Treatment of unresectable meningiomas with the antiprogesterone agent mifepristone

Grunberg, Steven M.; Weiss, Martin H.; Spitz, Irving M.; Ahmadi, Jamshid; Sadun, Alfredo A.; Russell, Christy; Lucci, Lois; Stevenson, Lani L.

doi:10.3171/jns.1991.74.6.0861

Cited by 360 publications

(156 citation statements)

References 35 publications

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“…Two studies were done with mifepristone in inoperable meningiomas. In 13 patients studied by Grunberg et al 29 , 5 tumors reduced, 3 improved without reduction of tumor and three enlarged regardless treatment. Two of three which failed were malignant.…”

Section: Discussionmentioning

confidence: 99%

Meningiomas and hormonal receptors: immunohistochemical study in typical and non-typical tumors

Hilbig

Barbosa-Coutinho

1998

Arq. Neuro-Psiquiatr.

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-The authors assessed 116 cases of meningiomas classified as typical, atypical and anaplastic and they used an immunohistochemical technique for estrogen and progesterone receptors attempting to determine if there is any difference between typical and non-typical tumors in relation to hormone receptors. The immunohistochemical technique to estrogen receptors was negative in all meningiomas studied. Progesterone receptors were detected in 58.3% of typical, and in 48.2% of non-typical meningiomas. This difference was not statistically significant. However, individually considering the criteria used for selection of non-typical tumours, those that concurrently displayed brain invasion and increased mitotic activity or necrosis, as well as the summation of those three features, were predominantly negative for progesterone receptors (respectively p=0.038; p=0.001; and p=0.044). The authors conclude that estrogen receptors were not present in meningiomas; that progesterone receptors in isolation are not enough to predict a higher tumoral malignancy but can be useful associated with other histological features.KEY WORDS: meningioma, progesterone receptor, estrogen receptor, immunohistochemistry. Meningiomas e receptores hormonais: estudo imuno-histoquímico em tumores típicos e não típicosRESUMO -Os autores avaliam 116 meningiomas classificados em típicos, atípicos ou anaplásicos usando técnica imuno-histoquímica para receptores de estrógeno (ER) e progesterona (PR) com o objetivo de determinar se existe diferença entre tumores típicos e não típicos em relação aos receptores hormonais. Todos os tumores estudados foram negativos para ER. Os receptores de progesterona foram detectados em 58,3% dos meningiomas típicos e em 48,2% dos tumores não-típicos. Essa diferença não foi estatisticamente significativa. Entretanto, considerando os critérios utilizados para seleção dos não-típicos, os tumores que apresentavam, de forma concomitante, invasão do sistema nervoso central e aumento da taxa mitótica ou necrose, bem como a soma das três características, foram predominantemente negativos para PR (p=0,038; 0,01 e 0,044, respectivamente). Os autores concluem que: ERs não estão presentes em meningiomas; PRs estão presentes na maioria dos meningiomas; a negatividade para PR isoladamente não é suficiente para predizer maior malignidade mas pode ser útil se associada a outras características histológicas. PALAVRAS-CHAVE: meningioma, receptores de progesterona, receptores de estrógeno, imunohistoquímica.Meningiomas are the most common meningeal tumors of the central nervous system. These tumors arise from the arachnoidial layer of meninges and, although they are generally benign, there are many cases showing atypical and anaplastic features 1 . Epidemiological data suggest that female sex hormones may play a role in the growth of meningiomas. They show a higher incidence in

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Section: Discussionmentioning

confidence: 99%

Meningiomas and hormonal receptors: immunohistochemical study in typical and non-typical tumors

Hilbig

Barbosa-Coutinho

1998

Arq. Neuro-Psiquiatr.

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“…Mifepristone was used as a progesterone receptor antagonist in an in vitro study for the suppression of meningioma growth in 1986, 19) and used to treat unresectable meningiomas in 1991. 8) Administration of another antiprogesterone agent, onapristone, resulted in marked reduction of the meningioma size in both in vitro and in vivo studies. 16) However, no antiprogesterone therapies have been established yet for the treatment of meningiomas.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Regression of an Asymptomatic Meningioma Associated With Discontinuation of Progesterone Agonist Administration -Case Report-

Shimizu

Matsumoto

Yamazaki

et al. 2008

Neurol. Med. Chir.(Tokyo)

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An 80-year-old male visited the hospital as an outpatient with a head injury sustained in a traffic accident. Brain computed tomography incidentally revealed a left frontal lobe tumor measuring 5 cm in a diameter. The patient had a history of taking chlormadinone acetate (a progesterone agonist) prescribed several years previously as treatment for benign prostatic hypertrophy. The tumor was seen as an isointense lesion on T 1 -weighted magnetic resonance (MR) images with enhancement by gadolinium, and as a heterogeneously hyperintense mass on T 2 -weighted MR images. The tentative diagnosis was left frontal meningioma attached to the sphenoid ridge or sphenoid plane. The patient was managed conservatively because of his advanced age and no symptoms or progression were observed during a 9-month follow-up period. The medication for benign prostatic hypertrophy was changed from chlormadinone acetate to naftopidil (an alpha-2-blocker) about 9 months after his first presentation. The patient presented again 2 years later complaining of dizziness. Computed tomography and MR imaging performed at this time revealed remarkable regression of the tumor. The signal intensity change with regression of the tumor on T 2 -weighted images was observed as a hypointense lesion. Thus, we wish to emphasize that treatment of meningiomas, especially those diagnosed incidentally, must be based on a thorough consideration of any history of hormonal therapy with prostate disease.

