Patterns of Care and Outcomes of Adjuvant Radiotherapy for Meningiomas: A Surveillance, Epidemiology, and End Results and Medicare Linked Analysis

Amsbaugh, Mark J.; Ugiliweneza, Beatrice; Burton, Eric; Skirboll, Stephen; Woo, Shiao Y.; Boakye, Max

doi:10.7759/cureus.567

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…Gross total resection was also found to be a strong predictor of longer survival. 3,21,23 Additionally, in patients who did not undergo surgery, we found differences in survival based on the reason why no cancer-directed surgery was performed, with relatively worse survival in patients who refused surgery or for whom surgery was contraindicated due to another condition as compared to patients for whom surgery was not recommended. We also found, as expected, that uninsured patients had worse survival than insured patients.…”

Section: Discussionmentioning

confidence: 78%

“…As in our previous work, we found that while pediatric meningiomas may include relatively more aggressive subtypes, young age is overall associated with reduced all-cause mortality. 4 In regard to sex, across all ages overall, meningiomas were more frequent in females than in males, but malignancy 19 and mortality 3,20,21 were greater in males than females. Also concordant with previous reports, black race and larger tumor size were found to be adverse prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

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Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

et al. 2020

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Meningiomas are known to have relatively lower aggressiveness and better outcomes than other central nervous system (CNS) tumors. However, there is considerable overlap between clinical and radiological features characterizing benign, atypical, and malignant tumors. In this study, we developed methods and a practical app designed to assist with the diagnosis and prognosis of meningiomas. Statistical learning models were trained and validated on 62,844 patients from the Surveillance, Epidemiology, and End Results database. We used balanced logistic regression-random forest ensemble classifiers and proportional hazards models to learn multivariate patterns of association between malignancy, survival, and a series of basic clinical variables-such as tumor size, location, and surgical procedure. We demonstrate that our models are capable of predicting meaningful individual-specific clinical outcome variables and show good generalizability across 16 SEER registries. A free smartphone and web application is provided for readers to access and test the predictive models (www.meningioma.app). Future model improvements and prospective replication will be necessary to demonstrate true clinical utility. Rather than being used in isolation, we expect that the proposed models will be integrated into larger and more comprehensive models that integrate imaging and molecular biomarkers. Whether for meningiomas or other tumors of the CNS, the power of these methods to make individual-patient predictions could lead to improved diagnosis, patient counseling, and outcomes.npj Digital Medicine (2020) 3:12 ; https://doi.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

et al. 2020

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“…Theoretical possibilities for such findings include local differences in medical care access and in particular to neuroimaging (e.g., head magnetic resonance imaging or head computed tomography), evaluations leading to coincidental discovery of tumors (migraine headache imaging), racial and socioeconomic disparities, and variance in population education levels. [3][4][5][6][7][8][9][10][11][12][13] The current study also noted a significant difference in treatment modalities utilized between registries for smallto medium-sized intracranial meningiomas, even when accounting for baseline differences in age and tumor size. For example, the distribution in tumor size between New Mexico and Greater California registries is nearly identical; however, the odds ratio for surgery was 1.5 times greater for the New Mexico population.…”

Section: Key Resultsmentioning

confidence: 49%

Geographical Differences in Intracranial Meningioma Management: Examining 65,973 Patients across the United States

