Integrative assessment of brain and bone invasion in meningioma patients

Abstract

Background Various prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. However, assessability of brain or bone involvement is often limited or varies between histopathologic, operative and imaging reports. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches. Methods A cohort of 111 patients was treated with primary, adjuvant or salvage irradiation between 2008 and 2017 using intensity-modulated radiotherapy. Positron-emission tomography (PET) was available for treatment planning in 81% of patients. Clinical data were extracted from the medical reports. Brain and bone involvement were stratified separately according to histopathologic, operative and imaging reports as well as judged in synopsis. Results WHO grade I tumours, lower estimated proliferation index, primary versus recurrence treatment and localization (i.e. skull base, optic nerve sheath) were beneficial prognostic factors for local control. Judgement of brain and bone invasion partly differed between diagnostic modalities. In synopsis, brain or bone invasion did not show a significant influence on local control rates. Conclusions Several previously described prognostic factors could be reproduced. However, partly divergent histopathological, surgical and image-based judgements could be found in regard to brain and bone invasion and all methods imply limitations. Therefore, we suggest a particular, complemental synopsis judgement. In synopsis, brain or bone involvement did not coherently impair local control in our irradiated patients. This might be explained by elaborate radiation techniques and PET-based treatment planning. Electronic supplementary material The online version of this article (10.1186/s13014-019-1341-x) contains supplementary material, which is available to authorized users.

A radiomics model for preoperative prediction of brain invasion in meningioma non-invasively based on MRI: A multicentre study

“…the samples (excluding incomplete MRI sequences, brain invasion, etc.) including 1127 cases in the training cohort and 691 cases in the validation cohort were evaluated for brain invasion by the surgeon and imaging records [9] . Surgical records described obvious adhesion between the surface of the tumour and the brain.…”

Diagnosis of Invasive Meningioma Based on Brain-Tumor Interface Radiomics Features on Brain MR Images: A Multicenter Study

“…To remedy this shortcoming, two recent studies ( 37 , 39 ) sought to ascertain the advantages of a hybrid strategy that contained knowledge from both operative and pathological observations. Their early findings showed that the combined method had the ability to transcend the shortcomings of sole neuropathological evaluation and may be of considerable therapeutic benefit.…”

Extent of Hyperostotic Bone Resection in Convexity Meningioma to Achieve Pathologically Free Margins

“…Because these high-grade tumors are essentially malignant mesenchymal tumors resembling sarcomas and not true meningiomas, this was somehow expected 18) . Whenever history and radiological findings suggest a grade III meningioma, aggressive excision of bone beyond the nidus and including all abnormal areas on preoperative MRI is warranted 19) .…”