scholarly journals Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report

2019 ◽  
Vol 46 (6) ◽  
pp. E11 ◽  
Author(s):  
Jason J. Labuschagne ◽  
Dinoshan Chetty
Keyword(s):  
Glioblastoma Multiforme ◽  
Stereotactic Radiosurgery ◽  
Single Case ◽  
Case Reports ◽  
Rare Complication ◽  
Secondary Malignancy ◽  
Surgical Removal ◽  
Who Grade ◽  
Grade Ii ◽  
Who Grade Ii Meningioma

The documentation and exact incidence of stereotactic radiosurgery (SRS)–induced neoplasia is not well understood, with most literature restricted to single case reports and single-center retrospective reviews. The authors present a rare case of radiosurgery-induced glioblastoma multiforme (GBM) following radiosurgical treatment of a meningioma. A 74-year-old patient with a sporadic meningioma underwent radiosurgery following surgical removal of a WHO grade II meningioma. Eighteen months later she presented with seizures, and MRI revealed an intraaxial tumor, which was resected and proven to be a glioblastoma. As far as the authors are aware, this case represents the third case of GBM following SRS for a meningioma. This report serves to increase the awareness of this possible complication following SRS. The possibility of this rare complication should be explained to patients when obtaining their consent for radiosurgery.

The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E16 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
John Hantzmon ◽  
Chun-Po Yen ◽  
Brian J. Williams ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Case Reports ◽  
Case Series ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Who Grade ◽  
Intracranial Meningiomas ◽  
Grade Ii ◽  
Grade Iii

Object WHO Grade II and III intracranial meningiomas are uncommon, but they portend a significantly worse prognosis than their benign Grade I counterparts. The mainstay of current management is resection to obtain cytoreduction and histological tissue diagnosis. The timing and benefit of postoperative fractionated external beam radiation therapy and stereotactic radiosurgery remain controversial. The authors review the stereotactic radiosurgery outcomes for Grade II and III meningiomas. Methods A comprehensive literature search was performed using PubMed to identify all radiosurgery series reporting the treatment outcomes for Grade II and III meningiomas. Case reports and case series involving fewer than 10 patients were excluded. Results From 1998 to 2013, 19 radiosurgery series were published in which 647 Grade II and III meningiomas were treated. Median tumor volumes were 2.2–14.6 cm3. The median margin doses were 14–21 Gy, although generally the margin doses for Grade II meningiomas were 16–20 Gy and the margin doses for Grade III meningiomas were 18–22 Gy. The median 5-year PFS was 59% for Grade II tumors and 13% for Grade III tumors, which may have been affected by patient age, prior radiation therapy, tumor volume, and radiosurgical dose and timing. The median complication rate following radiosurgery was 8%. Conclusions The current data for radiosurgery suggest that it has a role in the management of residual or recurrent Grade II and III meningiomas. However, better studies are needed to fully define this role. Due to the relatively low prevalence of these tumors, it is unlikely that prospective studies will be feasible. As such, well-designed retrospective analyses may improve our understanding of the effect of radiosurgery on tumor recurrence and patient survival and the incidence and impact of treatment-induced complications.

Treatment of WHO grade II meningiomas with stereotactic radiosurgery: identification of an optimal group for SRS using RPA

2021 ◽  
Author(s):  
Roman O. Kowalchuk ◽  
Matthew J. Shepard ◽  
Kimball Sheehan ◽  
Darrah Sheehan ◽  
Andrew Faramand ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Who Grade ◽  
Grade Ii

scholarly journals Predicting meningioma recurrence using spectrochemical analysis of tissues and subsequent predictive computational algorithms

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv5-iv5
Author(s):  
Taha Lilo ◽  
Camilo Morais ◽  
Kate Ashton ◽  
Ana Pardilho ◽  
Timothy Dawson ◽  
...  
Keyword(s):  
Feature Extraction ◽  
Tissue Bank ◽  
Spectrochemical Analysis ◽  
Classification Algorithms ◽  
Computational Algorithms ◽  
Who Grade ◽  
Grade Ii ◽  
Meningioma Recurrence ◽  
Who Grade Ii Meningioma

