A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas

Abstract

Background Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients. Methods A prognostic model of disease progression was developed in a retrospective cohort (2007–2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention. Results Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37–80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53–3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39–21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65–3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74–2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group. Conclusions The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.

Indications and outcome in surgically treated asymptomatic meningiomas: a single-center case-control study

“…The scoring system does not take into account other clinical characteristics such as gender, age, tumor location, or tumor morphology, which have been found to be predictive of significant growth in asymptomatic meningiomas in other studies [11,15,25]. In a similar way, Islim et al [6] present a prognostic model of disease progression developed from a retrospective cohort of 459 asymptomatic meningiomas. The patients were stratified based on imagining parameters such as tumor volume, tumor hyperintensity, peritumoral signal change, and proximity to critical neurovascular structures, and then placed into low-, medium-and high-risk groups.…”

“…In this study, we make no attempt to present the management as the optimal clinical decision-making process, but we describe real-life decisions. We hope this can create further discussion on the topical issue of management of asymptomatic meningioma [6,7,23]. Now we can only speculate how nuanced counseling on pros and cons of surgery was provided to the 25.6% of the asymptomatic cases that were operated upon because of the patient's own wish as main indication.…”

Initial Gamma Knife Radiosurgery for Large or Documented Growth Asymptomatic Meningiomas: Long-Term Results From a 27-Year Experience

“…The follow-up evaluations were evaluated by experienced clinicians and radiologists. Tumor volume was based on ABC/2 formula: (A) maximum tumor diameter on axial plane; (B) diameter perpendicular to (A), and (C) maximum height on sagittal/ coronal plane (16). Tumor shrinkage was defined as a reduction in tumor size at least 20% in any diameter.…”

Short Course Hypofractionated Radiotherapy for Frail or Elderly Patients With Meningioma

“…Intracranial meningiomas originate from the meninges and are classified into three grades according to the World Health Organization (I, II or III) [ 1 ]. Grade I tumors are slow-growing and are often found incidentally by CT or MRI [ 2 , 3 ]. The incidence of meningiomas increases with age, with the highest incidence in individuals age 80 or older [ 4 , 5 ].…”