Pulmonary metastases in patients with recurrent, treatment‐resistant meningioma

Abstract

BACKGROUND:Meningioma is the most common extra-axial primary intracranial tumor in adults that rarely metastasizes outside of the central nervous system (CNS). Among recognized sites of metastases, the lung is the most common, but the importance of lung metastases relative to prognosis is unknown. 111 Indium ( 111 In)-octreotide scintigraphy (octreotide scanning) is a valuable imaging modality with which to evaluate intracranial meningiomas and their response to treatment with somatostatin analogues and has the potential to identify extracranial metastatic disease. METHODS: In this retrospective multicenter study, adult patients treated for recurrent meningioma were identified. These patients underwent 111 In-octreotide positron emission tomography/computed tomography imaging (octreotide scintigraphy) and were found to have positive octreotide uptake in their lungs. RESULTS: Six cases were identified with recurrent meningioma (after surgery, radiotherapy, and at least 1 chemotherapy agent) and pulmonary lesions by octreotide scintigraphy. Biopsy of a pulmonary lesion in 1 patient confirmed the diagnosis of metastatic meningioma. Patients with metastatic pulmonary involvement identified by 111 In-octreotide scintigraphy in this case series had an overall survival of 6 months, which is less than that reported from previously published series of patients with unknown systemic disease status. CONCLUSIONS: 111 In-octreotide scintigraphy is useful for assessing both CNS disease and extracranial metastases. The presence of pulmonary metastases appears to negatively affect survival in patients with recurrent meningioma. The usefulness of 111 In-octreotide scintigraphy should be considered in staging patients with recurrent meningioma who are considered for further treatment. A prospective study to confirm this finding is warranted.

Pulmonary and pleural metastasis of intracranial anaplastic meningioma in a 3-year-old boy: A case report

“…Although metastasis of meningioma is a rare phenomenon in adult patients, it has been well-documented and its incidence has been estimated to be 0.1% (10,11). According to the results of the systematic review by Surov et al (12), metastatic lesions were localized most frequently in the lungs (37.2%), bones (16.5%), intraspinally (15.2%) and in the liver (9.2%).…”

Chromosomal alterations, prognostic factors, and targeted molecular therapies for malignant meningiomas

“…Following gross total resection (GTR), meningiomas have a recurrence rate of 10% to 30% at 10 years, whereas tumors with subtotal resection (STR) have a 10-year recurrence rate of 61%. [28][29][30][31][32] Moreover, all tumor grades have been correlated with increased survival when treated with total resection as compared with STR. [33][34][35][36] In a multi-institutional retrospective study of 199 patients with high grade meningiomas, analysis of grade II meningiomas showed that patients younger than 60 years of age who had undergone Simpson grade 1 resections had longer overall survival.…”

Design of Peptide Imaging Agents for Whole-body and Intraoperative Molecular Imaging

“…Initially used for scintigraphic imaging of NETs [26], Octreoscan is considered the gold standard for imaging gastroenteropancreatic (GEP) tumors and is more reliable and sensitive than magnetic resonance imaging (MRI) and computed tomography (CT) for diagnosis and staging. Recent studies have also demonstrated the use of this agent for the diagnosis of thymic tumors [27] and possibly in the assessment of pulmonary metastases in patients with recurrent, treatment-resistant meningioma [28].…”