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1. Efficacy of stereotactic radiosurgery for radiation-induced meningiomas.

Author

Huo M, Laperriere N, van Prooijen M, Shultz D, Coolens C, Hodaie M, Cusimano M, Gentili F, Zadeh G, Payne D, Schwartz M, and Tsang DS

Subjects
Adult, Aged, Cobalt adverse effects, Female, Humans, Male, Middle Aged, Treatment Outcome, Young Adult, Meningeal Neoplasms radiotherapy, Meningioma radiotherapy, Neoplasms, Radiation-Induced radiotherapy, Radiosurgery adverse effects
Abstract

Purpose: Stereotactic radiosurgery is an established treatment option for sporadic meningiomas, though limited data exists for radiation-induced lesions., Methods: Patients treated with cobalt-60 radiosurgery between October 2005 and December 2018 in an institutional registry were reviewed. Single fraction treatments were prescribed to the 50% isodose line. Lesions were deemed to be radiation-induced according to standard criteria previously established by Cahan et al. RESULTS: A total of 37 patients with 72 lesions were analysed. Median follow up per patient was 44 months (range, 1.4-150.7 months). Median age at initial radiotherapy was 5 years (4 months-48 years), and at radiosurgery was 38 years. Of the 72 lesions, 62 were grade 1 (n = 4) or radiologically-diagnosed (n = 58), six were grade 2 and four were grade 3. Median lesion volume was 2.13 cc (0.04-13.8 cc), while the median radiosurgery margin dose was 13 Gy. Local control, on a per lesion basis, was 88.6% at 5 years (95% confidence interval [CI] 72.3-95.6). For grade 1 or radiologically-diagnosed lesions, local control was 96.6% at 5 years (95% CI 77.9-99.5), whereas those with grade 2 or higher lesions had a local control of 40% at 5 years (95% CI 5.2-75.3, p = 0.005). Radiologic oedema developed in 17 lesions (23.6%) and was symptomatic in 12 patients (16.7%). Doses above 12 Gy were not associated with local control probability (p = 0.292)., Conclusion: Radiosurgery is an effective treatment option for grade 1 or radiologically-diagnosed radiation-induced meningiomas, with 12 Gy appearing to be a sufficient dose.

Published
2020
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2. Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas.

Author

Mansouri A, Larjani S, Klironomos G, Laperriere N, Cusimano M, Gentili F, Schwartz M, and Zadeh G

Subjects
Adult, Aged, Aged, 80 and over, Databases, Factual, Disease Progression, Female, Follow-Up Studies, Humans, Male, Meningioma pathology, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications therapy, Prognosis, Prospective Studies, Radiation Dosage, Radiosurgery adverse effects, Retrospective Studies, Treatment Outcome, Young Adult, Meningioma surgery, Radiosurgery methods
Abstract

Object: In this paper, the authors' aim was to determine short-term volumetric and diametric tumor growth and identify clinical, radiological, and dosimetric predictors of adverse radiation events (AREs) following stereotactic radiosurgery (SRS) for intracranial WHO Grade I meningiomas., Methods: This is a retrospective review of all WHO Grade I meningiomas that were treated with SRS (primary or adjuvant) between December 2005 and June 2012 at the University Health Network. Seventy-five patients had at least 24 months of both clinical and radiological follow-up and were, therefore, included in this study. Tumor growth was defined as any volumetric or diametric change greater than 10% per year. Any variation less than +10% was considered growth stability. Volumetric measurements were made using T1-weighted gadolinium-enhanced 3-T MRI scans and ITK-SNAP software. Tumor growth rates were calculated using the specific growth rate (SGR). Univariate statistics were used to identify predictors of post-SRS AREs. All statistical analyses were performed using IBM SPSS., Results: Women accounted for 69.3% of patients, and the mean treatment age was 58.6 years. Median follow-up was 36.2 months. Twenty-one (28%) patients had undergone prior resection. Two (3%) patients required salvage surgical intervention following SRS. The majority of the lesions (56%) were skull base tumors. Median tumor volume and diameter were 5.2 cm3 and 27.5 mm, respectively. The absence of tumor growth was observed in 39 cases (52%) based on the volumetric measurements, while the absence of tumor growth was observed in 69 cases (92%) based on the diametric measurements. Twenty-six patients (34.6%) experienced new-onset AREs, including headache (17.3%), cranial neuropathy (10.6%), speech impairment (2.7%), tremors (2.7%), and ataxia (1.3%). Fourteen patients (18.7%) experienced new-onset edema, and 4 of these patients were symptomatic. A lower conformity index (1.24 vs 1.4) was significantly associated with the development of edema (p<0.001 power>0.8). Patients with meningiomas that had growth rates of more than 10% per year were more likely to experience long-term headaches after SRS (p=0.022)., Conclusions: Volume-based reporting of SRS outcomes for meningiomas may be a more accurate method given the complex morphology of some lesions. The conformity index was identified as a predictor of edema following radiosurgery.

