scholarly journals Major complications from radiotherapy following treatment for atypical meningiomas

2019 ◽  
Vol 46 (6) ◽  
pp. E5 ◽  
Author(s):  
Troy Dawley ◽  
Zaker Rana ◽  
Hussam Abou-Al-Shaar ◽  
Anuj Goenka ◽  
Michael Schulder
Keyword(s):  
Cognitive Decline ◽  
Treatment Options ◽  
Mass Effect ◽  
Postoperative Management ◽  
Atypical Meningioma ◽  
Normal Brain ◽  
Who Grade ◽  
Cerebrospinal Fluid Diversion ◽  
Major Complications ◽  
Grade Ii

OBJECTIVEComplications from radiotherapy (RT), in a primary or adjuvant setting, have overall been described as uncommon, with few detailed descriptions of major complications. The authors present two cases involving significant complications and their management in their review of patients undergoing RT for treatment of atypical meningioma.METHODSThe authors conducted a retrospective review of all patients with pathologically confirmed atypical meningioma (WHO grade II) treated with primary or adjuvant RT from February 2011 through February 2019. They identified two patients with long-term, grade 3 toxicity. The cases of these patients are described in detail.RESULTSTwo patients had major complications associated with postoperative RT. Patients 1 and 2 both were treated with postoperative RT for pathologically confirmed atypical meningioma. Patient 1 experienced worsening behavioral changes, cognitive decline, and hydrocephalus following treatment. This required cerebrospinal fluid diversion. Patient 2 developed radiation necrosis with mass effect and cognitive decline. Neither patient returned to his/her initial post-RT status after steroid therapy, and each remained in need of supportive care. Both patients remained free of tumor progression at 52 and 38 months following treatment.CONCLUSIONSThe postoperative management of patients with atypical meningioma continues to be defined, with questions remaining regarding timing of RT, dose, target delineation, and fractionation. Both of the patients in this study received fractionated RT, which included a greater volume of normal brain than more focal treatment options such as would be required by stereotactic radiosurgery (SRS). Further research is needed to compare SRS and fractionated RT for the management of patients with grade II meningiomas. The more focused nature of SRS may make this a preferred option in certain cases of focal recurrence.

scholarly journals The Expression of Progesterone Receptors in Meningiomas of Different Grades

2019 ◽  
Vol 8 (2) ◽  
pp. 65-69
Author(s):  
Mohammad Tahir ◽  
Tehreem Atif ◽  
Summaya Sohail ◽  
Arfa Nawazish ◽  
Huma Mushtaq
Keyword(s):  
Progesterone Receptor ◽  
Treatment Options ◽  
Progesterone Receptors ◽  
Lower Grade ◽  
Immunoperoxidase Method ◽  
Nuclear Staining ◽  
Who Grade ◽  
Grade Ii ◽  
Who Grade Iii ◽  
Grade Iii

Background: Meningiomas are slow growing intracranial and intraspinal neoplasms with a tendency to recur locally. WHO grades them as I (benign), II (atypical) and III (anaplastic) in order of their increasing aggressiveness, based on histological parameters and brain parenchymal invasion. Progesterone receptors (PR) are more prevalent amongst the lower grade meningiomas. The objective of this study was to determine the immunohistochemical expression of progesterone receptors in meningiomas of different grades.Material and Methods: A total of 100 cases were selected over a period of 2.5 years. Three to five microns’ thick sections stained with Hematoxylin and Eosin were examined microscopically by a team of two Histopathologists and graded into grades I, II and III, according to 2016 WHO classification criteria. Another section of the original tumor was stained with progesterone receptor antibody using the conventional immunoperoxidase method. Stained slides were than examined by the same team of Histopathologists and declared positive (if nuclear staining was observed in more than 10% of tumor cells) or negative. Statistical analysis was done using SPSS version 21.Results: Out of a total of 100 cases of meningioma, there were 79 cases of benign/typical WHO grade I, 15 cases of atypical/ WHO grade II and 6 cases of anaplastic/ WHO grade III tumor. PR status was positive in 89.8 % (71/79) of grade I meningiomas and 46.6 % (7/15) of grade II/Atypical meningiomas. The 06 cases of Anaplastic/WHO grade III tumors were negative for PR. There was a higher prevalence of Progesterone receptors in female patients (89.8%; 53/59) as compared to male meningioma patients (60.9%; 25/41).Conclusion: We observed a decreased expression of progesterone receptor in higher grades of meningioma in this study. It is an effort to explore conservative treatment options for inoperable lesions, as anti-progesterone therapy may hold a promise as a new treatment option in the near future.

