Malignant transformation of WHO grade I meningiomas after surgery or radiosurgery: systematic review and meta-analysis of observational studies

Nakasu, Satoshi; Notsu, Akifumi; Na, Kiyong; Nakasu, Yoko

doi:10.1093/noajnl/vdaa129

Cited by 10 publications

(7 citation statements)

References 61 publications

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“…Skull base meningiomas have a lower incidence rate of malignant transformation than non-skull base tumors. Radiosurgery does not seem to increase the incidence rate of malignant transformation ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study

Zeng²,

Hu³

et al. 2023

Front. Neurol.

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ObjectiveTo explore the results of the Gamma Knife radiosurgery (GKRS) for World Health Organization (WHO) grade I intracranial meningiomas after surgical resection.MethodsA total of 130 patients who were pathologically diagnosed as having WHO grade I meningiomas and who underwent post-operative GKRS were retrospectively reviewed in a single center.ResultsOf the 130 patients, 51 patients (39.2%) presented with radiological tumor progression with a median follow-up time of 79.7 months (ranging from 24.0 to 291.3 months). The median time to radiological tumor progression was 73.4 months (ranging from 21.4 to 285.3 months), whereas 1-, 3-, 5-, and 10-year radiological progression-free survival (PFS) was 100, 90, 78, and 47%, respectively. Moreover, 36 patients (27.7%) presented with clinical tumor progression. Clinical PFS at 1, 3, 5, and 10 years was 96, 91, 84, and 67%, respectively. After GKRS, 25 patients (19.2%) developed adverse effects, including radiation-induced edema (n = 22). In a multivariate analysis, a tumor volume of ≥10 ml and falx/parasagittal/convexity/intraventricular location were significantly associated with radiological PFS [hazard ratio (HR) = 1.841, 95% confidence interval (CI) = 1.018–3.331, p = 0.044; HR = 1.761, 95% CI = 1.008–3.077, p = 0.047]. In a multivariate analysis, a tumor volume of ≥10 ml was associated with radiation-induced edema (HR = 2.418, 95% CI = 1.014–5.771, p = 0.047). Of patients who presented with radiological tumor progression, nine were diagnosed with malignant transformation. The median time to malignant transformation was 111.7 months (ranging from 35.0 to 177.2 months). Clinical PFS after repeat GKRS was 49 and 20% at 3 and 5 years, respectively. Secondary WHO grade II meningiomas were significantly associated with a shorter PFS (p = 0.026).ConclusionsPost-operative GKRS is a safe and effective treatment for WHO grade I intracranial meningiomas. Large tumor volume and falx/parasagittal/convexity/intraventricular location were associated with radiological tumor progression. Malignant transformation was one of the main cause of tumor progression in WHO grade I meningiomas after GKRS.

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Section: Discussionmentioning

confidence: 99%

Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study

Zeng²,

Hu³

et al. 2023

Front. Neurol.

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“…While higher-grade meningiomas are associated with poorer clinical outcomes, all grades of meningioma may result in significant morbidity as a consequence of tumor location and tumor-directed treatment. 25 To date, there is no systemic medical therapy demonstrating prolonged PFS or overall survival in refractory meningiomas. Thus, there is no approved systemic therapy for this indication.…”

Section: Discussionmentioning

confidence: 99%

A multi-institutional phase II trial of bevacizumab for recurrent and refractory meningioma

