. Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:509-515. [PMID: 38184831 PMCID: PMC10863686 DOI: 10.47162/rjme.64.4.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Meningiomas are the most common primary neoplasms of the central nervous system in adults, arising from the arachnoid cap cells. Thus, grade 2 meningiomas are situated on the border between benignity and malignancy. Among the many prognostic factors that have been investigated in these tumors, bone invasion is one of them. OBJECTIVE The aim of our study was to identify whether bone invasion influences tumor recurrence and progression-free survival (PFS) in patients with atypical meningiomas (AMs). PATIENTS, MATERIALS AND METHODS Out of 81 patients with AMs followed over a period of five years, we identified nine patients with bone invasion. We analyzed their demographic, clinical, imaging, and pathological characteristics, such as age, gender, radiological aspects, morphological features, extent of resection, recurrence rate, and PFS over a follow-up period of 60 months. Bone invasion was determined based on preoperative, surgical, and pathological reports. RESULTS Out of the nine patients with bone invasion, four had convexity meningiomas, four had parasagittal meningiomas and one had a falcine meningioma. Regarding tumor recurrence∕progression, most patients (n=6) recurred within the first 24 months after surgery. Our study showed that the early recurrence/progression of tumor (at 12 months) correlated with extensive presence of malignancy criteria, especially with the presence of 15-18 mitoses∕10 high-power fields, as well as with large foci of spontaneous necrosis, but also with tumor bone infiltration, extensive bone lamellae destruction, and tumor infiltration of adjacent muscle with its atrophy due to tumor compression. Patients with bone invasion had a PFS of 29.3 months, compared to patients without invasion who had a higher PFS (49.3 months). Significant statistical associations were observed between bone invasion and tumor recurrence (p=0.002) and PFS (p=0.004). CONCLUSIONS Our study emphasizes the importance of a thorough histopathological examination of the surgical specimen, which can provide significant data for the assessment of the progression of an AM [World Health Organization (WHO) grade 2] with bone invasion. AM infiltration in adjacent bone and muscle increases the rate of tumor recurrence and decreases PFS over a follow-up period of 60 months.
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Affiliation(s)
- Andrei Ionuţ Cucu
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Ştefan cel Mare University of Suceava, Romania
- 2nd Neurosurgery Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Claudia Florida Costea
- Department of Ophthalmology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- 2nd Ophthalmology Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Georgiana Macovei
- Department of Oral and Dental Diagnostics, Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | | | - Anca Sava
- Laboratory of Pathology, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Anatomy, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Laurenţiu Andrei Blaj
- 2nd Neurosurgery Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Neurosurgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Iulian Prutianu
- Department of Morpho-Functional Sciences I – Histology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Elena Porumb-Andrese
- Department of Dermatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Cristina Gena Dascălu
- Department of Medical Informatics, Biostatistics, Computer Science, Mathematics and Modelling Simulation, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Mihaela Coşman
- Department of Neurosurgery, Emergency County Hospital, Brăila, Romania
| | - Ion Poeată
- 2nd Neurosurgery Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Neurosurgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Şerban Turliuc
- Department of Psychiatry, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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Wang L, Cao Y, Zhang G, Sun D, Zhou W, Li W, Zhou J, Chen K, Zhang J. A radiomics model enables prediction venous sinus invasion in meningioma. Ann Clin Transl Neurol 2023; 10:1284-1295. [PMID: 37408500 PMCID: PMC10424646 DOI: 10.1002/acn3.51797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Preoperative prediction of meningioma venous sinus invasion would facilitate the selection of surgical approaches and predicting the prognosis. To predict venous sinus invasion in meningiomas, we used radiomic signatures to construct a model based on preoperative contrast-enhanced T1-weighted (T1C) and T2-weighted (T2) magnetic resonance imaging. METHODS In total, 599 patients with pathologically confirmed meningioma were retrospectively enrolled. For each patient enrolled in this study, 1595 radiomic signatures were extracted from T1C and T2 image sequences. Pearson correlation analysis and recursive feature elimination were used to select the most relevant signatures extracted from different image sequences, and logistic regression algorithms were used to build a radiomic model for risk prediction of meningioma sinus invasion. Furthermore, a nomogram was built by incorporating clinical characteristics and radiomic signatures, and a decision curve analysis was used to evaluate the clinical utility of the nomogram. RESULTS Twenty radiomic signatures that were significantly related to venous sinus invasion were screened from 3190 radiomic signatures. Venous sinus invasion was associated with tumor position, and the clinicoradiomic model that incorporated the above characteristics (20 radiomic signatures and tumor position) had the best discriminating ability. The areas under the curve for the training and validation cohorts were 0.857 (95% confidence interval [CI], 0.824-0.890) and 0.824 (95% CI, 0.752-0.8976), respectively. INTERPRETATION The clinicoradiomic model had good predictive performance for venous sinus invasion in meningioma, which can aid in devising surgical strategies and predicting prognosis.