Published
2015
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3. FACT-MNG: tumor site specific web-based outcome instrument for meningioma patients.

Author

Zlotnick D, Kalkanis SN, Quinones-Hinojosa A, Chung K, Linskey ME, Jensen RL, DeMonte F, Barker FG, Racine CA, Berger MS, Black PM, Cusimano M, Sekhar LN, Parsa A, Aghi M, and McDermott MW

Subjects
Humans, Internet, Meningeal Neoplasms surgery, Meningioma surgery, Outcome Assessment, Health Care, Quality of Life, Radiosurgery
Abstract

To formulate Functional Assessment of Cancer Therapy-Meningioma (FACT-MNG), a web-based tumor site-specific outcome instrument for assessing intracranial meningioma patients following surgical resection or stereotactic radiosurgery. We surveyed the relevant literature available on intracranial meningioma surgery and subsequent outcomes (38 papers), making note of which, if any, QOL/outcome instruments were utilized. None of the surgveyed papers included QOL assessment specific to tumor site. We subsequently developed questions that were relevant to the signs and symptoms that characterize each of 11 intracranial meningioma sites, and incorporated them into a modified combination of the Functional Assessment of Cancer Therapy-Brain (FACT-BR) and SF36 outcome instruments, thereby creating a new tumor site-specific outcome instrument, FACT-MNG. With outcomes analysis of surgical and radiosurgical treatments becoming more important, measures of the adequacy and success of treatment are needed. FACT-MNG represents a first effort to formalize such an instrument for meningioma patients. Questions specific to tumor site will allow surgeons to better assess specific quality of life issues not addressed in the past by more general questionnaires.

Published
2010
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4. Extradural middle fossa approach to a clear cell meningioma in a child.

Author

King J, Cusimano M, Hawkins C, and Dirks P

Subjects
Child, Diagnosis, Differential, Female, Humans, Neurilemmoma pathology, Tomography, X-Ray Computed, Cranial Fossa, Middle surgery, Meningeal Neoplasms pathology, Meningeal Neoplasms surgery, Meningioma pathology, Meningioma surgery, Neurosurgical Procedures methods
Published
2009
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5. Meningioma with dural venous sinus invasion and jugular vein extension.

Author

Vachhrajani S, Jea A, Rutka JA, Blaser S, Cusimano M, and Rutka JT

Subjects
Adolescent, Female, Humans, Meningeal Neoplasms diagnostic imaging, Meningioma diagnostic imaging, Neoplasm Invasiveness, Radiography, Cranial Sinuses, Jugular Veins, Meningeal Neoplasms pathology, Meningeal Neoplasms surgery, Meningioma pathology, Meningioma surgery
Abstract

Meningiomas represent the most common benign intracranial neoplasm in adults, with a considerably lower incidence in children. The authors present the case of an intracranial meningioma with invasion of, and intraluminal extension into, the transverse and sigmoid sinuses, jugular bulb, and internal jugular vein, resulting in venous occlusion in a 14-year-old girl. Computed tomography scanning, MR imaging, and conventional angiography were performed preoperatively. The patient underwent a 2-stage resection: the supratentorial component was resected first, and the infratentorial and venous sinus and jugular vein components were subsequently removed using a combined skull base approach. Gross-total resection was achieved by opening the lateral dural sinus and removing the meningioma from within the transverse and sigmoid sinuses, the jugular bulb, and the internal jugular vein. The patient remained neurologically intact after the staged tumor resections. Postoperative imaging confirmed the gross-total resection. This case illustrates the unusual property of an intracranial meningioma to invade the intrasinusoidal space and extend into the jugular vein without adherence to the underlying venous endothelium of the jugular vein.

