-
Radiation Oncology (London, England) Jun 2018The aim of the present study was to evaluate the influence of the applied safety margins of modern intensity-modulated radiotherapy (IMRT) in patients with high-grade...
BACKGROUND
The aim of the present study was to evaluate the influence of the applied safety margins of modern intensity-modulated radiotherapy (IMRT) in patients with high-grade meningiomas on local control and recurrence patterns.
METHODS
Twenty patients with a neuropathological diagnosis of a high-grade meningioma (WHO°II or °III) treated with adjuvant or definitive radiotherapy between 2010 and 2015 were included in the present retrospective analysis. All patients were planned PET-based. Recurrence patterns were assessed by means of MRI and/or DOTATATE-PET/computertomography (CT).
RESULTS
The median follow-up was 31.0 months [95% confidence interval (CI): 20.1-42.0] and the progression-free survival (PFS) after 24 months was 87.5%. Overall, four patients had a local recurrence of their meningioma. Of these, three were located in field according to the prior radiotherapy treatment region, while only one patient had a distant relapse. There were no independent factors influencing progression-free or overall survival (OS).
CONCLUSION
After radiotherapy (RT), patients with atypical or anaplastic meningiomas still have a defined risk of tumor recurrence. The aim of the present study was to examine mono-institutional data concerning target volume definition and recurrence patterns after radiotherapy of high-grade meningiomas as there are limited data available. Our data suggest that extended safety margins are necessary to achieve a favorable local control for high-grade meningiomas.
Topics: Adult; Aged; Disease-Free Survival; Female; Follow-Up Studies; Germany; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Retrospective Studies; Treatment Outcome
PubMed: 29898747
DOI: 10.1186/s13014-018-1056-4 -
Journal of Visualized Experiments : JoVE Jan 2021Leptomeningeal disease (LMD) is an uncommon type of central nervous system (CNS) metastasis to the cerebral spinal fluid (CSF). The most common cancers that cause LMD...
Leptomeningeal disease (LMD) is an uncommon type of central nervous system (CNS) metastasis to the cerebral spinal fluid (CSF). The most common cancers that cause LMD are breast and lung cancers and melanoma. Patients diagnosed with LMD have a very poor prognosis and generally survive for only a few weeks or months. One possible reason for the lack of efficacy of systemic therapy against LMD is the failure to achieve therapeutically effective concentrations of drug in the CSF because of an intact and relatively impermeable blood-brain barrier (BBB) or blood-CSF barrier across the choroid plexus. Therefore, directly administering drugs intrathecally or intraventricularly may overcome these barriers. This group has developed a model that allows for the effective delivery of therapeutics (i.e., drugs, antibodies, and cellular therapies) chronically and the repeated sampling of CSF to determine drug concentrations and target modulation in the CSF (when the tumor microenvironment is targeted in mice). The model is the murine equivalent of a magnetic resonance imaging-compatible Ommaya reservoir, which is used clinically. This model, which is affixed to the skull, has been designated as the "Murine Ommaya." As a therapeutic proof of concept, human epidermal growth factor receptor 2 antibodies (clone 7.16.4) were delivered into the CSF via the Murine Ommaya to treat mice with LMD from human epidermal growth factor receptor 2-positive breast cancer. The Murine Ommaya increases the efficiency of drug delivery using a miniature access port and prevents the wastage of excess drug; it does not interfere with CSF sampling for molecular and immunological studies. The Murine Ommaya is useful for testing novel therapeutics in experimental models of LMD.
Topics: Animals; Breast Neoplasms; Central Nervous System Diseases; Drug Delivery Systems; Female; Heterografts; Injections, Intraventricular; Meningeal Neoplasms; Mice; Models, Biological; Neoplasm Metastasis; Neoplastic Cells, Circulating; Prognosis
PubMed: 33586709
DOI: 10.3791/62033 -
Neurologia Medico-chirurgica 2010Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis... (Review)
Review
Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.