et al. 2018

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Background Age, tumor size and location, overall health, and patient preference are primary considerations driving treatment decision-making for intracranial meningiomas. However, even for the same individual patient, treatment recommendations may vary between centers and providers. Objective To study associations between geography, disease presentation, and management of intracranial meningioma in the United States. Methods The population-based Surveillance, Epidemiology, and End Results(SEER) data were queried between 2004 and 2014 for cases of intracranial meningioma. Results A total of 65,808 patients with intracranial meningioma were identified. Univariate analyses demonstrated strong associations between geographic location, age, and size of tumor at presentation. The mean age for all registries was 64.2 years, with a range from 62.0 (Utah registry) to 66.6 (Detroit registry). The greatest proportion of small tumors (<1 cm) were identified in the Utah registry (13.9% of tumors), while the greatest proportion of large tumors (> 4cm) were noted in the Hawaii registry (30.7% of tumors). Multivariable analysis demonstrated that the impact of geography on treatment selection was just as important as other established variables. For example, the distribution in tumor size between New Mexico and Greater California registries is nearly identical; however, the odds ratio for surgery was 1.5 times greater for the New Mexico population. Conclusion These data suggest that disease presentation and treatment are significantly influenced by regional referral patterns, provider or institutional treatment preferences, and regional availability of subspecialty expertise. Understanding such biases is important for patients, referring physicians, and treatment providers in an effort to provide balanced counseling and treatment.

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“…also found that the use of adjuvant SRS had remained stable over time in patients age >65 years between 2000 and 2010. 29 Additionally, the current analysis showed that private insurance and Medicare were associated with an increased likelihood of receiving SRS/HF-SRS, which may be a reflection of the referral patterns for insured patients. However, there was no association with academic versus nonacademic facility type.…”

Section: Discussionmentioning

confidence: 68%

Adjuvant treatment of meningioma with stereotactic radiation surgery and hypofractionated stereotactic radiation surgery: Patterns of care and survival in a large, hospital database

Albert

Lee

Vijayakumar

et al. 2018

Advances in Radiation Oncology

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ObjectivesStereotactic radiation surgery (SRS) and hypofractionated stereotactic radiation surgery (HF-SRS) have become an alternative to external beam radiation therapy (EBRT) in the adjuvant treatment of meningiomas. The purpose of this study was to identify national treatment patterns and survival outcomes for meningiomas on the basis of radiation treatment modality in the adjuvant setting.Methods and materialsThe National Cancer Database was queried for patients with meningioma diagnosed between 2010 and 2012. World Health Organization grade I disease with subtotal resection and all cases of grade II disease regardless of the extent of the resection were included. Logistic regression was used to determine factors that were associated with receipt of SRS/HF-SRS compared with EBRT. Cox regression was used to determine covariables associated with differences in overall survival (OS).ResultsA total of 802 patients met the inclusion criteria of which 173 patients received SRS/HF-SRS (22%) and 629 patients (78%) received EBRT. The 3-year OS rate was 97.3% for the SRS/HF-SRS group and 93.4% for the EBRT group (P = .018). On subgroup analysis by grade, for grade I the 3-year OS rate was 98.3% for the SRS/HF-SRS group versus 96.7% for the EBRT group (P = .117). For grade II disease, the 3-year OS rate was 94.4% in the SRS/HF-SRS group versus 92.4% in the EBRT group (P = .199). On multivariable analysis, World Health Organization grade II histology (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.21-0.56; P < .001) and gross total resection (OR: 0.29; 95% CI, 0.15-0.57; P < .001) were associated with a decreased likelihood of receiving SRS/HF-SRS but private insurance (OR: 8.89; 95% CI, 1.15-68.47; P = .036) and Medicare (OR: 10.03; 95% CI, 1.28-78.69; P = .028) were associated with an increased likelihood of receiving SRS/HF-SRS. Year of diagnosis was not associated with receipt of SRS/HF-SRS. The multivariable Cox regression demonstrated a trend toward improved OS for treatment with SRS/HF-SRS (hazard ratio: 0.24; 95% CI, 0.06-1.03; P = .055).ConclusionsSRS and HF-SRS are associated with similar survival as EBRT; however, SRS/HF-SRS is used infrequently and usage has not increased over time.

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Patterns of Care and Outcomes of Adjuvant Radiotherapy for Meningiomas: A Surveillance, Epidemiology, and End Results and Medicare Linked Analysis

Cited by 11 publications

References 26 publications

Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

Geographical Differences in Intracranial Meningioma Management: Examining 65,973 Patients across the United States

Adjuvant treatment of meningioma with stereotactic radiation surgery and hypofractionated stereotactic radiation surgery: Patterns of care and survival in a large, hospital database

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