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“…30 Cerrahi olarak çıkarılamayan menenjiomlu hastalara uygulanan mifepristone tedavisi sonrası tümörde regresyon tespit edilmiştir. 31 Schwannomlar genellikle izole olarak ortaya çıkan tümörlerdir. Nadiren NF-1 ile birlikte bulunurlar.…”

Section: Sonuçlarunclassified

Orbita Nörojenik Tümörlerinin Klinik ve Tedavi Özellikleri

Kızıltunç¹,

Günduz²,

Erden³

2013

tjo

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ÖzetAmaç: Orbita nörojenik tümörlerinin klinik ve tedavi özelliklerinin değerlendirilmesi Ge reç ve Yön tem: Ankara Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Tümör Bölümü'nde 1998-2011 yılları arasında orbital nörojenik tümör tanısı alan 35 hastanın dosyaları retrospektif olarak tarandı. Sonuçlar: Olguların yaş ortalaması 28.3 yaş (2-67) idi. Başvuruda 20 (%57) olguda proptozis, 11 (%31) olguda göz hareketlerinde kısıtlılık vardı. Olguların 21'ine (%60) cilt yoluyla, 7'sine (%20) konjonktival yolla orbitotomi yapıldı. Olguların 3'ü (%8) daha önce dış merkezde opere edilmişti. 4 (%12) olguya klinik olarak tanı konuldu. Olguların 11'ine (%31,4) total eksizyonel biyopsi, 7'sine (%20) subtotal eksizyonel biyopsi, 10'una (%28,6) insizyonel biyopsi yapıldı. Histopatolojik ve klinik tanıya göre olguların 14'ünde (%40) menenjiom, 12'sinde (%34) periferik sinir kılıfı tümörü, 9'unda (%26) optik sinir gliomu saptandı. Menenjiom olgularının 6'sı (%43) optik sinir kılıf menenjiomu, 5'i (%36) sfenoid kanat menenjiomu, 2'si (%14) ektopik menenjiom, 1'i (%7) perisellar menenjiomdu. Periferik sinir kılıfı tümörlerinin 6'sı ( Ma te ri al and Met hod:The records of 35 patients with orbital neurogenic tumors who were diagnosed and treated at Ankara University Faculty of Medicine, Department of Ophthalmology, between 1998 and 2011 were evaluated retrospectively. Re sults: Orbitotomy via a cutaneous approach was performed in 21 (60%) cases and orbitotomy via a transconjunctival approach was performed in 7 (20%) cases. Three (8%) cases had been operated at different centers. Four (12%) cases were diagnosed clinically. Total excisional biopsy was performed in 11 (31.4%) cases, subtotal excisional biopsy was performed in 7 (20%), and incisional biopsy was performed in 10 (28.6%) cases. 14 (40%) 35 cases were diagnosed as meningioma, 12 (34%) as peripheral nerve sheath tumor, and 9 (26%) cases were diagnosed as optic nerve glioma. Six (43%) meningioma cases were optic nerve sheath meningioma, 5 (36%) were sphenoid wing meningioma, 2 (14%) were ectopic meningioma, and 1 (7%) was perisellar meningioma. Six (50%) of peripheral nerve sheath tumors were schwannoma, 2 (16%) were solitary neurofibroma, 4 (34%) were plexiform neurofibroma. External beam radiotherapy was performed in 15 (42.8%) cases, cyberknife radiosurgery in 1 (2.8%) , chemotherapy in 1 (2.8%), and enucleation ( because of neovascular glaucoma and vitreous hemorrhage) was performed in 1 (2.8%) case. Dis cus si on: The most common orbital neurogenic tumors are meningioma, peripheral nerve sheath tumor, and optic nerve glioma. For meningioma and glioma, external beam radiotherapy is required; for schwannoma and solitary neurofibroma, total excisional biopsy is the preferred treatment. The success of visual and anatomic results are high after treatment. (Turk J Ophthalmol 2013; 43: 335-9)

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Treatment of unresectable meningiomas with the antiprogesterone agent mifepristone

Cited by 360 publications

References 35 publications

Meningiomas and hormonal receptors: immunohistochemical study in typical and non-typical tumors

Meningiomas and hormonal receptors: immunohistochemical study in typical and non-typical tumors

Spontaneous Regression of an Asymptomatic Meningioma Associated With Discontinuation of Progesterone Agonist Administration -Case Report-

Orbita Nörojenik Tümörlerinin Klinik ve Tedavi Özellikleri

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