Topics: Adolescent; Adult; Aged; Child; Cranial Nerve Diseases; Deafness; Deglutition Disorders; Female; Humans; Jugular Veins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neurosurgical Procedures; Skull Base Neoplasms; Young Adult
PubMed: 20185871
DOI: 10.2176/nmc.50.89 -
The Journal of Medical Investigation :... 2012With the wider use of CT and MRI, many meningiomas are discovered as incidental findings during diagnostic work-up for unrelated symptoms. The majority shows no or...
OBJECT
With the wider use of CT and MRI, many meningiomas are discovered as incidental findings during diagnostic work-up for unrelated symptoms. The majority shows no or minimal growth. The purpose of this study was to distinguish pathological features of incidentally-found growing meningiomas by comparing incidentally-found with symptomatic meningiomas.
METHODS
One hundred and thirty two consecutive non-recurrent surgically-treated meningiomas treated between 2005 and 2007 were divided into three categories: 19 incidentally-found growing meningiomas (IG), 50 incidentally-found meningiomas (I), and 63 symptomatic (S) meningiomas. The average follow-up period for the IG meningiomas was 3.7 years. Six out of 19 patients of the IG meningiomas became symptomatic during observation.
RESULTS
There is a significant difference of the incidence of WHO grades I, II, and III between all three groups (p=0.035). The incidence of WHO grades II and III in groups IG, I, and S were 26%, 2%, and 10%, respectively. We compare MIB-1 staining index between three groups: an average was 3.8% in IG, 1.3% in I, and 2.4% in S meningiomas.
CONCLUSIONS
Incidentally-found meningiomas need careful follow-up. One fourth of the meningiomas that showed signs of growing belonged to the atypical or malignant grade.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Grading; Ubiquitin-Protein Ligases
PubMed: 23037194
DOI: 10.2152/jmi.59.241 -
Zhongguo Fei Ai Za Zhi = Chinese... Oct 2015Leptomeningeal metastasis (LM) is one of the disastrous events in managing advanced non-small cell lung cancer (NSCLC) due to severe clinical symptoms and a grave... (Review)
Review
Leptomeningeal metastasis (LM) is one of the disastrous events in managing advanced non-small cell lung cancer (NSCLC) due to severe clinical symptoms and a grave prognosis. Although intrathecal (IT) chemotherapy show some effects for LM in advanced NSCLC, the prognosis is still poor (12 wk-14 wk). A large majority (84%-97%) of the patients were found to have adenocarcinoma histology. Epidermal growth factor receptor (EGFR) senstive mutations were detected in 43.0%-70.5% adenocarcinoma patients with LM. EGFR tyrosine kinase inhibitors (TKIs) showed to be effective for LM in selected NSCLC patients in some reseaches, and confer a survival benefit. Furthermore, future trials need be done to determine the effect of EGFR-TKIs treatment in NSCLC-LM patients.