Published
2008
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6. Hydroxyurea for treatment of meningioma.

Author

Cusimano MD

Subjects
Antineoplastic Agents administration & dosage, Humans, Hydroxyurea administration & dosage, Neoplasm Recurrence, Local drug therapy, Antineoplastic Agents therapeutic use, Hydroxyurea therapeutic use, Meningeal Neoplasms drug therapy, Meningioma drug therapy
Published
1998
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7. Surgical treatment of meningiomas involving the cavernous sinus: evolving ideas based on a ten year experience.

Author

Sekhar LN, Patel S, Cusimano M, Wright DC, Sen CN, and Bank WO

Subjects
Cavernous Sinus pathology, Cerebral Angiography, Cerebral Revascularization, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Meningeal Neoplasms diagnosis, Meningioma diagnosis, Microsurgery, Neoplasm Recurrence, Local diagnosis, Neoplasm Recurrence, Local surgery, Postoperative Complications etiology, Radiosurgery, Reoperation, Treatment Outcome, Cavernous Sinus surgery, Meningeal Neoplasms surgery, Meningioma surgery
Abstract

The outcomes of 114 patients with meningiomas operated at the University of Pittsburgh were analyzed. Cerebrospinal fluid leakage was the most frequent complication, observed in 25 patients (21%). Complications were more frequent in patients who had recurrent (previously operated) tumors and patients with extensive tumors. Our current analysis also indicates that patients with prior radio-therapy (usually external beam) have unacceptably high complication rates after microsurgery. Early results indicate that regrowth rates are much higher in patients with incomplete resection (20%) than those with gross total excision (5%). Of the 114 patients, 108 returned to independent living and/or their previous occupation.

Published
1996
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8. Grade zero removal of supratentorial convexity meningiomas.

Author

Perry JR and Cusimano MD

Subjects
Cell Division physiology, Follow-Up Studies, Humans, Meningeal Neoplasms pathology, Meningioma pathology, Neoplasm Recurrence, Local prevention & control, Tomography, X-Ray Computed, Meningeal Neoplasms surgery, Meningioma surgery, Neoplasm Recurrence, Local pathology
Published
1994
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9. Molecular and translational advances in meningiomas

Author

Suppiah S., Nassiri F., Bi W. L., Dunn I. F., Hanemann C. O., Horbinski C. M., Hashizume R., James C. D., Mawrin C., Noushmehr H., Perry A., Sahm F., Sloan A., Von Deimling A., Wen P. Y., Aldape K., Zadeh G., Au K., Barnhartz-Sloan J., Brastianos P. K., Butowski N., Carlotti C., Cusimano M. D., Dimeco F., Drummond K., Galanis E., Giannini C., Goldbrunner R., Griffith B., Herold-Mende C., Huang R. Y., James D., Jenkinson M. D., Jungk C., Kaufman T. J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J. C., Mamatjan Y., Mansouri A., McDermott M., Munoz D., Ng H. -K., Pirouzmand F., Poisson L. M., Pollo B., Raleigh D., Saladino A., Santarius T., Schichor C., Schultz D., Schmidt N. O., Selman W., Spears J., Snyder J., Tabatabai G., Tatagiba M., Tirapelli D., Tonn J. C., Tsang D., Vogelbaum M. A., Deimling A. V., Walbert T., Westphal M., Workewych A. M., Suppiah S., Nassiri F., Bi W.L., Dunn I.F., Hanemann C.O., Horbinski C.M., Hashizume R., James C.D., Mawrin C., Noushmehr H., Perry A., Sahm F., Sloan A., Von Deimling A., Wen P.Y., Aldape K., Zadeh G., Au K., Barnhartz-Sloan J., Brastianos P.K., Butowski N., Carlotti C., Cusimano M.D., Dimeco F., Drummond K., Galanis E., Giannini C., Goldbrunner R., Griffith B., Herold-Mende C., Huang R.Y., James D., Jenkinson M.D., Jungk C., Kaufman T.J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J.C., Mamatjan Y., Mansouri A., McDermott M., Munoz D., Ng H.-K., Pirouzmand F., Poisson L.M., Pollo B., Raleigh D., Saladino A., Santarius T., Schichor C., Schultz D., Schmidt N.O., Selman W., Spears J., Snyder J., Tabatabai G., Tatagiba M., Tirapelli D., Tonn J.C., Tsang D., Vogelbaum M.A., Deimling A.V., Walbert T., Westphal M., and Workewych A.M.

