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Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas: an international, multicenter matched cohort study

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Abstract

Objective

The optimal management of asymptomatic, skull-based meningiomas is not well defined. The aim of this study is to compare the imaging and clinical outcomes of patients with asymptomatic, skull-based meningiomas managed either with upfront stereotactic radiosurgery (SRS) or active surveillance.

Methods

This retrospective, multicenter study involved patients with asymptomatic, skull-based meningiomas. The study end-points included local tumor control and the development of new neurological deficits attributable to the tumor. Factors associated with tumor progression and neurological morbidity were also analyzed.

Results

The combined unmatched cohort included 417 patients. Following propensity score matching for age, tumor volume, and follow-up 110 patients remained in each cohort. Tumor control was achieved in 98.2% and 61.8% of the SRS and active surveillance cohorts, respectively. SRS was associated with superior local tumor control (p < 0.001, HR = 0.01, 95% CI = 0.002–0.13) compared to active surveillance. Three patients (2.7%) in the SRS cohort and six (5.5%) in the active surveillance cohort exhibited neurological deterioration. One (0.9%) patient in the SRS-treated and 11 (10%) patients in the active surveillance cohort required surgical management of their meningioma during follow-up.

Conclusions

SRS is associated with superior local control of asymptomatic, skull-based meningiomas as compared to active surveillance and does so with low morbidity rates. SRS should be offered as an alternative to active surveillance as the initial management of asymptomatic skull base meningiomas. Active surveillance policies do not currently specify the optimal time to intervention when meningioma growth is noted. Our results indicate that if active surveillance is the initial management of choice, SRS should be recommended when radiologic tumor progression is noted and prior to clinical progression.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Chamoun R, Krisht KM, Couldwell WT (2011) Incidental meningiomas. Neurosurg Focus 31:E19. https://doi.org/10.3171/2011.9.FOCUS11220

    Article  PubMed  Google Scholar 

  2. Nakamura M, Roser F, Michel J et al (2003) The natural history of incidental meningiomas. Neurosurgery 53:62–71. https://doi.org/10.1227/01.NEU.0000068730.76856.58

    Article  PubMed  Google Scholar 

  3. Hashimoto N, Rabo CS, Okita Y et al (2012) Slower growth of skull base meningiomas compared with non–skull base meningiomas based on volumetric and biological studies: clinical article. J Neurosurg 116:574–580. https://doi.org/10.3171/2011.11.JNS11999

    Article  PubMed  Google Scholar 

  4. Pikis S, Bunevicius A, Sheehan J (2021) Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery. Acta Neurochir 163:83–88. https://doi.org/10.1007/s00701-020-04648-4

    Article  PubMed  Google Scholar 

  5. Zeng L, Wang L, Ye F et al (2015) Clinical characteristics of patients with asymptomatic intracranial meningiomas and results of their surgical management. Neurosurg Rev 38:481–488. https://doi.org/10.1007/s10143-015-0619-1

    Article  PubMed  Google Scholar 

  6. Goldbrunner R, Stavrinou P, Jenkinson MD et al (2021) EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol noab. https://doi.org/10.1093/neuonc/noab150

    Article  Google Scholar 

  7. Sughrue ME, Rutkowski MJ, Aranda D et al (2010) Treatment decision making based on the published natural history and growth rate of small meningiomas: a review and meta-analysis. J Neurosurg 113:1036–1042. https://doi.org/10.3171/2010.3.JNS091966

    Article  PubMed  Google Scholar 

  8. Oya S, Kim S-H, Sade B, Lee JH (2011) The natural history of intracranial meningiomas: clinical article. J Neurosurg 114:1250–1256. https://doi.org/10.3171/2010.12.JNS101623

    Article  PubMed  Google Scholar 

  9. Sheehan J, Pikis S, Islim A et al (2021) An international multicenter matched cohort analysis of incidental meningioma progression during active surveillance or after stereotactic radiosurgery: the IMPASSE Study. Neuro Oncol. https://doi.org/10.1093/neuonc/noab132

    Article  Google Scholar 

  10. Huang RY, Bi WL, Weller M et al (2019) Proposed response assessment and endpoints for meningioma clinical trials: report from the response assessment in neuro-oncology working group. Neuro Oncol 21:26–36. https://doi.org/10.1093/neuonc/noy137

    Article  PubMed  Google Scholar 

  11. Barnett GH, Linskey ME, Adler JR et al (2007) Stereotactic radiosurgery–an organized neurosurgery-sanctioned definition. J Neurosurg 106:1–5. https://doi.org/10.3171/jns.2007.106.1.1

    Article  PubMed  Google Scholar 

  12. R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/

  13. RStudio Team (2020). RStudio: Integrated Development Environment for R. RStudio, PBC, Boston, MA URL http://www.rstudio.com/.