Topics: Animals; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Meningeal Neoplasms; Neoplasm Metastasis
PubMed: 26483335
DOI: 10.3779/j.issn.1009-3419.2015.10.05 -
Pathology Oncology Research : POR 2023Primary melanocytic tumors originating from CNS melanocytes are rare, with a low incidence of 0.7 cases per 10 million annually. This study focuses on primary... (Review)
Review
Primary melanocytic tumors originating from CNS melanocytes are rare, with a low incidence of 0.7 cases per 10 million annually. This study focuses on primary leptomeningeal melanocytomas, emphasizing their epidemiology, clinical characteristics, and diagnostic challenges. Despite their infrequency, these tumors warrant attention due to their unique features and potential for local recurrence. A 32-year-old female presented with syncope and seizures, leading to the discovery of two left-sided supratentorial lesions initially misidentified as convexity meningiomas. Detailed imaging suggested meningioma-like features, but intraoperative findings revealed unexpected hyperpigmented lesions. Histopathological examination, supported by immunohistochemistry, confirmed primary leptomeningeal melanocytoma. The surgical approach and subsequent management are discussed. The discussion emphasizes challenges in diagnosing primary leptomeningeal melanocytomas. Treatment debates, especially regarding adjuvant radiotherapy, are explored. Recurrence risks stress the importance of vigilant follow-up, advocating for complete surgical resection as the primary approach. The rarity of supratentorial cases adds complexity to diagnosis, necessitating a multidisciplinary approach. Insights from this case contribute to understanding and managing primary leptomeningeal melanocytomas, addressing challenges in differentiation from more common tumors and prompting ongoing research for refined diagnostics and optimized treatments. This study contributes insights into primary leptomeningeal melanocytomas, highlighting their rarity in supratentorial regions. The case underscores the importance of a multidisciplinary approach, incorporating clinical, radiological, and histopathological expertise for accurate diagnosis and tailored management. Ongoing research is crucial to refine treatment strategies, enhance prognostic precision, and improve outcomes for individuals with this uncommon CNS neoplasm.
Topics: Female; Adult; Humans; Meningioma; Melanoma; Meningeal Neoplasms; Melanocytes; Nevus, Pigmented; Supratentorial Neoplasms; Skin Neoplasms; Magnetic Resonance Imaging
PubMed: 38239282
DOI: 10.3389/pore.2023.1611482 -
Neurosurgery Jun 2023Stereotactic radiosurgery (SRS) is an effective adjuvant therapy for residual tumor after subtotal resection of parasellar meningiomas. Fat graft placement between the...
BACKGROUND
Stereotactic radiosurgery (SRS) is an effective adjuvant therapy for residual tumor after subtotal resection of parasellar meningiomas. Fat graft placement between the optic nerve/chiasm and residual tumor (optic neuropexy [OPN]) allows for safe SRS therapy.
OBJECTIVE
To evaluate the radiological temporal profile of the fat graft after OPN, immediately after surgery and at 3, 6, and 12 months intervals, to elucidate the optimal time point of adjuvant SRS.
METHODS
A single-center, retrospective, cohort study of 23 patients after surgery for parasellar meningioma was conducted. Fat graft volume and MRI signal ratios were calculated. SRS dosimetric parameters (tumor/optic nerve) were measured at the time of SRS and compared with a hypothetical dosimetric plan based on an early postoperative MRI.
RESULTS
Of 23 patients, 6 (26%) had gross total resection and 17 (74%) had subtotal resection. Fat grafts showed a progressive loss of volume and signal ratio over time. Radiosurgery was performed in 14 (82.3%; 8 hypofractionated radiosurgery and 6 single fraction). At 3 months, there is a loss of 46% of the fat volume and degradation of its tissue intensity, decreasing differentiation from tumor and nerve. The hypothetical treatment plan (performed on an early postoperative MRI) showed that single-fraction SRS would have been possible in 6 of the 8 hypofractionated cases.
CONCLUSION
OPN is a technique that can be safely performed after resection of parasellar meningiomas. Because of the reduction of the fat volume and tissue differentiation between fat and tumor/nerves, adjuvant radiosurgery is better performed within the first 3 months after surgery.