Subjects
Cancer Research, Supplement Articles, Genomics, Intracranial Neoplasm, sporadic meningioma, Bioinformatics, World health, Translational Research, Biomedical, Meningioma, 03 medical and health sciences, biomolecular, 0302 clinical medicine, Meningeal Neoplasms, otorhinolaryngologic diseases, medicine, Recurrent disease, Humans, Meningeal Neoplasm, Molecular Targeted Therapy, xenograft, Stage (cooking), neoplasms, MENINGIOMA, business.industry, cell line, Prognosis, medicine.disease, Combined Modality Therapy, nervous system diseases, 3. Good health, Clinical trial, Oncology, 030220 oncology & carcinogenesis, Neurology (clinical), genetic, business, epigenetic, 030217 neurology & neurosurgery
Abstract

Meningiomas are the most common primary intracranial neoplasm. The current World Health Organization (WHO) classification categorizes meningiomas based on histopathological features, but emerging molecular data demonstrate the importance of genomic and epigenomic factors in the clinical behavior of these tumors. Treatment options for symptomatic meningiomas are limited to surgical resection where possible and adjuvant radiation therapy for tumors with concerning histopathological features or recurrent disease. At present, alternative adjuvant treatment options are not available in part due to limited historical biological analysis and clinical trial investigation on meningiomas. With advances in molecular and genomic techniques in the last decade, we have witnessed a surge of interest in understanding the genomic and epigenomic landscape of meningiomas. The field is now at the stage to adopt this molecular knowledge to refine meningioma classification and introduce molecular algorithms that can guide prediction and therapeutics for this tumor type. Animal models that recapitulate meningiomas faithfully are in critical need to test new therapeutics to facilitate rapid-cycle translation to clinical trials. Here we review the most up-to-date knowledge of molecular alterations that provide insight into meningioma behavior and are ready for application to clinical trial investigation, and highlight the landscape of available preclinical models in meningiomas.

Published
2019
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10. Life after surgical resection of a meningioma: a prospective cross-sectional study evaluating health-related quality of life

Author

Nassiri F., Price B., Shehab A., Au K., Cusimano M. D., Jenkinson M. D., Jungk C., Mansouri A., Santarius T., Suppiah S., Teng K. X., Toor G. S., Zadeh G., Walbert T., Drummond K. J., Aldape K., Barnhartz-Sloan J., Bi W. L., Brastianos P. K., Butowski N., Carlotti C., Dimeco F., Dunn I. F., Galanis E., Giannini C., Goldbrunner R., Griffith B., Hashizume R., Hanemann C. O., Herold-Mende C., Horbinski C., Huang R. Y., James D., Kaufman T. J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J. C., Mamatjan Y., Mawrin C., McDermott M., Munoz D., Noushmehr H., Ng H. -K., Perry A., Pirouzmand F., Poisson L. M., Pollo B., Raleigh D., Sahm F., Saladino A., Schichor C., Schultz D., Schmidt N. O., Selman W., Sloan A., Spears J., Snyder J., Tabatabai G., Tatagiba M., Tirapelli D., Tonn J. C., Tsang D., Vogelbaum M. A., Deimling A. V., Wen P. Y., Westphal M., Workewych A. M., Nassiri F., Price B., Shehab A., Au K., Cusimano M.D., Jenkinson M.D., Jungk C., Mansouri A., Santarius T., Suppiah S., Teng K.X., Toor G.S., Zadeh G., Walbert T., Drummond K.J., Aldape K., Barnhartz-Sloan J., Bi W.L., Brastianos P.K., Butowski N., Carlotti C., Dimeco F., Dunn I.F., Galanis E., Giannini C., Goldbrunner R., Griffith B., Hashizume R., Hanemann C.O., Herold-Mende C., Horbinski C., Huang R.Y., James D., Kaufman T.J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J.C., Mamatjan Y., Mawrin C., McDermott M., Munoz D., Noushmehr H., Ng H.-K., Perry A., Pirouzmand F., Poisson L.M., Pollo B., Raleigh D., Sahm F., Saladino A., Schichor C., Schultz D., Schmidt N.O., Selman W., Sloan A., Spears J., Snyder J., Tabatabai G., Tatagiba M., Tirapelli D., Tonn J.C., Tsang D., Vogelbaum M.A., Deimling A.V., Wen P.Y., Westphal M., and Workewych A.M.

