Jason Sheehan1, Stylianos Pikis1, Abdurrahman I Islim2,3, Ching-Jen Chen1, Adomas Bunevicius1, Selcuk Peker4, Yavuz Samanci4, Ahmed M Nabeel5,6, Wael A Reda5,7, Sameh R Tawadros5,7, Amr M N El-Shehaby5,7, Khaled Abdelkarim5,7, Reem M Emad5,8, Violaine Delabar9, David Mathieu9, Cheng-Chia Lee10,11, Huai-Che Yang10,11, Roman Liscak12, Jaromir Hanuska12, Roberto Martinez Alvarez13, Dev Patel14, Douglas Kondziolka14,15, Nuria Martinez Moreno13, Manjul Tripathi16, Herwin Speckter17, Camilo Albert17, Greg N Bowden18, Ronald J Benveniste19, Lawrence Dade Lunsford20, Michael D Jenkinson2,3. 1. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA. 2. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. 3. Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. 4. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey. 5. Gamma Knife Center Cairo, Nasser Institute, Cairo, Egypt. 6. Department of Neurosurgery, Benha University, Benha, Egypt. 7. Department of Neurosurgery, Ain Shams University, Cairo, Egypt. 8. Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt. 9. Division of Neurosurgery, Centre Hospitalier Université de Sherbrooke, Sherbrooke, Quebec, Canada. 10. Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei City, Taiwan (ROC). 11. Department of Neurosurgery, National Yang-Ming University, Beitou District, Taipei City, Taiwan (ROC). 12. Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 13. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain. 14. Department of Neurosurgery, New York University, Cary, North Carolina, USA. 15. Department of Neurosurgery and Radiation Oncology, New York University, New York, NY, USA. 16. Department of Neurosurgery and Radiotherapy, Nehru Hospital Sector 12, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India. 17. Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic. 18. Department of Neurosurgery, 2D1.02 Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada. 19. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA. 20. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abstract
BACKGROUND: The optimal management of patients with incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma patients. METHODS: Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups. RESULTS: In the unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (P < .001; OR 56.860 [95% CI 26.253-123.150]). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (P = .764; OR 0.890 [95% CI 0.416-1.904]). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (P < .001; OR 94.461 [95% CI 23.082-386.568]). In matched cohorts, new neurological deficits were noted in 2.3% of SRS-treated and 3.2% of conservatively managed patients (P = .475; OR 0.700 [95% CI 0.263-1.863]). CONCLUSIONS: SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.
BACKGROUND: The optimal management of patients with incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma patients. METHODS: Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups. RESULTS: In the unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (P < .001; OR 56.860 [95% CI 26.253-123.150]). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (P = .764; OR 0.890 [95% CI 0.416-1.904]). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (P < .001; OR 94.461 [95% CI 23.082-386.568]). In matched cohorts, new neurological deficits were noted in 2.3% of SRS-treated and 3.2% of conservatively managed patients (P = .475; OR 0.700 [95% CI 0.263-1.863]). CONCLUSIONS: SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.
Authors: Raymond Y Huang; Wenya Linda Bi; Michael Weller; Thomas Kaley; Jaishri Blakeley; Ian Dunn; Evanthia Galanis; Matthias Preusser; Michael McDermott; Leland Rogers; Jeffrey Raizer; David Schiff; Riccardo Soffietti; Jörg-Christian Tonn; Michael Vogelbaum; Damien Weber; David A Reardon; Patrick Y Wen Journal: Neuro Oncol Date: 2019-01-01 Impact factor: 12.300
Authors: Abdurrahman I Islim; Midhun Mohan; Richard D C Moon; Nisaharan Srikandarajah; Samantha J Mills; Andrew R Brodbelt; Michael D Jenkinson Journal: J Neurooncol Date: 2019-01-17 Impact factor: 4.130
Authors: Abdurrahman I Islim; Ruwanthi Kolamunnage-Dona; Midhun Mohan; Richard D C Moon; Anna Crofton; Brian J Haylock; Nitika Rathi; Andrew R Brodbelt; Samantha J Mills; Michael D Jenkinson Journal: Neuro Oncol Date: 2020-02-20 Impact factor: 12.300
Authors: Othman Bin-Alamer; Nada Alnefaie; Jumanah Qedair; Adhiraj Chaudhary; Hana Hallak; Arif Abdulbaki; Arka N Mallela; Paolo Palmisciano; Zachary C Gersey; Andrew D Legarreta; Mohamed A Labib; Gabriel Zada; Jason P Sheehan; William T Couldwell; L Dade Lunsford; Hussam Abou-Al-Shaar Journal: J Neurooncol Date: 2022-08-17 Impact factor: 4.506
Authors: Abdurrahman I Islim; Georgios Mantziaris; Stylianos Pikis; Ching-Jen Chen; Adomas Bunevicius; Selçuk Peker; Yavuz Samanci; Ahmed M Nabeel; Wael A Reda; Sameh R Tawadros; Amr M N El-Shehaby; Khaled Abdelkarim; Reem M Emad; Violaine Delabar; David Mathieu; Cheng-Chia Lee; Huai-Che Yang; Roman Liscak; Jaromir May; Roberto Martinez Alvarez; Nuria Martinez Moreno; Manjul Tripathi; Douglas Kondziolka; Herwin Speckter; Camilo Albert; Greg N Bowden; Ronald J Benveniste; Lawrence Dade Lunsford; Jason P Sheehan; Michael D Jenkinson Journal: Cancers (Basel) Date: 2022-03-03 Impact factor: 6.639