Topics: Humans; Meningioma; Treatment Outcome; Retrospective Studies; Cohort Studies; Neoplasm, Residual; Radiosurgery; Meningeal Neoplasms; Follow-Up Studies
PubMed: 36700760
DOI: 10.1227/neu.0000000000002351 -
Journal of Neuro-oncology Jan 2024Malignant and benign brain tumors with a propensity to recur continue to be a clinical challenge despite decades-long efforts to develop systemic and more advanced local... (Review)
Review
Malignant and benign brain tumors with a propensity to recur continue to be a clinical challenge despite decades-long efforts to develop systemic and more advanced local therapies. GammaTile (GT Medical Technologies Inc., Tempe AZ) has emerged as a novel brain brachytherapy device placed during surgery, which starts adjuvant radiotherapy immediately after resection. GammaTile received FDA clearance in 2018 for any recurrent brain tumor and expanded clearance in 2020 to include upfront use in any malignant brain tumor. More than 1,000 patients have been treated with GammaTile to date, and several publications have described technical aspects of the device, workflow, and clinical outcome data. Herein, we review the technical aspects of this brachytherapy treatment, including practical physics principles, discuss the available literature with an emphasis on clinical outcome data in the setting of brain metastases, glioblastoma, and meningioma, and provide an overview of the open and pending clinical trials that are further defining the efficacy and safety of GammaTile.
Topics: Humans; Treatment Outcome; Neoplasm Recurrence, Local; Brain Neoplasms; Meningioma; Brachytherapy; Meningeal Neoplasms
PubMed: 38261141
DOI: 10.1007/s11060-023-04523-z -
Brain Pathology (Zurich, Switzerland) Nov 2020Meningiomas are common in adults (~35% of brain tumors) but rare in children, where they exhibit unique clinical, pathological and molecular features compared to adult...
Meningiomas are common in adults (~35% of brain tumors) but rare in children, where they exhibit unique clinical, pathological and molecular features compared to adult counterparts. Thus, data generated from adult cohorts may be imperfectly suited to guiding diagnostic, prognostic and treatment decisions for children. We studied 50 meningioma patients ≤18 years with available clinical and pathological data to address the need for data obtained in the pediatric setting. As previously described, we noted a slight bias toward male patients and a higher proportion of spinal tumors compared to adults. Thirty-eight of 50 specimens were further analyzed by next generation sequencing. Loss-of-function mutations in NF2 and chromosome 22 losses were common, but pathogenic variants in other genes (SMARCB1, FUBP1, BRAF, TERT promoter, CHEK2, SMAD and GATA3) were identified in a minority of cases. Copy number variants outside of chromosomes 22 and 1 were infrequent. H3K27 hypomethylation, a useful biomarker in adult tumors, was not found in our cohort. In exploring the correlation between mitotic count and recurrence-free survival, we found a threshold of six mitoses per 10 high powered fields as the optimal cutoff in predicting recurrence-free survival. If independently validated in larger studies, adjusted grading thresholds could enhance the clinical management of pediatric meningiomas.
Topics: Adolescent; Brain Neoplasms; Child; Child, Preschool; DNA Copy Number Variations; DNA Methylation; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Mutation; Neoplasm Grading; Spinal Cord Neoplasms; Survival Rate
PubMed: 32716568
DOI: 10.1111/bpa.12884 -
Acta Medica Portuguesa May 1993The article describes the most recent advances in the field of the embryology, physiopathology, therapy, and prognosis of meningiomas. It is assumed that the future of... (Review)
Review
The article describes the most recent advances in the field of the embryology, physiopathology, therapy, and prognosis of meningiomas. It is assumed that the future of our knowledge of these neoplasms will be based upon the present basic and clinical research. The well known arachnoid cell origin of meningiomas is emphasized, the ultrastructure of the arachnoid villi is mentioned and the double embryological origin of the meningeal membranes--neuroectodermal and mesodermal--is stressed. Based upon personal ultrastructural and immunohistochemical studies, the probable pericytic and arachnoid origin of the so-called hemangiopericytic and sarcomatous meningiomas respectively, is reported. The several possible physiopathological mechanisms of the peritumoral oedema are summarized. Concerning the biological behaviour of meningiomas, the relevance of complete surgical resection is stressed, although new imaging or histological technics are also important in the prediction of recurrences. Lastly, regarding the management of these kind of tumors, other therapeutic procedures beyond surgery are also considered.
Topics: Humans; Meningeal Neoplasms; Meningioma; Prognosis
PubMed: 8337952
DOI: No ID Found