scholarly journals MNGI-10. ATYPICAL MENINGIOMA: EARLY OUTCOMES WITH OR WITHOUT POSTOPERATIVE RADIATION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi141-vi141
Author(s):  
Peter Pan ◽  
David Pisapia ◽  
Rohan Ramakrishna ◽  
Theodore Schwartz ◽  
Philip Stieg ◽  
...  
Keyword(s):  
Single Case ◽  
Previous Treatment ◽  
Progression Free Survival ◽  
Atypical Meningioma ◽  
Who Grade ◽  
Long Term Stability ◽  
Grade Ii ◽  
Atypical Meningiomas ◽  
Lost To Follow Up

Abstract BACKGROUND Adjuvant radiotherapy (RT) in atypical meningioma, especially for gross-totally resected tumors, remains controversial. METHODS We retrospectively identified histologically-confirmed cases of WHO Grade II atypical meningioma at a large academic institution from 2004–2018. Clinicodemographic, surgical, radiation therapy (RT), and histopathologic data were collected, as well as imaging and clinical outcomes, with a median follow-up time of 26 months (IQR 32). Patients were stratified by resection status and whether or not upfront RT was administered. Additionally, subanalyses were performed to compare external beam RT (EBRT) and stereotactic radiosurgery (SRS). Progression was defined by radiology report. RESULTS Of 122 patients, 45 were excluded for lacking adequate records of previous treatment, less than 3 months follow-up, or lacking MR imaging. Of 77 patients analyzed, 57% (44/77) were female; median 59-years-old. 48% (24/50) of gross-total-resections (GTR) received upfront RT – only a single case progressed, at 39 months. Of 26 GTR patients without upfront RT, 8/26 (31%) progressed at median 19.5 months – of these, 2 were lost to follow-up, 5 received salvage RT, and 1 had surgery alone. Adjuvant RT was associated with superior progression free survival (PFS) in GTR (Cox proportional hazard ratio 0.15, likelihood-ratio p=0.025; median PFS not reached). Of 15 subtotal resections (STR) receiving upfront RT, 11 received EBRT and 4 received SRS – 6 progressed (median 37 months), all after EBRT. Upfront SRS demonstrated superior PFS over EBRT following STR (p=0.036). Across the cohort there was one confirmed death, a GTR patient (without RT) who suffered an ischemic stroke at 11 months. CONCLUSION This large single-center retrospective analysis indicates adjuvant RT improves PFS in GTR atypical meningiomas, in concordance with prior studies. It is limited by short median follow-up, possibly related to long-term stability in treated patients. In STR tumors, SRS may contribute to improved PFS compared to EBRT.

WHO Grade II and III supratentorial hemispheric ependymomas in adults: case series and review of treatment options

2008 ◽  
Vol 91 (3) ◽  
pp. 323-328 ◽  
Author(s):  
Toba N. Niazi ◽  
Elizabeth M. Jensen ◽  
Randy L. Jensen
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Who Grade ◽  
Grade Ii

scholarly journals Outcomes following Upfront Radiation versus Monitoring in Atypical Meningiomas: 16-year Experience at a Tertiary Medical Center

2021 ◽  
Author(s):  
Peter C Pan ◽  
David J Pisapia ◽  
Rohan Ramakrishna ◽  
Theodore H Schwartz ◽  
Susan C Pannullo ◽  
...  
Keyword(s):  
Medical Center ◽  
Progression Free Survival ◽  
Atypical Meningioma ◽  
World Health ◽  
Subtotal Resection ◽  
Who Grade ◽  
Resection Status ◽  
Grade Ii ◽  
Health Organization ◽  
Atypical Meningiomas

Abstract Background The role of post-operative upfront radiotherapy (RT) in the management of gross totally resected atypical meningiomas remains unclear. This single-center retrospective review of newly-diagnosed histologically-confirmed cases of World Health Organization (WHO) Grade II atypical meningioma at Weill Cornell Medicine from 2004-2020 aims to compare overall survival (OS) and progression free survival (PFS) of post-operative upfront radiotherapy versus observation, stratified by resection status (gross total resection [GTR)] versus subtotal resection [STR]). Methods 90 cases of atypical meningioma were reviewed (56% women; median age 61 years; median follow-up 41 months). Results In patients with GTR, hazard ratio (HR) of PFS was 0.09 for post-operative upfront RT versus observation alone (95% confidence interval [CI] 0.01-0.68; p = 0.02), though HR for OS was not significant (HR 0.46; 95% CI 0.05-4.45; p = 0.5). With RT, PFS was 100% at 12 and 36 months (compared to 84% and 63% respectively with observation); OS at 36 months was 100% (compared to 94% with observation). In patients with STR, though PFS at 36 months was higher for RT arm versus observation (84% versus 74%), OS at 36 months was 100% in both arms. HR was not significant (HR 0.76; 95% CI 0.16-3.5; p = 0.73). Conclusion This retrospective study suggests post-operative upfront radiotherapy following GTR of atypical meningioma is associated with improved PFS compared to observation. Further studies are required to draw conclusions about OS.

