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

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

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

10.1101/856211 ◽

2019 ◽

Author(s):

Ryang-Hun Lee ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

Je Il Ryu ◽

Young Soo Kim ◽

...

Keyword(s):

Brain Edema ◽

Predictive Factors ◽

Tumor Volume ◽

Radiation Treatment ◽

Characteristic Curve ◽

Critical Role ◽

Hazard Ratio ◽

Intracranial Meningioma ◽

Large Tumor ◽

Peritumoral Brain Edema

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.

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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.

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Peritumoral brain edema associated with meningioma

Cancer ◽

10.1002/(sici)1097-0142(19990215)85:4<936::aid-cncr23>3.0.co;2-j ◽

1999 ◽

Vol 85 (4) ◽

pp. 936-944 ◽

Cited By ~ 106

Author(s):

Hiroyuki Yoshioka ◽

Seiji Hama ◽

Eiji Taniguchi ◽

Kazuhiko Sugiyama ◽

Kazunori Arita ◽

...

Keyword(s):

Brain Edema ◽

Peritumoral Brain Edema

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Peritumoral brain edema in angiomatous supratentorial meningiomas: an investigation of the vascular endothelial growth factor A pathway

Apmis ◽

10.1111/apm.12052 ◽

2013 ◽

Vol 121 (11) ◽

pp. 1025-1036 ◽

Cited By ~ 14

Author(s):

Damoun Nassehi ◽

Lars P. Sørensen ◽

Henrik Dyrbye ◽

Carsten Thomsen ◽

Marianne Juhler ◽

...

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Brain Edema ◽

Vascular Endothelial ◽

Peritumoral Brain Edema ◽

Endothelial Growth Factor

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Role of hydrodynamic processes in the pathogenesis of peritumoral brain edema in meningiomas

Journal of Neurosurgery ◽

10.3171/jns.2000.93.4.0594 ◽

2000 ◽

Vol 93 (4) ◽

pp. 594-604 ◽

Cited By ~ 26

Author(s):

Michael Bitzer ◽

Thomas Nägele ◽

Beverly Geist-Barth ◽

Uwe Klose ◽

Eckardt Grönewäller ◽

...

Keyword(s):

Contrast Agent ◽

Brain Edema ◽

Brain Tissue ◽

Magnetic Resonance Images ◽

Content Type ◽

Extracellular Contrast Agent ◽

Peritumoral Brain Edema ◽

Hydrodynamic Processes ◽

Fine Print

Object. In a prospective study, 28 patients with 32 intracranial meningiomas were examined to determine the role of hydrodynamic interaction between tumor and surrounding brain tissue in the pathogenesis of peritumoral brain edema.Methods. Gadolinium—diethylenetriamine pentaacetic acid (Gd-DPTA), an extracellular contrast agent used for routine clinical imaging, remains strictly extracellular without crossing an intact blood—brain barrier. Therefore, it is well suited for investigations of hydrodynamic extracellular mechanisms in the development of brain edema. Spin-echo T1-weighted magnetic resonance images were acquired before and after intravenous administration of 0.2 mmol/kg Gd-DPTA. Additional T1-weighted imaging was performed 0.6, 3.5, and 6.5 hours later. No significant Gd-DPTA diffused from tumor into peritumoral brain tissue in 12 meningiomas without surrounding brain edema. In contrast, in 17 of 20 meningiomas with surrounding edema, contrast agent in peritumoral brain tissue was detectable after 3.5 hours and 6.5 hours. In three of 20 meningiomas with minimum surrounding edema (< 5 cm3), contrast agent effusion was absent. After 3.5 hours and 6.5 hours strong correlations of edema volume and the maximum distance of contrast spread from the tumor margin into adjacent brain parenchyma (r = 0.84 and r = 0.87, respectively, p < 0.0001) indicated faster effusion in larger areas of edema.Conclusions. The results of this study show that significant contrast agent effusion from the extracellular space of the tumor into the interstitium of the peritumoral brain tissue is only found in meningiomas with surrounding edema. This supports the hypothesis that hydrodynamic processes play an essential role in the pathogenesis of peritumoral brain edema in meningiomas.

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