Predictive factors for the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

AbstractBackground and purposeDisruption of the tumor-brain barrier in meningioma plays a critical role in the development of peritumoral brain edema (PTBE). We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation in patients with intracranial meningioma.MethodsWe measured Hounsfield units (HU) of the frontal skull on simulation brain CT in patients who underwent linear accelerator (LINAC)-based radiation treatment for intracranial meningioma. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off values for several predictive factors. The cumulative hazard for PTBE was estimated and classified according to these factors. Hazard ratios were then estimated to identify independent predictive factors associated with the development of PTBE after radiation in intracranial meningioma patients.ResultsA total of 83 intracranial meningiomas in 76 patients who received LINAC-based radiation treatment in our hospital over an approximate 5-year period were included for the study. We found mean frontal skull HU ≤630.625 and gross tumor volume >7.194 cc to be independent predictors of PTBE after radiation treatment in patients with meningioma (hazard ratio, 8.38; P=0.021; hazard ratio, 5.78; P=0.034, respectively). In addition, patients who were ≥65 years showed a marginally significant association with PTBE.ConclusionsOur study suggests that possible osteoporotic conditions, large tumor volume, and older age may be associated with PTBE occurrence after LINAC-based radiation treatment for intracranial meningioma. In the future we anticipate that these findings may enhance the understanding of the underlying mechanisms of PTBE after radiation in meningioma patients.

Download Full-text

Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

Radiation Oncology ◽

10.1186/s13014-021-01890-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sang Mook Kang ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

Je Il Ryu ◽

Yu Deok Won ◽

...

Keyword(s):

Regression Analysis ◽

Brain Edema ◽

Linear Accelerator ◽

Cox Regression ◽

Radiation Treatment ◽

Characteristic Curve ◽

Intracranial Meningioma ◽

Cox Regression Analysis ◽

Number Of Patients ◽

Peritumoral Brain Edema

Abstract Purpose Disruption of the tumor-brain barrier in meningioma is a crucial factor in peritumoral brain edema (PTBE). We previously reported the possible effect of osteoporosis on the integrity of the arachnoid trabeculae because both the bone and the arachnoid trabeculae are composed of type 1 collagen. We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation treatment in patients with meningioma. Methods A receiver operating characteristic curve analysis was used to identify the optimal cut-off values of mean skull Hounsfield unit for predicting osteopenia and osteoporosis in patients from our registry. Multivariate Cox regression analysis was used to determine whether possible osteoporosis independently predicted PTBE development in patients with meningioma after radiation. Results A total of 106 intracranial meningiomas were included for the study. All patients received linear accelerator-based radiation therapy in our hospital over an approximate 6-year period. Multivariate Cox regression analysis identified that hypothetical osteoporosis was an independent predictive factor for the development of PTBE in patients with meningioma after linear accelerator-based radiation treatment (hazard ratio 5.20; 95% confidence interval 1.11–24.46; p = 0.037). Conclusions Our study suggests that possible osteoporotic conditions may affect PTBE development after linear accelerator-based radiation treatment for intracranial meningioma. However, due to the study’s small number of patients, these findings need to be validated in future studies with larger cohorts, before firm recommendations can be made. Graphic abstract

Download Full-text

Significance of skull osteoporosis to the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma

PLoS ONE ◽

10.1371/journal.pone.0226312 ◽

2020 ◽

Vol 15 (2) ◽

pp. e0226312 ◽

Cited By ~ 1

Author(s):

Ryang-Hun Lee ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

Je Il Ryu ◽

Young Soo Kim ◽

...

Keyword(s):

Brain Edema ◽

Radiation Treatment ◽

Intracranial Meningioma ◽

Peritumoral Brain Edema

Download Full-text

The importance of pial blood supply to the development of peritumoral brain edema in meningiomas

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.4.7 ◽

1997 ◽

Vol 2 (4) ◽

pp. E6 ◽

Cited By ~ 1

Author(s):

Michael Bitzer ◽

Lars Wöckel ◽

Andreas R. Luft ◽

Ajay K. Wakhloo ◽

Dirk Petersen ◽

...