scholarly journals Maximum 11C-methionine PET uptake as a prognostic imaging biomarker for newly diagnosed and untreated astrocytic glioma

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Kosuke Nakajo ◽  
Takehiro Uda ◽  
Toshiyuki Kawashima ◽  
Yuzo Terakawa ◽  
Kenichi Ishibashi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Surgical Excision ◽  
University Hospital ◽  
World Health ◽  
Imaging Biomarker ◽  
Normal Brain ◽  
Newly Diagnosed ◽  
Who Grade ◽  
Astrocytic Glioma ◽  
Grade Ii

AbstractThis study aimed whether the uptake of amino tracer positron emission tomography (PET) can be used as an additional imaging biomarker to estimate the prognosis of glioma. Participants comprised 56 adult patients with newly diagnosed and untreated World Health Organization (WHO) grade II–IV astrocytic glioma who underwent surgical excision and were evaluated by 11C-methionine PET prior to the surgical excision at Osaka City University Hospital from July 2011 to March 2018. Clinical and imaging studies were retrospectively reviewed based on medical records at our institution. Preoperative Karnofsky Performance Status (KPS) only influenced progression-free survival (hazard ratio [HR] 0.20; 95% confidence interval [CI] 0.10–0.41, p < 0.0001), whereas histology (anaplastic astrocytoma: HR 5.30, 95% CI 1.23–22.8, p = 0.025; glioblastoma: HR 11.52, 95% CI 2.27–58.47, p = 0.0032), preoperative KPS ≥ 80 (HR 0.23, 95% CI 0.09–0.62, p = 0.004), maximum lesion-to-contralateral normal brain tissue (LN max) ≥ 4.03 (HR 0.24, 95% CI 0.08–0.71, p = 0.01), and isocitrate dehydrogenase (IDH) status (HR 14.06, 95% CI 1.81–109.2, p = 0.011) were factors influencing overall survival (OS) in multivariate Cox regression. OS was shorter in patients with LN max ≥ 4.03 (29.3 months) than in patients with LN max < 4.03 (not reached; p = 0.03). OS differed significantly between patients with IDH mutant/LN max < 4.03 and patients with IDH mutant/LN max ≥ 4.03. LN max using 11C-methionine PET may be used in prognostic markers for newly identified and untreated WHO grade II–IV astrocytic glioma.

scholarly journals Diagnosis and Predictors of Treatment Outcomes in Meningiomas with Atypical or Anaplastic Histology

2018 ◽  
Vol 27 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Gustavo Simiano Jung ◽  
Ricardo Ramina ◽  
Erasmo Barros Da Silva Jr ◽  
Maurício Coelho Neto
Keyword(s):  
Treatment Outcomes ◽  
Treatment Options ◽  
Gross Total Resection ◽  
Total Resection ◽  
Who Grade ◽  
Grade Ii ◽  
Anaplastic Histology ◽  
Biological Nature

Atypical and anaplastic meningiomas (WHO grade II and III) are uncommon tumors with poorer prognosis than benign meningiomas. They represent a small and heterogeneous subgroup of meningiomas that has more aggressive biological nature and higher frequency of recurrence. Treatment of these tumors remains challenging and recurrence is common even after gross total resection. We report five year experience of an experienced neurosurgical center (INC) reviewing treatment options and predictor of treatment outcomes for malignant meningiomas.

scholarly journals A basic review on systemic treatment options in WHO grade II-III gliomas

2021 ◽  
Vol 92 ◽  
pp. 102124
Author(s):  
Maximilian J. Mair ◽  
Marjolein Geurts ◽  
Martin J. van den Bent ◽  
Anna S. Berghoff
Keyword(s):  
Systemic Treatment ◽  
Treatment Options ◽  
Who Grade ◽  
Grade Ii

Role of Gamma Knife surgery for intracranial atypical (WHO Grade II) meningiomas

2013 ◽  
Vol 119 (6) ◽  
pp. 1410-1414 ◽  
Author(s):  
Shunya Hanakita ◽  
Tomoyuki Koga ◽  
Hiroshi Igaki ◽  
Naoya Murakami ◽  
Soichi Oya ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Local Control ◽  
Univariate Analysis ◽  
Atypical Meningioma ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Who Grade ◽  
Fractionated Radiotherapy ◽  
Grade Ii