  14. Islim AI, Mohan M, Moon RDC et al (2019) Incidental intracranial meningiomas: a systematic review and meta-analysis of prognostic factors and outcomes. J Neurooncol 142:211–221. https://doi.org/10.1007/s11060-019-03104-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Meling TR, Da Broi M, Scheie D, Helseth E (2019) Meningiomas: skull base versus non-skull base. Neurosurg Rev 42:163–173. https://doi.org/10.1007/s10143-018-0976-7

    Article  PubMed  Google Scholar 

  16. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35. https://doi.org/10.1002/1097-0142(1950)3:1%3c32::AID-CNCR2820030106%3e3.0.CO;2-3

    Article  CAS  PubMed  Google Scholar 

  17. Rubin G, Herscovici Z, Laviv Y et al (2011) Outcome of untreated meningiomas. Isr Med Assoc J 13:157–160

    PubMed  Google Scholar 

  18. Lee EJ, Kim JH, Park ES et al (2017) A novel weighted scoring system for estimating the risk of rapid growth in untreated intracranial meningiomas. J Neurosurg 127:971–980. https://doi.org/10.3171/2016.9.JNS161669

    Article  PubMed  Google Scholar 

  19. Goldbrunner R, Minniti G, Preusser M et al (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17:e383–e391. https://doi.org/10.1016/S1470-2045(16)30321-7

    Article  PubMed  Google Scholar 

  20. Bir SC, Patra DP, Maiti TK et al (2017) Direct comparison of gamma knife radiosurgery and microsurgery for small size meningiomas. World Neurosurg 101:170–179. https://doi.org/10.1016/j.wneu.2017.01.105

    Article  PubMed  Google Scholar 

  21. Gupta A, Xu Z, Cohen-Inbar O et al (2019) Treatment of asymptomatic meningioma with gamma knife radiosurgery: long-term follow-up with volumetric assessment and clinical outcome. Neurosurgery 85:E889–E899. https://doi.org/10.1093/neuros/nyz126

    Article  PubMed  Google Scholar 

  22. Kim KH, Kang SJ, Choi J-W et al (2018) Clinical and radiological outcomes of proactive gamma knife surgery for asymptomatic meningiomas compared with the natural course without intervention. J Neurosurg 130:1740–1749. https://doi.org/10.3171/2017.12.JNS171943

    Article  Google Scholar 

  23. Bindal R, Goodman JM, Kawasaki A et al (2003) The natural history of untreated skull base meningiomas. Surg Neurol 59:87–92. https://doi.org/10.1016/S0090-3019(02)00995-3

    Article  PubMed  Google Scholar 

  24. Goldbrunner R, Stavrinou P, Jenkinson MD et al (2021) EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. https://doi.org/10.1093/neuonc/noab150

    Article  PubMed  Google Scholar 

  25. Nakamura M, Struck M, Roser F et al (2008) Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery 62:844–852. https://doi.org/10.1227/01.NEU.0000333788.83349.1E

    Article  Google Scholar 

  26. Nakamura M, Roser F, Dormiani M et al (2005) Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas. Neurosurgery 57:77–90. https://doi.org/10.1227/01.neu.0000154699.29796.34

    Article  PubMed  Google Scholar 

  27. Bambakidis NC, Kakarla UK, Kim LJ et al (2008) Evolution of surgical approaches int the treatment of petroclival meningionas: a retrospective review. Neurosurgery. https://doi.org/10.1227/01.NEU.0000333784.04435.65

    Article  PubMed  Google Scholar 

  28. Chen C-M, Huang AP-H, Kuo L-T, Tu Y-K (2011) Contemporary surgical outcome for skull base meningiomas. Neurosurg Rev 34:281–296. https://doi.org/10.1007/s10143-011-0321-x

    Article  PubMed  Google Scholar 

  29. Sheehan JP, Lee C-C, Xu Z et al (2015) Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas. J Neurosurg 123:1287–1293. https://doi.org/10.3171/2014.12.JNS142159

    Article  PubMed  Google Scholar 

  30. Daou BJ, Palmateer G, Wilkinson DA et al (2021) Radiation-induced imaging changes and cerebral edema following stereotactic radiosurgery for brain AVMs. AJNR Am J Neuroradiol 42:82–87. https://doi.org/10.3174/ajnr.A6880