Subjects
Male, cognition, Cancer Research, medicine.medical_specialty, Cross-sectional study, insomnia, Population, Neurosurgery, Supplement Articles, meningioma, surgery, Meningioma, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Internal medicine, Meningeal Neoplasms, otorhinolaryngologic diseases, medicine, Humans, Longitudinal Studies, Prospective Studies, Prospective cohort study, education, education.field_of_study, business.industry, COGNIÇÃO, Cognition, Middle Aged, Prognosis, medicine.disease, humanities, 3. Good health, health-related quality of life, Cross-Sectional Studies, Oncology, 030220 oncology & carcinogenesis, Quality of Life, Female, fatigue, Neurology (clinical), business, 030217 neurology & neurosurgery, Follow-Up Studies, Cohort study
Abstract

Background Few studies have evaluated the health-related quality of life (HRQoL) of patients with meningiomas. Here, we report the largest prospective, longitudinal cross-sectional cohort study of HRQoL in meningiomas to date, in order to identify possible actionable determinants of global HRQoL. Methods Adults who had undergone resection of a grade I intracranial meningioma and were in routine follow-up at a single large tertiary center underwent HRQoL assessment using the QLQ-C30 questionnaire administered opportunistically at follow-up visits. Averaged transformed QLQ-C30 scores at 12-month intervals were compared with scores from a normative reference population, with reference to known minimal clinically meaningful difference (CMD) in scores. To evaluate for possible determinants of changes in global HRQoL, global HRQoL scores were correlated (Spearman's Rho) with subdomain and symptom scores and with interval time from surgical resection. Results A total of 291 postoperative patients with histologically confirmed and surgically treated grade I meningiomas consented to participation and a total of 455 questionnaires were included for analysis. Patients with meningiomas reported reduced global HRQoL at nearly every 12-month interval with clinically and statistically significant impairments at 12, 48, 108, and 120 months postoperative compared with the normative population (P < 0.05). Meningioma patients at the 12-month interval also reported a reduction of each subdomain of HRQoL assessment (P < 0.05); however, a CMD was only seen in cognitive functioning. Physical, emotional, cognitive, and social subdomains, as well as fatigue and sleep/insomnia, were significantly associated with global HRQoL at the first 12-month interval. Overall, there was no significant correlation between time from surgery and global HRQoL or the subdomain functional or symptom sections of the QLQ-C30. Conclusions Meningioma patients report considerable limitations in HRQoL for more than 120 months after surgery, particularly in cognitive, emotional, and social function, as well as suffering significant fatigue and sleep impairment compared with a normative reference population. The majority of these reported functional impairments and symptoms are strongly associated with global HRQoL and thus can be considered determinants of global HRQoL that if treated, have the potential to improve HRQoL for our meningioma patients. This hypothesis requires future study of targeted interventions to determine their efficacy.

Published
2019
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11. DNA methylation profiling to predict recurrence risk in meningioma: development and validation of a nomogram to optimize clinical management