Abstract Introduction Meningioma recurrence remains a clinical dilemma. This has a significant clinical and huge financial implication. Hence, the search for predictors for meningioma recurrence has become an increasingly urgent research topic in recent years. Objective Using spectrochemical analytical methods such as attenuated total reflection Fourier-transform infrared (ATR-FTIR) and Raman spectroscopy, our primary objective is to compare the spectral fingerprint signature of WHO grade I meningioma vs. WHO grade I meningioma that recurred. Secondary objectives compare WHO grade I meningioma vs. WHO grade II meningioma and WHO grade II meningioma vs. WHO grade I meningioma recurrence. Materials and Methods Our selection criteria included convexity meningioma only restricted to Simpson grade I & II only and WHO grade I & grade II only with a minimum 5 years follow up. We obtained tissue from tumour blocks retrieved from the tissue bank. These were sectioned onto slides and de-waxed prior to ATR-FTIR or Raman spectrochemical analysis. Derived spectral datasets were then explored for discriminating features using computational algorithms in the IRootLab toolbox within MATLAB; this allowed for classification and feature extraction. Results After analysing the data using various classification algorithms with cross-validation to avoid over-fitting of the spectral data, we can readily and blindly segregate those meningioma samples that recurred from those that did not recur in the follow-up timeframe. The forward feature extraction classification algorithms generated results that exhibited excellent sensitivity and specificity, especially with spectra obtained following ATR-FTIR spectroscopy. Our secondary objectives remain to be fully developed.

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.

scholarly journals Epilepsy and insular Grade II gliomas: an interdisciplinary point of view from a retrospective monocentric series of 46 cases

2009 ◽  
Vol 27 (2) ◽  
pp. E8 ◽  
Author(s):  
Luc Taillandier ◽  
Hugues Duffau
Keyword(s):  
Seizure Frequency ◽  
Point Of View ◽  
Favorable Effect ◽  
Surgical Removal ◽  
Extensive Experience ◽  
Who Grade ◽  
Grade Ii ◽  
Sequential Treatments ◽  
Few Data

OBJECTThere are few data in the literature concerning a multimodal approach to insular WHO Grade II gliomas (GIIGs) and the control of epilepsy after treatment. In this paper, the authors describe a monocentric series of 46 cases in which patients underwent various sequential treatments for insular GIIGs. On the basis of global results with regard to epilepsy, the respective interests in the various treatments are discussed.METHODSAvailable data on 46 patients harboring insular GIIGs were extracted from a local database of 288 GIIGs. The various therapeutic sequences were analyzed in parallel with the course of seizure frequency.RESULTSDespite the usual difficulties with seizure quantification in retrospective studies, the authors showed that 1) the negative course of seizure frequency was mostly connected to tumor progression, 2) surgery almost always had a favorable effect on epilepsy, and 3) chemotherapy had a mostly favorable effect with acceptable tolerance. The authors were unable to draw conclusions about the role of radiotherapy given the too few cases.CONCLUSIONSThis extensive experience with insular GIIGs tends to confirm interest in their surgical removal and supports interest in chemotherapy from an epileptological point of view.

A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations

2009 ◽  
Vol 110 (4) ◽  
pp. 696-708 ◽  
Author(s):  
Hugues Duffau
Keyword(s):  
Posterior Part ◽  
Surgical Removal ◽  
Consecutive Series ◽  
Glioma Surgery ◽  
Who Grade ◽  
Additional Surgery ◽  
Grade Ii ◽  
The Impact ◽  
Grade Ii Glioma