Keyword(s):

Brain Edema ◽

Blood Supply ◽

Tumor Size ◽

Tumor Volume ◽

Volume Ratio ◽

Total Tumor Volume ◽

Pial Vessels ◽

Peritumoral Brain Edema ◽

Tumor Region ◽

The Mean

The authors studied the pial and dural blood supplies in 74 intracranial meningiomas and quantified their associated peritumoral brain edema (PTBE). The extent and localization of pial blush in relation to the total tumor volume were determined angiographically. The amount of edema and tumor size were calculated using computerized tomography. The edema-tumor volume ratio was defined as Edema Index (EI). There were 49 meningiomas with PTBE; of those tumors, 46 were supplied by pial vessels, and three were supplied exclusively by dural vessels. Tumors without PTBE showed no pial blush. The mean EI in meningiomas with pial blush was significantly larger (EI = 3.0) than in meningiomas without pial supply (EI = 1.1; p < 0.0001). Meningiomas in which 10% of the whole tumor volume was supplied by pial vessels had only a small mean EI of 2.2, whereas tumors with pial blood supply greater than or equal to 20% had a mean EI of 3.3 (p < 0.026). In 69.9% of cases with pial blood supply, major portions of the edema were located adjacent to the tumor region supplied by pial vessels. Edema index differences among tumors of different subgroups, as defined by size or histology, were significantly related to the pial supply in each subset. Thus, pial blood supply may be causative for the development of PTBE in meningiomas.

Download Full-text

Predictive Factors of Postoperative Peritumoral Brain Edema after Meningioma Resection

Neurology India ◽

10.4103/0028-3886.333500 ◽

2021 ◽

Vol 69 (6) ◽

pp. 1682

Author(s):

Jian Gong ◽

Liang-Ming Li ◽

Wen-Jian Zheng ◽

Ying-Zhi Chen ◽

Zi-Hui Hu ◽

...

Keyword(s):

Brain Edema ◽

Predictive Factors ◽

Peritumoral Brain Edema

Download Full-text

The importance of pial blood supply to the development of peritumoral brain edema in meningiomas

Journal of Neurosurgery ◽

10.3171/jns.1997.87.3.0368 ◽

1997 ◽

Vol 87 (3) ◽

pp. 368-373 ◽

Cited By ~ 61

Author(s):

Michael Bitzer ◽

Lars Wöckel ◽

Andreas R. Luft ◽

Ajay K. Wakhloo ◽

Dirk Petersen ◽

...

Keyword(s):

Brain Edema ◽

Blood Supply ◽

Tumor Volume ◽

Volume Ratio ◽

Content Type ◽

Total Tumor Volume ◽

Pial Vessels ◽

Peritumoral Brain Edema ◽

Tumor Region ◽

The Mean

✓ In a retrospective analysis, the authors studied the pial and dural blood supplies in 74 intracranial meningiomas and quantified their associated peritumoral brain edema (PTBE). The extent and localization of pial blush in relation to the total tumor volume were determined angiographically. The amount of edema and tumor size were calculated using computerized tomography. The edema—tumor volume ratio was defined as Edema Index (EI). There were 49 meningiomas with PTBE; of those tumors, 46 were supplied by pial vessels, and three were supplied exclusively by dural vessels. Tumors without PTBE showed no pial blush. The mean EI in meningiomas with pial blush was significantly larger (EI = 3) than in meningiomas without pial supply (EI = 1.1; p < 0.0001). Meningiomas with a smaller pial supply than dural supply had a significantly smaller mean EI than tumors with a pial supply equal to or greater than the dural supply (EI = 2.9 vs. EI = 3.7; p < 0.015). In 69.9% of cases with pial blood supply, major portions of the edema were located adjacent to the tumor region supplied by pial vessels. Edema index differences among tumors of different subgroups, as defined by size or histology, were significantly related to the pial supply in each subset. Thus, pial blood supply may be associated with the development of PTBE in meningiomas.

Download Full-text

Peritumoral Brain Edema in Meningiomas Depends on Aquaporin-4 Expression and Not on Tumor Grade, Tumor Volume, Cell Count, or Ki-67 Labeling Index

Molecular Imaging and Biology ◽

10.1007/s11307-016-1000-7 ◽

2016 ◽

Vol 19 (2) ◽

pp. 298-304 ◽

Cited By ~ 13

Author(s):

Matthias Gawlitza ◽

Eckhard Fiedler ◽

Stefan Schob ◽

Karl-Titus Hoffmann ◽

Alexey Surov

Keyword(s):

Cell Count ◽

Brain Edema ◽

Tumor Volume ◽

Tumor Grade ◽

Labeling Index ◽

Aquaporin 4 ◽

Ki 67 ◽

Peritumoral Brain Edema ◽

Volume Cell

Download Full-text

Peritumoral Brain Edema in Metastases May Be Related to Glymphatic Dysfunction

Frontiers in Oncology ◽

10.3389/fonc.2021.725354 ◽

2021 ◽

Vol 11 ◽

Author(s):

