The growth rate and clinical outcomes of radiation induced meningioma undergoing treatment or active monitoring

Abstract

Introduction Radiation induced meningioma (RIM) incidence is increasing in line with improved childhood cancer survival. No optimal management strategy consensus exists. This study aimed to delineate meningioma growth rates from tumor discovery and correlate with clinical outcomes. Methods Retrospective study of patients with a RIM, managed at a specialist tertiary neuroscience center (2007–2019). Tumor volume was measured from diagnosis and at subsequent interval scans. Meningioma growth rate was determined using a linear mixed-effects model. Clinical outcomes were correlated with growth rates accounting for imaging and clinical prognostic factors. Results Fifty-four patients (110 meningiomas) were included. Median duration of follow-up was 74 months (interquartile range [IQR], 41–102 months). Mean radiation dose was 41 Gy (standard deviation [SD] = 14.9) with a latency period of 34.4 years (SD = 13.7). Median absolute growth rate was 0.62 cm3/year and the median relative growth rate was 72%/year. Forty meningiomas (between 27 patients) underwent surgical intervention after a median follow-up duration of 4 months (IQR 2–35). Operated RIMs were clinically aggressive, likely to be WHO grade 2 at first resection (43.6%) and to progress after surgery (41%). Median time to progression was 28 months (IQR 13–60.5). A larger meningioma at discovery was associated with growth (HR 1.2 [95% CI 1.0–1.5], P = 0.039) but not progression after surgery (HR 2.2 [95% CI 0.7–6.6], P = 0.181). Twenty-seven (50%) patients had multiple meningiomas by the end of the study. Conclusion RIMs exhibit high absolute and relative growth rates after discovery. Surgery is recommended for symptomatic or rapidly growing meningiomas only. Recurrence risk after surgery is high.

Characterization and incidence of radiation-induced meningiomas in a brain tumor database

“…These ndings are consistent with Gillespie et al, whose institutional retrospective study of similar design reported a recurrence rate of 50% and a median progression time of 28 months [12], compared to our cohort with a 73% recurrence rate, and mean progression of 81.4 months. Broadly, the utility of radiation for the treatment of RIMs has not been well characterized.…”

Evaluation of the growth rates and related prognostic factors in radiation-induced meningiomas

“…2 and 3 and a summary of observed correlations and prognostic factors of tumor growth is presented in Table 2. These ndings are in sharp contrast to a recent study by Gillespie and Islim, where a mean growth rate of 0.62 cm³ per year and RGR of 72% per year were described for RIM [14]. Notably, the mean baseline volume of 4.9 cm³ found in their study was also signi cantly higher (almost 25 times) when compared to ours.…”

“…Furthermore, the growth rate of RIMs has not been widely studied [14], particularly using volumetric methods. Volumetric analysis of RIMs growth patterns would be meaningful for both the patient and oncologist since patients treated in their childhood with RT for cancer are undergoing regular brain imaging with small, asymptomatic meningiomas being frequently diagnosed.…”

Clinical Outcomes Following Re-Operations for Intracranial Meningioma

“…Patient sex, age, presenting clinical features, the WHO performance status, and Age-Adjusted Charlson Comorbidity Index (ACCI) were included [ 16 , 20 ]. The risk factors associated with meningioma development, including a history of cranio-spinal radiation, hormone replacement therapy, and genetic syndromes were recorded [ 3 , 21 , 22 ]. The radiological features of the meningioma before the first operation were recorded.…”