Radiation therapy for atypical and anaplastic meningiomas: an overview of current results and controversial issues

Vagnoni, Lorenzo; Aburas, Sami; Giraffa, Martina; Russo, Ivana; Chiarella, Vito; Paolini, Sergio; Tini, Paolo; Minniti, Giuseppe

doi:10.1007/s10143-022-01806-3

Cited by 18 publications

(13 citation statements)

References 93 publications

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“…Hyperostosis and osteolysis in the adjacent area of an AM are frequently encountered, specifically showing the pattern of bone involvement [ 19 ]. If hyperostosis of underlying bones is identified especially in meningioma grade 1, osteolysis is seen more often in meningioma grade 2 and grade 3 [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

Cucu,

Costea,

Macovei

et al. 2024

Rom J Morphol Embryol

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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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Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

Cucu,

Costea,

Macovei

et al. 2024

Rom J Morphol Embryol

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“…Photon-based RT is usually recommended as adjuvant therapy or as the primary treatment for meningioma. Several RT techniques have been developed: IMRT, VMAT, and stereotactic irradiation modalities (i.e., Gamma Knife, CyberKnife) ( 39 , 44 ).…”

Section: Meningiomasmentioning

confidence: 99%

The role of particle radiotherapy in the treatment of skull base tumors

et al. 2023

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The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial nerves. Due to this complexity, management of skull base tumors requires a multidisciplinary approach involving a team of specialists such as neurosurgeons, otorhinolaryngologists, radiation oncologists, endocrinologists, and medical oncologists. In the case of pediatric patients, cancer management should be performed by a team of pediatric-trained specialists. Radiation therapy may be used alone or in combination with surgery to treat skull base tumors. There are two main types of radiation therapy: photon therapy and particle therapy. Particle radiotherapy uses charged particles (protons or carbon ions) that, due to their peculiar physical properties, permit precise targeting of the tumor with minimal healthy tissue exposure. These characteristics allow for minimizing the potential long-term effects of radiation exposure in terms of neurocognitive impairments, preserving quality of life, and reducing the risk of radio-induced cancer. For these reasons, in children, adolescents, and young adults, proton therapy should be an elective option when available. In radioresistant tumors such as chordomas and sarcomas and previously irradiated recurrent tumors, particle therapy permits the delivery of high biologically effective doses with low, or however acceptable, toxicity. Carbon ion therapy has peculiar and favorable radiobiological characteristics to overcome radioresistance features. In low-grade tumors, proton therapy should be considered in challenging cases due to tumor volume and involvement of critical neural structures. However, particle radiotherapy is still relatively new, and more research is needed to fully understand its effects. Additionally, the availability of particle therapy is limited as it requires specialized equipment and expertise. The purpose of this manuscript is to review the available literature regarding the role of particle radiotherapy in the treatment of skull base tumors.

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“…Meningiomas are neoplasms derived from arachnoid cap cells. Although most meningiomas are WHO grade 1 tumors, less than one-quarter of all meningiomas are classified as WHO grade 2 and 3 tumors, which show more aggressive behavior and are difficult to treat with multimodal therapy [ 14 , 15 , 16 ]. In particular, WHO grade 2 and 3 meningiomas are more likely to recur after the treatment and can be difficult to remove completely.…”

Section: Introductionmentioning

confidence: 99%

Drug Repositioning for Refractory Benign Tumors of the Central Nervous System

Tamura

2023

IJMS

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Drug repositioning (DR) is the process of identifying novel therapeutic potentials for already-approved drugs and discovering new therapies for untreated diseases. DR can play an important role in optimizing the pre-clinical process of developing novel drugs by saving time and cost compared with the process of de novo drug discovery. Although the number of publications related to DR has rapidly increased, most therapeutic approaches were reported for malignant tumors. Surgical resection represents the definitive treatment for benign tumors of the central nervous system (BTCNS). However, treatment options remain limited for surgery-, chemotherapy- and radiation-refractory BTCNS, as well as malignant tumors. Meningioma, pituitary neuroendocrine tumor (PitNET), and schwannoma are the most common BTCNS. The treatment strategy using DR may be applied for refractory BTCNS, such as Grade 2 meningiomas, neurofibromatosis type 2-related schwannomatosis, and PitNETs with cavernous sinus invasion. In the setting of BTCNS, stable disease can provide significant benefit to the patient. DR may provide a longer duration of survival without disease progression for patients with refractory BTCNS. This article reviews the utility of DR for refractory BTCNS.

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Radiation therapy for atypical and anaplastic meningiomas: an overview of current results and controversial issues

Cited by 18 publications

References 93 publications

Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

The role of particle radiotherapy in the treatment of skull base tumors

Drug Repositioning for Refractory Benign Tumors of the Central Nervous System

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