Object Atypical meningioma often recurs even after resection. As a salvage modality, radiotherapy or stereotactic radiosurgery (SRS) is attempted for this aggressive tumor. This retrospective study was performed to evaluate the efficacy of SRS that involved Gamma Knife surgery (GKS) for atypical meningioma. Methods The authors reviewed records from 22 patients with histologically proven atypical meningioma who underwent GKS for 28 lesions at the authors' institute. The median patient age was 70 years (range 24–91 years), and the median tumor volume for each procedure was 6.0 cm3 (range 1.6–38.7 cm3). The margin dose ranged from 14 to 20 Gy (median 18 Gy). Follow-up periods ranged from 3 months to 98 months (median 23.5 months). Results In total, 39 GKS procedures were performed for 28 lesions. The local control rates at 1, 2, and 5 years were 74%, 39%, and 16%, respectively. Volume less than 6 cm3 (p = 0.01), a margin dose higher than 18 Gy (p = 0.02), and a Karnofsky Performance Scale (KPS) score of 90 or more (p = 0.02) were factors associated with a longer duration of tumor control in the univariate analysis. Conclusions Atypical meningioma could be more successfully controlled when a higher margin dose was used to treat patients with a good performance (KPS score of ≥ 90) status and smaller tumor volumes. It would be desired if patients are treated with a relatively higher margin dose, ideally as high as the dose applied for malignant tumor. A boost SRS after fractionated radiotherapy may be effective to achieve better local control.

High Cervical Ependymoma Resection: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 516-517
Author(s):  
Simone E Dekker ◽  
Chad A Glenn ◽  
Thomas A Ostergard ◽  
Brian D Rothstein ◽  
Nicholas C Bambakidis
Keyword(s):  
High Speed ◽  
Treatment Options ◽  
Tumor Resection ◽  
Postoperative Management ◽  
Skin Incision ◽  
Gross Total Resection ◽  
Total Resection ◽  
Who Grade ◽  
Postoperative Mri ◽  
High Cervical

Abstract This operative video illustrates resection of a cervical ependymoma in a 40-yr-old female with numbness of upper and lower extremities and ataxia. Magnetic resonance imaging (MRI) demonstrated an enhancing intramedullary intradural spinal mass at C2-3. The patient underwent a posterior cervical laminoplasty for tumor resection. This video highlights the natural history of this disease, treatment options, surgical procedure, potential risks and complications, and postoperative management of ependymomas. A posterior midline skin incision was made from the inion to the level of C4 which exposed the posterolateral elements of C1-3. C2 and C3 lamina were removed as a single piece using the high-speed drill. A C1 laminectomy was then also performed to provide adequate superior exposure. The dura was opened widely in the midline. Careful midline myelotomy was then performed overlying the tumor. The tumor is noted to be densely adherent to the surrounding spinal cord. Gross total resection was completed using ultrasonic aspiration and microdissection. The dura was closed in a watertight fashion followed by a synthetic dural sealant. The bony elements of C2, C3 were then reconstructed using osteoplastic laminoplasty, titanium miniplates, and screws at C2-3. The wound was closed in multiple layers using sutures. Specimens were sent for frozen and permanent pathological analysis, eventually demonstrating WHO grade II ependymoma. There were no complications. Postoperative MRI demonstrated gross total resection. The patient had an uneventful postoperative course. The strength was at baseline at long term follow-up, with small sensory deficit.

Positron emission tomography with injection of methionine as a prognostic factor in glioma

2001 ◽  
Vol 95 (5) ◽  
pp. 746-750 ◽  
Author(s):  
Olivier De Witte ◽  
Ilan Goldberg ◽  
David Wikler ◽  
Sandrine Rorive ◽  
Philippe Damhaut ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Emission Tomography ◽  
Normal Brain ◽  
Brain Uptake ◽  
Who Grade ◽  
Content Type ◽  
Positron Emission ◽  
Grade Ii ◽  
Met Pet ◽  
Fine Print

Object. Positron emission tomography with l-[methyl-11C]methionine (MET-PET) provides information on the metabolism of gliomas. The aim of this study was to determine the predictive value of MET-PET in the treatment of patients with gliomas. Methods. Since 1992, 85 patients with a World Health Organization (WHO) classification—verified glioma underwent PET studies in which MET was injected before (74 cases) or after treatment (11 cases). Analysis of PET data was conducted by the same investigator using two scales: a qualitative visual grading scale and a quantitative scale (ratio between tumor uptake and normal brain uptake, classified on a seven-level scale). Uptake of MET was present in 98% of gliomas. The investigator judged this uptake to be moderate to very high based on visual inspection (qualitative scale). For all grades of gliomas, a visual grade of 3 was statistically associated with a shorter patient survival period (p < 0.005). The tumor/normal brain uptake ratio was significantly influenced by the histological grade of the tumor. A statistically poor outcome was demonstrated when this ratio was higher than a threshold of 2.2 for a WHO Grade II tumor and 2.8 for WHO Grade III tumor. For Grade II and III tumors, oligodendrogliomas had a higher uptake of MET than astrocytomas. Conclusions. Uptake of MET was present in 98% of the gliomas studied. A high uptake is statistically associated with a poor survival time. The intensity of MET uptake represents a prognostic factor for WHO Grade II and III tumors considered separately.

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