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. O’Connor KP, Algan O, Vesely SK et al (2019) Factors associated with treatment failure and radiosurgery-related edema in WHO ragde 1 and 2 meningioma patients receiving gamma knife radiosurgery. World Neurosurg 130:e558–e565. https://doi.org/10.1016/j.wneu.2019.06.152

    Article  PubMed  Google Scholar 

  32. Ganz JC, Reda WA, Abdelkarim K (2009) Adverse radiation effects after gamma knife surgery in relation to dose and volume. Acta Neurochir (Wien) 151:9–19. https://doi.org/10.1007/s00701-008-0174-4

    Article  CAS  Google Scholar 

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Georgios Mantziaris, Stylianos Pikis & Jason Sheehan

  2. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey

    Yavuz Samanci & Selcuk Peker

  3. Gamma Knife Center Cairo-Nasser Institute, Giza, Egypt

    Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Amr M. N. El-Shehaby, Khaled Abdelkarim & Reem M. Emad

  4. Department of Neurosurgery, Benha University, Benha, Egypt

    Ahmed M. Nabeel

  5. Ain Shams University, Cairo, Egypt

    Wael A. Reda, Sameh R. Tawadros, Amr M. N. El-Shehaby & Khaled Abdelkarim

  6. Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    Reem M. Emad

  7. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherché du CHUS, Sherbrooke, Québec, Canada

    Violaine Delabar & David Mathieu

  8. Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, and National Yang-Ming University, Taipei, Taiwan

    Cheng-chia Lee & Huai-che Yang

  9. Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic

    Roman Liscak & Jaromir Hanuska

  10. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain

    Roberto Martinez Alvarez & Nuria Martinez Moreno

  11. Department of Neurosurgery and Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manjul Tripathi

  12. Department of Radiology, Dominican Gamma Knife Center and , CEDIMAT, Santo Domingo, Dominican Republic

    Herwin Speckter & Camilo Albert

  13. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, USA

    Ronald J. Benveniste

  14. Department of Neurosurgery, University of Alberta, Edmonton, Canada

    Greg N. Bowden

  15. Department of Neurosurgery, New York University, New York, USA

    Dev N. Patel & Douglas Kondziolka

  16. Department of Radiation Oncology, New York University, New York, USA

    Kenneth Bernstein

  17. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, USA

    L. Dade Lunsford

  18. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK

    Michael D. Jenkinson & Abdurrahman I. Islim

  19. Institute of Systems and Molecular Biology, University of Liverpool, Liverpool, UK

    Michael D. Jenkinson & Abdurrahman I. Islim

Authors
  1. Georgios Mantziaris
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  2. Stylianos Pikis
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  3. Yavuz Samanci
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  4. Selcuk Peker
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  5. Ahmed M. Nabeel
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  6. Wael A. Reda
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  7. Sameh R. Tawadros
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  8. Amr M. N. El-Shehaby
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  9. Khaled Abdelkarim
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  11. Violaine Delabar
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  12. David Mathieu
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  13. Cheng-chia Lee
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  14. Huai-che Yang
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  15. Roman Liscak
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  16. Jaromir Hanuska
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  17. Roberto Martinez Alvarez
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  18. Nuria Martinez Moreno
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  19. Manjul Tripathi
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  20. Herwin Speckter
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  21. Camilo Albert
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  22. Ronald J. Benveniste
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  23. Greg N. Bowden
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  24. Dev N. Patel
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  25. Douglas Kondziolka
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  26. Kenneth Bernstein
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  27. L. Dade Lunsford
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  28. Michael D. Jenkinson
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  29. Abdurrahman I. Islim
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  30. Jason Sheehan
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Contributions

Conceptualization: Jason Sheehan; Methodology: Jason Sheehan; Formal analysis and investigation: Georgios Mantziaris, Stylianos Pikis, Jason Sheehan; Writing—original draft preparation: Georgios Mantziaris; Writing—review and editing: All authors; Supervision: Jason Sheehan.

Corresponding author

Correspondence to Jason Sheehan.

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Conflict of interest

L. Dade Lunsford is a shareholder in Elekta AB, the manufacturer of some radiosurgical devices. Roman Liscak is a consultant for Elekta AB. All remaining authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

The participating centers obtained approval by the local institutional review boards for the study and for sharing de-identified data with the coordinating office.

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Mantziaris, G., Pikis, S., Samanci, Y. et al. Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas: an international, multicenter matched cohort study. J Neurooncol 156, 509–518 (2022). https://doi.org/10.1007/s11060-021-03923-3

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