Evolution of the neurosurgical management of progestin‐associated meningiomas: a 23-year single‐center experience

Malaizé, Henri; Samoyeau, Thomas; Zanello, Marc; Roux, Alexandre; Benzakoun, Joseph; Peeters, Sophie; Zah‐Bi, Gilles; Edjlali, Myriam; Tauziède‐Espariat, Arnault; Dezamis, Edouard; Chrétien, Fabrice; Varlet, Pascale; Plu‐Bureau, Geneviève; Oppenheim, Catherine; Pallud, Johan

doi:10.1007/s11060-021-03696-9

Cited by 16 publications

(17 citation statements)

References 24 publications

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“…Although there is a clear tendency towards regression or stabilization after NA and CHA discontinuation, similar to what is observed with CA, the percentage of tumor regression seems to be less important after cessation of CHA or NA [11,15,18,32]. Bernat et al reported a series of 12 CA-related patients, with tumor regression seen in over 90% of the patients.…”

Section: Discussionmentioning

confidence: 68%

“…While the link between CA and meningioma was thoroughly studied, there is far less available data regarding the link between CHA-NA and risk of intracranial meningioma [20,[31][32][33]. The rst suspicion of a link between NA and meningioma was published in 2004 by Cottin et al who described the case of a patient diagnosed with a large meningioma after being treated with NA for 16 years for pulmonary lymphangioleiomyomatosis [34].…”

Section: Discussionmentioning

confidence: 99%

“…In a recently published studying a consecutive series of patients between 1995 and 2008, Malaize et al reported an increased number of patients diagnosed with progestin associated meningiomas over time. The rate of conservatively managed meningiomas also increased over time, with tumor regression seen in 29.6% of cases and tumor stability in 68.5% of patients [32].…”

Section: Discussionmentioning

confidence: 99%

“…Bernat et al reported a series of 12 CA-related patients, with tumor regression seen in over 90% of the patients. Malaize et al showed that CA-related meningioma had a better answer to treatment discontinuation compared to CHA and NA-related tumors [11,32].…”

Section: Discussionmentioning

confidence: 99%

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WITHDRAWN: Nomegestrol Acetate or Chlormadinone Acetate Progestative Treatment in Women: Meningioma Behavior at Treatment Discontinuation

Florea

Boissonneau

Passeri

et al. 2021

Preprint

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Background: Associations between progestins and meningiomas is now well established. While the link between cyproterone acetate (CA) and meningioma was thoroughly studied, there is far less available data regarding the link between chlormadinone acetate (CHA) or nomegestrol acetate (NA) and risk of intracranial meningiomaMethods: We are presenting a series of 28 patients diagnosed with single or multiple meningiomas while treated with CHA-NA, in which the clinical and radiological course were analyzed after treatment discontinuation.Results: 28 women, with a mean age of 56 years old, were diagnosed with one or multiple meningioma while being treated with either CHA or NA. After stopping treatment, 89.3% showed either tumor shrinkage or tumor stabilization on follow-up MRIs. Multiple meningiomas were more likely observed in patients with long periods of treatment (>10 years, p 0.03) and seem to have a better clinical course (p 0.01). Most of the lesions were located on the skull base (55.4%). Four patients with multiple meningiomas showed discordant tumors evolution, with some tumors growing while others were decreasing. Most of the growing meningiomas were either convexity or midline lesions and more posteriorly located. Conclusion: Our study demonstrated a significant percentage of tumor diminution or stabilization after NA and CHA discontinuation. Therefore, treatment discontinuation with close monitoring should be the first measure taken if urgent surgery is not indicated. However, our results seem to be less encouraging than previously described in patients treated by CA, with more patients showing tumor growth despite treatment discontinuation. Further studies are needed to differentiate the effect of the different progestins treatment on meningiomas.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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WITHDRAWN: Nomegestrol Acetate or Chlormadinone Acetate Progestative Treatment in Women: Meningioma Behavior at Treatment Discontinuation

Florea

Boissonneau

Passeri

et al. 2021

Preprint

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“…Several reports have documented an increased risk of meningioma development in patients with long term progestative treatment but causal relationship remains di cult to prove. Similarly, some authors reported a relationship between long term nomegestrol acetate (NA) [8,13,[24][25][26] or chlormadinone acetate (ChlA) [13,15,25,27] treatment and meningioma development. Meningioma regression after CA withdrawal is reported by many authors [2-5, 7-10, 12-15, 19, 21-24, 26, 28] in one third of cases especially for anterior and middle skull base locations.…”

Section: Introductionmentioning

confidence: 98%

Have Progestin Related and Sporadic High Grade Meningiomas the Same Natural History?