Kumthekar

Grimm

Aleman

et al. 2022

Neuro-Oncology Advances

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Background Systemic therapies for refractory meningiomas are limited with no FDA approved therapeutics. Vascular endothelial growth factor (VEGF) is a signaling protein associated with neovascularization, peritumoral edema, and meningioma tumorigenesis. Methods This phase II study investigates the efficacy of bevacizumab (BEV), a VEGF binding monoclonal antibody, in patients with progressive Grade I (G1M), Grade II (G2M), Grade III (G3M) meningioma, and other non-parenchymal tumors including vestibular schwannoma (n=4) and hemangiopericytoma (HPC) (n=4) with primary endpoint of PFS-6. Non-meningiomas were included with the respective meningioma grade in analysis. Secondary endpoints include median overall survival (mOS), and response rate. Results 50 patients (26 women; median age 54 years; range 23-81), 42 with of progressive meningioma) were treated: 10 G1M, 20 G2M, and 12 G3M. Prior treatments include surgical resection (41 patients), radiosurgery (24 patients), external beam radiotherapy (28 patients) and chemotherapy (14 patients). Median infusions administered was 16 (range, 2-68). Response was graded using the Macdonald criteria. PFS-6, mPFS, and mOS were 87%, 22 months, 35 months for G1M; 77%, 23 months, 41 months for G2M, and 46%, 8 months, 12 months for G3M. Best radiographic responses include stable disease (G1M: 100%; G2M: 85%; G3M: 82%); partial response (G1M: 0%; G2M: 5%; G3M: 0%) and progressive disease (G1M: 0%; G2M: 10%; G3M:18%). The most common toxicities were hypertension (n=19, 42.2%), proteinuria (n=16, 35.6%), and fatigue (n=14, 31.1%). Conclusion This study showed BEV is well tolerated and appears to be a promising systemic treatment option for patients with recurrent and refractory meningiomas.

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“…18 Of interest, at reoperation, the meningioma demonstrated transformation to WHO grade 2, a phenomenon observed in only 2 out of 100 reoperated cases. 32 This person did not stop taking CPA following surgical resection. To what extent the continued use of CPA had on recurrence and/or WHO grade transformation cannot be concluded.…”

Section: Findings From This Systematic Review Of Case Reportsmentioning

confidence: 99%

Development and Growth of Intracranial Meningiomas in Transgender Women Taking Cyproterone Acetate as Gender-Affirming Progestogen Therapy: A Systematic Review

et al. 2022

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Background: Gender-affirming hormone therapy is critical to the management of transgender persons. Cyproterone acetate (CPA) is a synthetic, progesterone-like compound commonly used in high doses as gender-affirming progestogen therapy in transgender women. An association between high-dose CPA and the development and growth of intracranial meningioma, including case reports in transgender women, has been described. This systematic review summarizes these cases at the patient level and discusses their management. Methods: This systematic review was registered with PROSPERO (CRD42020191965). A detailed search of the PubMed, EMBASE, and Web of Science electronic bibliographic databases was performed (inception-December 20, 2020). Two review authors independently completed screening, data extraction, and risk of bias assessment in duplicate. Results: Nine records were included describing (n = 12) individual case reports and (n = 35) intracranial meningiomas. The median age at presentation was 48 years (interquartile range [IQR], 43-55 years), most frequent daily CPA doses were 50 mg/day (n = 5) and 100 mg/day (n = 5), and the median duration of CPA use was 9.5 years (IQR, 6.5-17.5 years). Multiple meningiomas were common (n = 7). For most cases (n = 10), surgical resection was the initial preferred management strategy, but two were successfully managed by CPA cessation. Conclusions: Transgender women receiving high doses of CPA may be at increased risk of intracranial meningioma development and/or growth, although this remains a rare disease. For presumed CPA-associated meningioma, drug cessation appears to be an appropriate management strategy when surgery is not imminently required to manage raised intracranial pressure or prevent neurological deterioration. Given the importance of gender-affirming hormone therapy to transgender persons, a suitable alternative hormone regimen should be offered, although the use of CPA in both high doses and for prolonged periods of time is now in decline.

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Malignant transformation of WHO grade I meningiomas after surgery or radiosurgery: systematic review and meta-analysis of observational studies

Cited by 10 publications

References 61 publications

Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study

Post-operative gamma knife radiosurgery for WHO grade I intracranial meningiomas: A single-center, retrospective study

A multi-institutional phase II trial of bevacizumab for recurrent and refractory meningioma

Development and Growth of Intracranial Meningiomas in Transgender Women Taking Cyproterone Acetate as Gender-Affirming Progestogen Therapy: A Systematic Review

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