Cheng Hong Toh ◽

Tiing Yee Siow ◽

Mauricio Castillo

Keyword(s):

Regression Analysis ◽

Linear Regression ◽

Brain Metastases ◽

Brain Edema ◽

Tumor Volume ◽

Linear Regression Analysis ◽

Cerebral Metastasis ◽

Dynamic Susceptibility ◽

Factors Associated ◽

Peritumoral Brain Edema

ObjectivesThe proliferation of microvessels with increased permeability is thought to be the cause of peritumoral brain edema (PTBE) in metastases. The contribution of the glymphatic system to the formation of PTBE in brain metastases remains unexplored. We aimed to investigate if the PTBE volume of brain metastases is related to glymphatic dysfunction.Materials and MethodsA total of 56 patients with brain metastases who had preoperative dynamic susceptibility contrast-enhanced perfusion-weighted imaging for calculation of tumor cerebral blood volume (CBV) and diffusion tensor imaging for calculations of tumor apparent diffusion coefficient (ADC), tumor fractional anisotropy (FA), and analysis along perivascular space (ALPS) index were analyzed. The volumes of PTBE, whole tumor, enhancing tumor, and necrotic and hemorrhagic portions were manually measured. Additional information collected for each patient included age, sex, primary cancer, metastasis location and number, and the presence of concurrent infratentorial tumors. Linear regression analyses were performed to identify factors associated with PTBE volume.ResultsAmong 56 patients, 45 had solitary metastasis, 24 had right cerebral metastasis, 21 had left cerebral metastasis, 11 had bilateral cerebral metastases, and 11 had concurrent infratentorial metastases. On univariable linear regression analysis, PTBE volume correlated with whole tumor volume (β = -0.348, P = 0.009), hemorrhagic portion volume (β = -0.327, P = 0.014), tumor ADC (β = 0.530, P <.001), and ALPS index (β = -0.750, P <.001). The associations of PTBE volume with age, sex, tumor location, number of tumors, concurrent infratentorial tumor, enhancing tumor volume, necrotic portion volume, tumor FA, and tumor CBV were not significant. On multivariable linear regression analysis, tumor ADC (β = 0.303; P = 0.004) and ALPS index (β = -0.624; P < 0.001) were the two independent factors associated with PTBE volume.ConclusionMetastases with higher tumor ADC and lower ALPS index were associated with larger peritumoral brain edema volumes. The higher tumor ADC may be related to increased periarterial water influx into the tumor interstitium, while the lower ALPS index may indicate insufficient fluid clearance. The changes in both tumor ADC and ALPS index may imply glymphatic dysfunction, which is, at least, partially responsible for peritumoral brain edema formation.

Download Full-text

Association between tumor size and peritumoral brain edema in patients with convexity and parasagittal meningiomas

PLoS ONE ◽

10.1371/journal.pone.0252945 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252945

Author(s):

Chansub Shin ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

Je Il Ryu ◽

Yu Deok Won ◽

...

Keyword(s):

Brain Edema ◽

Operating Characteristic ◽

Characteristic Curve ◽

Curve Analysis ◽

Common Complication ◽

3D Slicer ◽

Contrast Enhanced ◽

Peritumoral Brain Edema ◽

Logistic Regressions ◽

Parasagittal Meningioma

Background and purpose Peritumoral brain edema (PTBE) is a common complication in meningioma and disruption of the tumor-brain barrier in meningioma is crucial for PTBE formation. To evaluate the association between meningioma size and PTBE, we measured meningioma volumes using the 3D slicer in patients with convexity and parasagittal meningiomas. Methods Receiver operating characteristic curve analysis was used to determine the optimal cut-off meningioma volume values for predicting PTBE occurrence. Logistic regressions were used to estimate the odds ratios for PTBE occurrence in patients with convexity and parasagittal meningiomas according to several predictive factors. Results A total of 205 convexity or parasagittal meningioma patients with no other brain disease who underwent one or more contrast-enhanced brain MRIs were enrolled in this 10-year analysis in two hospitals. The optimal cut-off meningioma volume value for prediction of PTBE in all study patients was 13.953 cc (sensitivity = 76.1%; specificity = 92.5%). If a meningioma is assumed to be a complete sphere, 13.953 cc is about 2.987 cm in diameter. Conclusions Our study suggests a cut-off value of 3 cm meningioma diameter for prediction of PTBE in patients with convexity and parasagittal meningiomas. We believe that we have revealed why the meningioma diameter of 3 cm is clinically meaningful.

Download Full-text