Object Few experiences of insular surgery have been reported. Moreover, there are no large surgical studies with long-term follow-up specifically dedicated to WHO Grade II gliomas involving the insula. In this paper, the author describes a personal consecutive series of 51 cases in which patients underwent surgery for an insular Grade II glioma. On the basis of the functional and oncological results, advances and limitations of this challenging surgery are discussed. Methods Fifty-one patients harboring an insular Grade II glioma (revealed by seizures in 50 cases) underwent surgery. Findings on preoperative neurological examination were normal in 45 patients (88%). All surgeries were conducted under cortico-subcortical stimulation, and in the case of 16 patients while awake. Results Despite an immediate postoperative worsening in 30 cases (59%), the condition of all but 2 patients (96%) returned to baseline or better. Postoperative MR imaging demonstrated that 77% of resections were total or subtotal. Ten patients underwent a second or third surgery, with no additional deficit. Forty-two patients (82%) are alive with a median follow-up of 4 years. Conclusions This is the largest reported experience with insular Grade II glioma surgery. The better knowledge of the insular pathophysiology and the use of intraoperative functional mapping allow the risk of permanent deficit to be minimized (and even enable improvement in quality of life) while increasing the extent of resection and thus the impact on the course of the disease. Therefore, surgical removal must always be considered for insular Grade II glioma. However, this surgery remains challenging, especially within the anterior perforating substance and the posterior part of the (dominant) insula. Additional surgery can be suggested in cases in which the first resection is not complete.

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E14 ◽  
Author(s):  
Elizabeth N. Kuhn ◽  
Glen B. Taksler ◽  
Orrin Dayton ◽  
Amritraj G. Loganathan ◽  
Tamara Z. Vern-Gross ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Retrospective Chart Review ◽  
Distant Recurrence ◽  
High Grade ◽  
Who Grade ◽  
Distant Failure ◽  
Grade Ii ◽  
Male Sex ◽  
Multifocal Disease

Object The purpose of this study was to evaluate patterns of failure after stereotactic radiosurgery (SRS) for meningiomas and factors that may influence these outcomes. Methods Based on a retrospective chart review, 279 patients were treated with SRS for meningiomas between January 1999 and March 2011 at Wake Forest Baptist Health. Disease progression was determined using serial imaging, with a minimum follow-up of 6 months (median 34.2 months). Results The median margin dose was 12.0 Gy (range 8.8–20 Gy). Local control rates for WHO Grade I tumors were 96.6%, 84.4%, and 75.7% at 1, 3, and 5 years, respectively. WHO Grade II and III tumors had local control rates of 72.3%, 57.7%, and 52.9% at 1, 3, and 5 years, respectively. Tumors without pathological grading had local control rates of 98.7%, 97.6%, and 94.2% at 1, 3, and 5 years, respectively. Of the local recurrences, 63.1% were classified as marginal (within 2 cm of treatment field). The 1-, 3-, and 5-year rates of distant failure were 6.5%, 10.3%, and 16.6%, respectively, for Grade I tumors and 11.4%, 17.2%, and 22.4%, respectively, for Grade II/III tumors. Tumors without pathological grading had distant failure rates of 0.7%, 3.2%, and 6.5% at 1, 3, and 5 years, respectively. Wilcoxon analysis revealed that multifocal disease (p < 0.001) and high-grade histology (WHO Grade II or III; p < 0.001) were significant predictors of local recurrence. Additionally, male sex was a significant predictor of distant recurrence (p = 0.04). Multivariate analysis also showed that doses greater than or equal to 12 Gy were associated with improved local control (p = 0.015). Conclusions In this patient series, 12 Gy was the minimum sufficient margin dose for the treatment of meningiomas. Male sex is a risk factor for distant failure, whereas high-grade histology and multifocal disease are risk factors for local failure.

scholarly journals Overall Survival Benefit Associated with Adjuvant Radiotherapy in Who Grade II Meningioma

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Chenyang Wang ◽  
Tania Kaprealian ◽  
John Suh ◽  
Charlotte Kubicky ◽  
Jeremy Ciporen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adjuvant Radiotherapy ◽  
Survival Benefit ◽  
Who Grade ◽  
Grade Ii ◽  
Overall Survival Benefit ◽  
Who Grade Ii Meningioma
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