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Affiliation(s)
- Limei Wang
- Department of RadiologyThe Fifth Affiliated Hospital of Zunyi Medical UniversityZhuhaiChina
| | - Yuntai Cao
- Department of RadiologyAffiliated Hospital of Qinghai UniversityXiningChina
| | - Guojin Zhang
- Department of Radiology, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Dandan Sun
- Department of RadiologyThe Fifth Affiliated Hospital of Zunyi Medical UniversityZhuhaiChina
| | - Wusheng Zhou
- Department of RadiologyThe Fifth Affiliated Hospital of Zunyi Medical UniversityZhuhaiChina
| | - Wenyi Li
- Department of RadiologyThe Fifth Affiliated Hospital of Zunyi Medical UniversityZhuhaiChina
| | - Junlin Zhou
- Department of RadiologyLanzhou University Second HospitalLanzhouChina
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhouChina
| | - Kuntao Chen
- Department of RadiologyThe Fifth Affiliated Hospital of Zunyi Medical UniversityZhuhaiChina
| | - Jing Zhang
- Department of RadiologyThe Fifth Affiliated Hospital of Zunyi Medical UniversityZhuhaiChina
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Cucu AI, Costea CF, Turliuc Ş, Blaj LA, Prutianu I, Dumitrescu GF, Dascălu CG, Poeată I, Coşman M, Istrate AC, Macovei G, Tătăranu LG. Predictor factors for recurrence in atypical meningiomas. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:333-342. [PMID: 37867351 PMCID: PMC10720934 DOI: 10.47162/rjme.64.3.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Atypical meningiomas (AMs), World Health Organization (WHO) grade 2, are a group of tumors with uneven and unpredictable clinical behavior. Our aim was to analyze possible tumor recurrence predictors, and to identify factors that improve progression-free survival (PFS). PATIENTS, MATERIALS AND METHODS Our retrospective study included 81 patients followed up in the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, between 1 January 2010 and 31 December 2020. The histopathological specimens were reviewed according to the WHO 2021 criteria. Analyses included clinical, imaging, pathological and surgical factors. RESULTS The tumor recurred in 53.1% of the 81 cases within 60 months of surgery. Tumor location (p<0.000), tumor volume (p<0.010), extent of surgical resection (p<0.000) and dural sinus invasion (p<0.001) were predictive factors of recurrence. Gross total resection (Simpson grade I and II) was achieved in 59.2% of patients. Patients with the tumors located in the brain convexity and volume <26.4 cm³ had better survival rates up to recurrence. PFS showed a significant relationship between Simpson grade I-III and biopsy (p<0.000) and was statistically influenced by tumor volume and location, and dural sinus invasion. CONCLUSIONS AMs are a heterogeneous group of tumors, and we identified posterior fossa location, volume ≥26.4 cm³, Simpson grade III and IV resection and dural sinus invasion as predictive factors for relapse and a shorter PFS. Whereas certain characteristics provide some prognostic value, future molecular characterizations of AMs are necessary, which will support the clinical decision-making process.
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Affiliation(s)
- Andrei Ionuţ Cucu
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Ştefan cel Mare University of Suceava, Romania
- Department of Neurosurgery, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Claudia Florida Costea
- Department of Ophthalmology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- Department of Ophthalmology, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Şerban Turliuc
- Department of Psychiatry, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Laurenţiu Andrei Blaj
- Department of Neurosurgery, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Neurosurgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Iulian Prutianu
- Department of Morpho-Functional Sciences I – Histology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | | | - Cristina Gena Dascălu
- Department of Medical Informatics, Biostatistics, Computer Science, Mathematics and Modelling Simulation, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Ion Poeată
- Department of Neurosurgery, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Neurosurgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Mihaela Coşman
- Department of Neurosurgery, Emergency County Hospital, Brăila, Romania
| | - Ana-Cristina Istrate
- Department of Radiology and Imaging, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Georgiana Macovei
- Department of Oral and Dental Diagnostics, Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Ligia Gabriela Tătăranu
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Bagdasar–Arseni Clinical Emergency Hospital, Bucharest, Romania
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