Devalckeneer¹,

Aboukaïs²,

Faisant³

et al. 2021

Preprint

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Introduction: High grade progestin related meningiomas have been reported in recent series but we found no previous study describing their long-term outcome. Our study aimed to evaluate patients operated on for high grade intracranial meningioma and who underwent long term exposure to high dose of cyproterone acetate, nomegestrol acetate and chlormadinone acetate.Methods: Our study retrospectively included 9 patients with high grade progestin related intracranial meningioma between December 2006 and December 2020. In each patient, clinico-radiological follow-up was performed every 6 months after diagnosis and treatment withdrawal recommendation. Results: The mean progestative exposure was 11.4 years. Edema existence or absence of cleft sign on MRI were the key factors for surgical indication. All patients underwent surgery. Ajduvant radiotherapy was indicated in 1 patient, and Gamma Knife Radiosurgery was proposed in 2 other patients for a second location of mengioma. 6 patients harbored a grade II chordoïd meningioma subtype with 100% PR expression and 3 patients a grade II atypical meningioma subtype with lower PR expression. The mean follow-up was 7.1 years and none of the 9 patients presented with a recurrence.Conclusion: Patients with Grade II progestin related meningiomas have less tumor recurrence after surgery than patients with sporadic high grade meningomas, especially after progestin withdrawal. The presence/ appearance of peri-meningioma edema and the absence of cleft sign before volumetric change should suggest the existence of an underlying high grade meningioma. In these cases, surgical resection may immediately be considered and adjuvant radiotherapy should be reserved for proven recurrence cases.

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Atypical evolution of meningiomatosis after discontinuation of cyproterone acetate: clinical cases and histomolecular characterization

et al. 2021

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Long-term use of cyproterone acetate (CPA) is associated with an increased risk of developing an intracranial meningioma. Discontinuation of CPA most often induce stabilization or regression of the tumor. The exact mechanism of regression is unknown as well as the reason why some meningiomas are still growing after CPA discontinuation.We are reporting four patients with multiple meningiomas, showing opposite tumor evolutions after stopping the CPA highlighting the underlying histologic and genetic features. MethodsPatients presenting several meningiomaswith opposite evolutions following the discontinuation of CPA were identi ed. The clinical and radiological data's were reviewed. A retrospective volumetric analysis of the meningiomas was performed. All the growing meningiomas were operated. Each tumor was characterized histopathologically and by molecular and genetic analyses. ResultsFour female withmultiple meningiomas and opposite tumor volume evolution after CPA discontinuation were identi ed. The histopathological results found broblastic meningiomas for tumorsgrowinglocated in the convexity and a more brousmeningioma in the skull-base tumor which decreased. Meningothelial and transitional meningiomaswere found in two skull-base growing meningiomas.The molecular characterization found twoNF2-mutations among the 4 growing meningiomas. In one patient who presented both patterns, the shrinking skull-basetumor harbored a PIK3CA-mutation whereas the growing tumor, a NF2-mutation. ConclusionTo our knowledge, this is the rst report of such an atypical tumor evolution of CPA-associated meningiomatosis after CPA discontinuation in the same patient. Underlying biological mechanisms explaining this observationespecially, the close relationship between mutational landscapes and the meningeal embryologyin CPA-related meningiomasrequire further research.

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Evolution of the neurosurgical management of progestin‐associated meningiomas: a 23-year single‐center experience

Cited by 16 publications

References 24 publications

WITHDRAWN: Nomegestrol Acetate or Chlormadinone Acetate Progestative Treatment in Women: Meningioma Behavior at Treatment Discontinuation

WITHDRAWN: Nomegestrol Acetate or Chlormadinone Acetate Progestative Treatment in Women: Meningioma Behavior at Treatment Discontinuation

Have Progestin Related and Sporadic High Grade Meningiomas the Same Natural History?

Atypical evolution of meningiomatosis after discontinuation of cyproterone acetate: clinical cases and histomolecular characterization

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