Trends in Management of Intracranial Meningiomas: Analysis of 49,921 Cases from Modern Cohort

Agarwal, Vijay; McCutcheon, Brandon A.; Hughes, Joshua D.; Carlson, Matthew L.; Glasgow, Amy E.; Habermann, Elizabeth B.; Nguyen, Quoc-Bao D.; Link, Michael J.; Gompel, Jamie J. Van

doi:10.1016/j.wneu.2017.06.127

Cited by 40 publications

(32 citation statements)

References 16 publications

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“…Meningiomas represent the most common primary intracranial neoplasm and can arise anywhere along the skull-base or convexities thereby mandating a catalog of therapeutic considerations to individualize treatment. 1 The great majority of the intracranial meningioma literature has reported total population data, while very limited information exists regarding racial differences in disease epidemiology and management trends. 2 We sought to further investigate racial differences in intracranial meningiomas with regard to disease incidence, presentation, treatment, and outcome in the United States.…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in Disease Presentation and Management of Intracranial Meningioma

Anzalone

Glasgow²,

Gompel

et al. 2018

J Neurol Surg B

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Objective/Hypothesis The aim of the study was to determine the impact of race on disease presentation and treatment of intracranial meningioma in the United States. Study Design This study comprised of the analysis of a national population-based tumor registry. Methods Analysis of the surveillance, epidemiology, and end results (SEER) database was performed, including all patients identified with a diagnosis of intracranial meningioma. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model. Results A total of 65,973 patients with intracranial meningiomas were identified. Of these, 45,251 (68.6%) claimed white, 7,796 (12%) black, 7,154 (11%) Hispanic, 4,902 (7%) Asian, and 870 (1%) patients reported “other-unspecified” or “other-unknown.” The median annual incidence of disease was lowest among black (3.43 per 100,000 persons) and highest among white (9.52 per 100,000 persons) populations (p < 0.001). Overall, Hispanic patients were diagnosed at the youngest age and white patients were diagnosed at the oldest age (mean of 59 vs. 66 years, respectively; p < 0.001). Compared with white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors (p < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely to undergo surgery than white, black, and Asian populations. Black populations had the poorest disease specific and overall survival rates at 5 years following surgery compared with other groups. Conclusion Racial differences among patients with intracranial meningioma exist within the United States. Understanding these differences are of vital importance toward identifying potential differences in the biological basis of disease or alternatively inequalities in healthcare delivery or access Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.

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Section: Introductionmentioning

confidence: 99%

Racial Differences in Disease Presentation and Management of Intracranial Meningioma

Anzalone

Glasgow²,

Gompel

et al. 2018

J Neurol Surg B

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“…Interestingly, in 2007, they noticed that the majority of patients underwent either surgery or radiation as a treatment modality, which is different from our findings where observation was the main treatment modality. 13 The total number of meningiomas that were diagnosed and treated has increased over time. The number nearly doubled between 2004 and 2015.…”

Section: Discussionmentioning

confidence: 99%

“…22 Agarwal et al reported an increase in the odds for using observation as the main treatment modality for smaller or WHO grade 1 tumors, with an increase in the odds for using surgery for larger or WHO grades 2 and 3 meningiomas. 13 For WHO grade 3 tumors, several reports showed that a combination therapy increases survival. [23][24][25] Cao et al noted that for WHO grade 3 tumors, no significant difference in progression-free survival between patients with and without radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Management Paradigms of Intracranial Meningioma

Aljuboori

Alhourani

Woo

et al. 2019

J Neurol Surg B Skull Base

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Objective Intracranial meningiomas are the most common primary brain tumor. Treatment paradigms have evolved over time. There are limited number of population-based studies that examine this modern evolution. Here, we describe the trends of management of intracranial meningiomas using a national database. Methods The data were obtained from the National Cancer Database for the years 2004 to 2015, the collected variables included: patients' age, gender, insurance type, income, comorbidity score, the tumor size and grade, and treatment modality (observation, surgery, radiotherapy, or combination therapy). We performed statistical analyses to detect association between unique variables and outcomes. In addition, we performed mortality analyses for various treatment modalities. Results A total of 199,096 patients with a diagnosis of intracranial meningioma were included, the majority of patients were white females, mean age of 61 years, and half of the tumors were ≤ 3 cm. Observation was the most commonly used management modality followed by surgical resection, radiotherapy, and combination therapy. For the entire time period, there was an increased use of observation as a primary management method. Predictors of mortality included increased age, larger tumor size, higher tumor grade, treatment at a community hospital, and higher comorbidity scores. Conclusion Population-based studies of intracranial meningiomas are uncommon; our study is one of the few reports that examine the changes in the modern management paradigms of meningioma in the United States over time. Additionally, we shed light on the factors that affected survival of patients with this condition.

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“…nign meningiomas represent approximately 94% of all meningioma cases, whereas atypical and anaplastic meningiomas account for about 4% and 1%, respectively. 1 These tumors are most common in older individuals, with an average age of approximately 64 years at onset and an increasing incidence with age. 1 There is also a well-documented increased incidence of these tumors in women (73% in women overall 8 and 80% of spinal cord meningiomas in women 23 ).…”

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confidence: 99%

“…1 These tumors are most common in older individuals, with an average age of approximately 64 years at onset and an increasing incidence with age. 1 There is also a well-documented increased incidence of these tumors in women (73% in women overall 8 and 80% of spinal cord meningiomas in women 23 ). Some evidence suggests that this trend is not seen in pediatric patients, 8 in whom these tumor types are rare and likely associated with neurofibromatosis type 2 (NF2) or therapeutic radiation for other malignancies.…”

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confidence: 99%

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

Reddy¹,

Ryoo²,

Denyer³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.

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Trends in Management of Intracranial Meningiomas: Analysis of 49,921 Cases from Modern Cohort

Cited by 40 publications

References 16 publications

Racial Differences in Disease Presentation and Management of Intracranial Meningioma

Racial Differences in Disease Presentation and Management of Intracranial Meningioma

Trends in the Management Paradigms of Intracranial Meningioma

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

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