Author

Nassiri F., Mamatjan Y., Suppiah S., Badhiwala J. H., Mansouri S., Karimi S., Saarela O., Poisson L., Gepfner-Tuma I., Schittenhelm J., Ng H. -K., Noushmehr H., Harter P., Baumgarten P., Weller M., Preusser M., Herold-Mende C., Tatagiba M., Tabatabai G., Sahm F., Von Deimling A., Aldape K., Au K., Barnhartz-Sloan J., Bi W. L., Brastianos P. K., Butowski N., Carlotti C., Cusimano M. D., Dimeco F., Drummond K., Dunn I. F., Galanis E., Giannini C., Goldbrunner R., Griffith B., Hashizume R., Hanemann C. O., Horbinski C., Huang R. Y., James D., Jenkinson M. D., Jungk C., Kaufman T. J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J. C., Malta T. M., Mawrin C., McDermott M., Munoz D., Perry A., Pirouzmand F., Poisson L. M., Pollo B., Raleigh D., Saladino A., Santarius T., Schichor C., Schultz D., Schmidt N. O., Selman W., Sloan A., Spears J., Snyder J., Tirapelli D., Tonn J. C., Tsang D., Vogelbaum M. A., Wen P. Y., Walbert T., Westphal M., Workewych A. M., Zadeh G., Aldape K. D., Nassiri F., Mamatjan Y., Suppiah S., Badhiwala J.H., Mansouri S., Karimi S., Saarela O., Poisson L., Gepfner-Tuma I., Schittenhelm J., Ng H.-K., Noushmehr H., Harter P., Baumgarten P., Weller M., Preusser M., Herold-Mende C., Tatagiba M., Tabatabai G., Sahm F., Von Deimling A., Aldape K., Au K., Barnhartz-Sloan J., Bi W.L., Brastianos P.K., Butowski N., Carlotti C., Cusimano M.D., Dimeco F., Drummond K., Dunn I.F., Galanis E., Giannini C., Goldbrunner R., Griffith B., Hashizume R., Hanemann C.O., Horbinski C., Huang R.Y., James D., Jenkinson M.D., Jungk C., Kaufman T.J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J.C., Malta T.M., Mawrin C., McDermott M., Munoz D., Perry A., Pirouzmand F., Poisson L.M., Pollo B., Raleigh D., Saladino A., Santarius T., Schichor C., Schultz D., Schmidt N.O., Selman W., Sloan A., Spears J., Snyder J., Tirapelli D., Tonn J.C., Tsang D., Vogelbaum M.A., Wen P.Y., Walbert T., Westphal M., Workewych A.M., Zadeh G., and Aldape K.D.

Subjects
Oncology, Cancer Research, medicine.medical_specialty, recurrence, predictor, ESTUDOS DE VALIDAÇÃO, Meningioma, nomogram, Internal medicine, medicine, Biomarkers, Tumor, Meningeal Neoplasms, Humans, Survival rate, Retrospective Studies, Oncotype DX Breast Cancer Assay, business.industry, Hazard ratio, Cancer, Disease Management, Retrospective cohort study, Nomogram, DNA Methylation, medicine.disease, Prognosis, Gene Expression Regulation, Neoplastic, Survival Rate, Clinical research, Basic and Translational Investigations, Neurology (clinical), methylation, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

Background Variability in standard-of-care classifications precludes accurate predictions of early tumor recurrence for individual patients with meningioma, limiting the appropriate selection of patients who would benefit from adjuvant radiotherapy to delay recurrence. We aimed to develop an individualized prediction model of early recurrence risk combining clinical and molecular factors in meningioma. Methods DNA methylation profiles of clinically annotated tumor samples across multiple institutions were used to develop a methylome model of 5-year recurrence-free survival (RFS). Subsequently, a 5-year meningioma recurrence score was generated using a nomogram that integrated the methylome model with established prognostic clinical factors. Performance of both models was evaluated and compared with standard-of-care models using multiple independent cohorts. Results The methylome-based predictor of 5-year RFS performed favorably compared with a grade-based predictor when tested using the 3 validation cohorts (ΔAUC = 0.10, 95% CI: 0.03–0.018) and was independently associated with RFS after adjusting for histopathologic grade, extent of resection, and burden of copy number alterations (hazard ratio 3.6, 95% CI: 1.8–7.2, P < 0.001). A nomogram combining the methylome predictor with clinical factors demonstrated greater discrimination than a nomogram using clinical factors alone in 2 independent validation cohorts (ΔAUC = 0.25, 95% CI: 0.22–0.27) and resulted in 2 groups with distinct recurrence patterns (hazard ratio 7.7, 95% CI: 5.3–11.1, P < 0.001) with clinical implications. Conclusions The models developed and validated in this study provide important prognostic information not captured by previously established clinical and molecular factors which could be used to individualize decisions regarding postoperative therapeutic interventions, in particular whether to treat patients with adjuvant radiotherapy versus observation alone.

