Georgios Mantziaris1, Stylianos Pikis1, Yavuz Samanci2, Selcuk Peker2, Ahmed M Nabeel3,4, Wael A Reda3,5, Sameh R Tawadros3,5, Amr M N El-Shehaby3,5, Khaled Abdelkarim3,5, Reem M Emad3,6, Violaine Delabar7, David Mathieu7, Cheng-Chia Lee8, Huai-Che Yang8, Roman Liscak9, Jaromir Hanuska9, Roberto Martinez Alvarez10, Nuria Martinez Moreno10, Manjul Tripathi11, Herwin Speckter12, Camilo Albert12, Ronald J Benveniste13, Greg N Bowden14, Dev N Patel15, Douglas Kondziolka15, Kenneth Bernstein16, L Dade Lunsford17, Michael D Jenkinson18,19, Abdurrahman I Islim18,19, Jason Sheehan20. 1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA. 2. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey. 3. Gamma Knife Center Cairo-Nasser Institute, Giza, Egypt. 4. Department of Neurosurgery, Benha University, Benha, Egypt. 5. Ain Shams University, Cairo, Egypt. 6. Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt. 7. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherché du CHUS, Sherbrooke, Québec, Canada. 8. Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, and National Yang-Ming University, Taipei, Taiwan. 9. Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 10. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain. 11. Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 12. Department of Radiology, Dominican Gamma Knife Center and , CEDIMAT, Santo Domingo, Dominican Republic. 13. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, USA. 14. Department of Neurosurgery, University of Alberta, Edmonton, Canada. 15. Department of Neurosurgery, New York University, New York, USA. 16. Department of Radiation Oncology, New York University, New York, USA. 17. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, USA. 18. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. 19. Institute of Systems and Molecular Biology, University of Liverpool, Liverpool, UK. 20. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA. jsheehan@virginia.edu.
Abstract
OBJECTIVE: The optimal management of asymptomatic, skull-based meningiomas is not well defined. The aim of this study is to compare the imaging and clinical outcomes of patients with asymptomatic, skull-based meningiomas managed either with upfront stereotactic radiosurgery (SRS) or active surveillance. METHODS: This retrospective, multicenter study involved patients with asymptomatic, skull-based meningiomas. The study end-points included local tumor control and the development of new neurological deficits attributable to the tumor. Factors associated with tumor progression and neurological morbidity were also analyzed. RESULTS: The combined unmatched cohort included 417 patients. Following propensity score matching for age, tumor volume, and follow-up 110 patients remained in each cohort. Tumor control was achieved in 98.2% and 61.8% of the SRS and active surveillance cohorts, respectively. SRS was associated with superior local tumor control (p < 0.001, HR = 0.01, 95% CI = 0.002-0.13) compared to active surveillance. Three patients (2.7%) in the SRS cohort and six (5.5%) in the active surveillance cohort exhibited neurological deterioration. One (0.9%) patient in the SRS-treated and 11 (10%) patients in the active surveillance cohort required surgical management of their meningioma during follow-up. CONCLUSIONS: SRS is associated with superior local control of asymptomatic, skull-based meningiomas as compared to active surveillance and does so with low morbidity rates. SRS should be offered as an alternative to active surveillance as the initial management of asymptomatic skull base meningiomas. Active surveillance policies do not currently specify the optimal time to intervention when meningioma growth is noted. Our results indicate that if active surveillance is the initial management of choice, SRS should be recommended when radiologic tumor progression is noted and prior to clinical progression.
OBJECTIVE: The optimal management of asymptomatic, skull-based meningiomas is not well defined. The aim of this study is to compare the imaging and clinical outcomes of patients with asymptomatic, skull-based meningiomas managed either with upfront stereotactic radiosurgery (SRS) or active surveillance. METHODS: This retrospective, multicenter study involved patients with asymptomatic, skull-based meningiomas. The study end-points included local tumor control and the development of new neurological deficits attributable to the tumor. Factors associated with tumor progression and neurological morbidity were also analyzed. RESULTS: The combined unmatched cohort included 417 patients. Following propensity score matching for age, tumor volume, and follow-up 110 patients remained in each cohort. Tumor control was achieved in 98.2% and 61.8% of the SRS and active surveillance cohorts, respectively. SRS was associated with superior local tumor control (p < 0.001, HR = 0.01, 95% CI = 0.002-0.13) compared to active surveillance. Three patients (2.7%) in the SRS cohort and six (5.5%) in the active surveillance cohort exhibited neurological deterioration. One (0.9%) patient in the SRS-treated and 11 (10%) patients in the active surveillance cohort required surgical management of their meningioma during follow-up. CONCLUSIONS: SRS is associated with superior local control of asymptomatic, skull-based meningiomas as compared to active surveillance and does so with low morbidity rates. SRS should be offered as an alternative to active surveillance as the initial management of asymptomatic skull base meningiomas. Active surveillance policies do not currently specify the optimal time to intervention when meningioma growth is noted. Our results indicate that if active surveillance is the initial management of choice, SRS should be recommended when radiologic tumor progression is noted and prior to clinical progression.
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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