Initial management of meningiomas: Analysis of the National Cancer Database

Abstract

Background: Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States. Methods: We analyzed the National Cancer Database from 2004-2014, for all patients with diagnosis of meningioma. Results: 201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher

Trends in the use of radiation for meningioma across the United States

“…Although multi-fraction SRS regimens are used, only one prospective trial examining this has been performed, for which long-term results have not yet been published [ 4 ]. Other studies using the National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results (SEER) databases have been performed recently to analyze trends in treatment and outcomes for the disease entity as a whole, however none have done this with a focus on radiotherapy and the use of SRS [ 5 - 7 ]. Keeping in mind that radiation treatment and techniques differ by grade and the known clinicopathologic data, we utilized the NCDB to examine trends in the use of radiation therapy for meningioma and assessed factors that led to the use of radiation as well as predictors of survival in these patients.…”

Risk Stratification to Define the Role of Radiotherapy for Benign and Atypical Meningioma: A Recursive Partitioning Analysis

“…1 Although maximal safe resection is the mainstay of treatment and the extent of surgical resection is one of the most important prognostic factors for meningioma, [2][3][4][5][6] a significant portion of patients receive surgery combined with radiotherapy (RT). 7 As anaplastic meningioma is the most aggressive type of meningioma and shows high rates of local recurrence, 8 adjuvant RT has an important role in its treatment. 2,3 However, the role of adjuvant RT in treating benign and atypical meningioma remains controversial and lacks high-level evidence.…”

Imaging and Pathological Features and Recurrence Causes of Cystic Meningioma

“…The observed predominance of women over men in the case of cystic meningiomas aligns with general epidemiological trends seen with meningiomas. Multiple studies have pointed towards hormonal factors as a potential explanation (7,8). Estrogen and progesterone receptors are frequently found in meningioma cells, suggesting that these tumors might be influenced by sex hormones.…”

“…The definition of cystic meningioma is associated with meningiomas macroscopical cysts. These macroscopical cysts can be described as intra-tumoral degenerative cysts, reactive intraparenchymal cysts, or peritumoral arachnoid cysts (6,7).…”