Published
2019

12. Advances in multidisciplinary therapy for meningiomas

Author

Brastianos P. K., Galanis E., Butowski N., Chan J. W., Dunn I. F., Goldbrunner R., Herold-Mende C., Ippen F. M., Mawrin C., McDermott M. W., Sloan A., Snyder J., Tabatabai G., Tatagiba M., Tonn J. C., Wen P. Y., Aldape K., Nassiri F., Zadeh G., Jenkinson M. D., Raleigh D. R., Au K., Barnhartz-Sloan J., Bi W. L., Carlotti C., Cusimano M. D., Dimeco F., Drummond K., Giannini C., Griffith B., Hashizume R., Hanemann C. O., Horbinski C., Huang R. Y., James D., Jungk C., Kaufman T. J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J. C., Mamatjan Y., Mansouri A., Munoz D., Noushmehr H., Ng H. -K., Perry A., Pirouzmand F., Poisson L. M., Pollo B., Sahm F., Saladino A., Santarius T., Schichor C., Schultz D., Schmidt N. O., Selman W., Spears J., Suppiah S., Tirapelli D., Tsang D., Vogelbaum M. A., Deimling A. V., Walbert T., Westphal M., Workewych A. M., Brastianos P.K., Galanis E., Butowski N., Chan J.W., Dunn I.F., Goldbrunner R., Herold-Mende C., Ippen F.M., Mawrin C., McDermott M.W., Sloan A., Snyder J., Tabatabai G., Tatagiba M., Tonn J.C., Wen P.Y., Aldape K., Nassiri F., Zadeh G., Jenkinson M.D., Raleigh D.R., Au K., Barnhartz-Sloan J., Bi W.L., Carlotti C., Cusimano M.D., Dimeco F., Drummond K., Giannini C., Griffith B., Hashizume R., Hanemann C.O., Horbinski C., Huang R.Y., James D., Jungk C., Kaufman T.J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J.C., Mamatjan Y., Mansouri A., Munoz D., Noushmehr H., Ng H.-K., Perry A., Pirouzmand F., Poisson L.M., Pollo B., Sahm F., Saladino A., Santarius T., Schichor C., Schultz D., Schmidt N.O., Selman W., Spears J., Suppiah S., Tirapelli D., Tsang D., Vogelbaum M.A., Deimling A.V., Walbert T., Westphal M., and Workewych A.M.

Subjects
Oncology, Cancer Research, medicine.medical_treatment, Supplement Articles, meningioma, Systemic therapy, surgery, 0302 clinical medicine, Meningeal Neoplasms, Trabectedin, Cancer, clinical trial, targeted therapy, Prognosis, Combined Modality Therapy, 3. Good health, 6.1 Pharmaceuticals, 030220 oncology & carcinogenesis, International Consortium on Meningiomas, Patient Safety, Meningioma, medicine.drug, medicine.medical_specialty, Oncology and Carcinogenesis, Antineoplastic Agents, Radiosurgery, 03 medical and health sciences, Internal medicine, medicine, otorhinolaryngologic diseases, Humans, Meningeal Neoplasm, Oncology & Carcinogenesis, neoplasms, business.industry, Neurosciences, Evaluation of treatments and therapeutic interventions, medicine.disease, RADIOTERAPIA, Brain Disorders, nervous system diseases, Clinical trial, Radiation therapy, radiation, Neurology (clinical), Cranial Irradiation, business, 030217 neurology & neurosurgery
Abstract

Surgery has long been established as the first-line treatment for the majority of symptomatic and enlarging meningiomas, and evidence for its success is derived from retrospective case series. Despite surgical resection, a subset of meningiomas display aggressive behavior with early recurrences that are difficult to treat. The decision to radically resect meningiomas and involved structures is balanced against the risk for neurological injury in patients. Radiation therapy has largely been used as a complementary and safe therapeutic strategy in meningiomas with evidence primarily stemming from retrospective, single-institution reports. Two of the first cooperative group studies (RTOG 0539 and EORTC 22042) evaluating the outcomes of adjuvant radiation therapy in higher-risk meningiomas have shown promising preliminary results. Historically, systemic therapy has resulted in disappointing results in meningiomas. However, several clinical trials are under way evaluating the efficacy of chemotherapies, such as trabectedin, and novel molecular agents targeting Smoothened, AKT1, and focal adhesion kinase in patients with recurrent meningiomas.

Published
2019

13. Imaging and diagnostic advances for intracranial meningiomas

Author

Huang R. Y., Bi W. L., Griffith B., Kaufmann T. J., La Fougere C., Schmidt N. O., Tonn J. C., Vogelbaum M. A., Wen P. Y., Aldape K., Nassiri F., Zadeh G., Dunn I. F., Au K., Barnhartz-Sloan J., Brastianos P. K., Butowski N., Carlotti C., Cusimano M. D., Dimeco F., Drummond K., Galanis E., Giannini C., Goldbrunner R., Hashizume R., Hanemann C. O., Herold-Mende C., Horbinski C., James D., Jenkinson M. D., Jungk C., Kaufman T. J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J. C., Mamatjan Y., Mansouri A., Mawrin C., McDermott M., Munoz D., Noushmehr H., Ng H. -K., Perry A., Pirouzmand F., Poisson L. M., Pollo B., Raleigh D., Sahm F., Saladino A., Santarius T., Schichor C., Schultz D., Selman W., Sloan A., Spears J., Snyder J., Suppiah S., Tabatabai G., Tatagiba M., Tirapelli D., Tsang D., Deimling A. V., Walbert T., Westphal M., Workewych A. M., Huang R.Y., Bi W.L., Griffith B., Kaufmann T.J., La Fougere C., Schmidt N.O., Tonn J.C., Vogelbaum M.A., Wen P.Y., Aldape K., Nassiri F., Zadeh G., Dunn I.F., Au K., Barnhartz-Sloan J., Brastianos P.K., Butowski N., Carlotti C., Cusimano M.D., Dimeco F., Drummond K., Galanis E., Giannini C., Goldbrunner R., Hashizume R., Hanemann C.O., Herold-Mende C., Horbinski C., James D., Jenkinson M.D., Jungk C., Kaufman T.J., Krischek B., Lachance D., Lafougere C., Lee I., Liu J.C., Mamatjan Y., Mansouri A., Mawrin C., McDermott M., Munoz D., Noushmehr H., Ng H.-K., Perry A., Pirouzmand F., Poisson L.M., Pollo B., Raleigh D., Sahm F., Saladino A., Santarius T., Schichor C., Schultz D., Selman W., Sloan A., Spears J., Snyder J., Suppiah S., Tabatabai G., Tatagiba M., Tirapelli D., Tsang D., Deimling A.V., Walbert T., Westphal M., and Workewych A.M.

Subjects
Cancer Research, medicine.medical_specialty, Neuroimaging, Supplement Articles, Multimodal Imaging, perfusion, Meningioma, 03 medical and health sciences, 0302 clinical medicine, Medical imaging, medicine, Meningeal Neoplasms, Humans, Meningeal Neoplasm, Radiation treatment planning, medicine.diagnostic_test, business.industry, imaging, Magnetic resonance imaging, medicine.disease, radiology, 3. Good health, Tumor detection, RADIOLOGIA, PET, Oncology, 030220 oncology & carcinogenesis, Radiological weapon, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery, CT, MRI
Abstract

The archetypal imaging characteristics of meningiomas are among the most stereotypic of all central nervous system (CNS) tumors. In the era of plain film and ventriculography, imaging was only performed if a mass was suspected, and their results were more suggestive than definitive. Following more than a century of technological development, we can now rely on imaging to non-invasively diagnose meningioma with great confidence and precisely delineate the locations of these tumors relative to their surrounding structures to inform treatment planning. Asymptomatic meningiomas may be identified and their growth monitored over time; moreover, imaging routinely serves as an essential tool to survey tumor burden at various stages during the course of treatment, thereby providing guidance on their effectiveness or the need for further intervention. Modern radiological techniques are expanding the power of imaging from tumor detection and monitoring to include extraction of biologic information from advanced analysis of radiological parameters. These contemporary approaches have led to promising attempts to predict tumor grade and, in turn, contribute prognostic data. In this supplement article, we review important current and future aspects of imaging in the diagnosis and management of meningioma, including conventional and advanced imaging techniques using CT, MRI, and nuclear medicine.

Published
2019

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