The Long-Term Outcome of Cyberknife Radiotherapy for Central Skull Base Meningiomas: A Single-Center Experience

2021 ◽  
Author(s):  
Sukwoo Hong ◽  
Kengo Sato ◽  
Kenji Kagawa ◽  
Shunsuke Ichi
Keyword(s):  
Adverse Events ◽  
Skull Base ◽  
Normal Pressure ◽  
Target Volume ◽  
Term Outcome ◽  
Who Grade ◽  
Long Term Outcome ◽  
Previous Operation ◽  
Grade Ii ◽  
Skull Base Meningiomas

Abstract Few reports exist demonstrating the effects of CyberKnife radiotherapy (CKRT) on the central skull base meningiomas (CSMs). Retrospective analysis of 113 patients were performed. The median age was 62 (IQR 50 – 72) years old, and 78 patients (69%) were female. Upfront CKRT was performed in 41 (36%), where 17 (15%) patients were asymptomatic. The other CKRT was for postoperative adjuvant therapy in 32 (28%), and for the recurrent or relapsed tumors in 40 (35%) patients. Previous operation was done in 74 patients (66%). Among the available pathology in 46 patients, 37 (80%) were WHO grade I, 8 (17%) were grade II, and 1 (2%) were grade III. The median prescribed dose covered 95% of the planning target volume was 2500 (IQR 2100 – 2500) cGy and the median target volume was 9.5 (IQR 3.9 – 16.9) cm3. The median PFS was 48 (IQR 23 – 73) months and 84% and 78% were free of tumor progression at five, and 10 years respectively. The median follow-up was 49 (IQR 28 – 83) months. PFS was better in grade I than grade II (p = 0.02). No other baseline factors including the history of previous operation was associated with PD or PFS. Adverse events of radiation therapy were radiation- induced optic neuropathy (0.9%), and cerebral edema (4.4%). Asymptomatic cavernous carotid stenosis was found in three (2.7%), five (4.4%) underwent ventriculoperitoneal shunt placement for normal pressure hydrocephalus, and five (4.4%) died. CKRT is useful for the management of CSMs with low rate of adverse events.

scholarly journals Adult intracranial WHO grade II ependymomas: long-term outcome and prognostic factor analysis in a series of 114 patients

2010 ◽  
Vol 12 (9) ◽  
pp. 976-984 ◽  
Author(s):  
P. Metellus ◽  
J. Guyotat ◽  
O. Chinot ◽  
A. Durand ◽  
M. Barrie ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Prognostic Factor ◽  
Term Outcome ◽  
Who Grade ◽  
Long Term Outcome ◽  
Grade Ii

Skull base meningiomas expanding into orbit and paranasal sinuses: Long-term outcome

1997 ◽  
Vol 99 ◽  
pp. S235
Author(s):  
V.A. Tcherekaev ◽  
A.N. Konovalov ◽  
U.B. Makhamudov ◽  
V.N. Shimansky ◽  
A.G. Korshunov ◽  
...  
Keyword(s):  
Skull Base ◽  
Paranasal Sinuses ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Skull Base Meningiomas

scholarly journals Long-Term Clinical Outcome of First Recurrence Skull Base Meningiomas

2019 ◽  
Vol 9 (1) ◽  
pp. 106
Author(s):  
Yuki Kuranari ◽  
Ryota Tamura ◽  
Noboru Tsuda ◽  
Kenzo Kosugi ◽  
Yukina Morimoto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Tumor Size ◽  
Removal Rate ◽  
World Health ◽  
Who Grade ◽  
Multiple Lesions ◽  
Grade Ii ◽  
Skull Base Meningiomas

Skull base meningiomas (SBMs) are considered to be less aggressive and have a slower growth rate than non-SBMs. However, SBMs often develop local recurrences after surgical resection. Gross total removal is difficult because SBMs are deep-seated tumors and involve critical neurovascular structures. The treatment strategy for recurrent SBMs remains controversial. The present study aimed to evaluate the long-term clinical course and prognostic factors associated with shorter progression-free survival (PFS) of recurrent SBMs. This retrospective study included 85 recurrent SBMs from 65 patients who underwent surgery from January 2005 to September 2018. Overall survival (OS) and PFS were evaluated, and the associations among shorter PFS and age, sex, tumor size, lesions, World Health Organization (WHO) grading, removal rate, and time since prior surgery were analyzed. The median follow-up period for PFS was 68 months. The 2-, 5-, and 10-year PFS rates were 68.0%, 52.8%, and 22.7%, respectively. WHO grade II or III, multiple lesions, and tumor size were significantly associated with shorter PFS (p < 0.0001, p = 0.030, and p = 0.173, respectively). Although, radiotherapy did not improve PFS and OS for overall patients, PFS of the patients with subtotal and partial removal for WHO grade II SBMs was significantly improved by the radiotherapy. Multivariate analysis identified WHO grade II or III and multiple lesions as independent prognostic factors for shorter PFS (p < 0.0001 and p = 0.040, respectively). It is essential to estimate the risks associated with shorter PFS for patients with recurrent SBMs to aid in the development of appropriate postoperative strategies.

A comparison of World Health Organization tumor grades at recurrence in patients with non–skull base and skull base meningiomas

2010 ◽  
Vol 112 (5) ◽  
pp. 925-933 ◽  
Author(s):  
Susan L. McGovern ◽  
Kenneth D. Aldape ◽  
Mark F. Munsell ◽  
Anita Mahajan ◽  
Franco DeMonte ◽  
...  
Keyword(s):  
Skull Base ◽  
Labeling Index ◽  
World Health ◽  
Skull Base Tumors ◽  
Who Grade ◽  
Grade Ii ◽  
Health Organization ◽  
Skull Base Meningiomas ◽  
Mib 1

Object Despite a favorable outcome for most patients with WHO Grade I meningiomas, a subset of these patients will have recurrent or progressive disease that advances to a higher grade and requires increasingly aggressive therapy. The goal of this study was to identify clinical characteristics associated with the recurrence of benign meningiomas and their acceleration to atypical and malignant histological types. Methods Records of 216 patients with WHO Grade I, II, or III meningioma that were initially treated between 1965 and 2001 were retrospectively reviewed. Median follow-up was 7.2 years. Results Patients with non–skull base cranial meningiomas (82 of 105 [78%]) were more likely to have undergone a gross-total resection than patients with skull base meningiomas (32 of 78 [41%]; p < 0.001). Consequently, patients with Grade I non–skull base cranial meningiomas had better 5-year recurrence-free survival (69%) than patients with Grade I skull base meningiomas (56%) or Grade II or III tumors at any site (50%; p = 0.005). Unexpectedly, patients with non–skull base tumors who experienced a recurrence (8 of 22 [36%]) were more likely than patients with skull base tumors (1 of 19 [5%]) to have a higher grade tumor at recurrence (p = 0.024). Furthermore, the median MIB-1 labeling index of Grade I non–skull base cranial meningiomas (2.60%) was significantly higher than that of Grade I skull base tumors (1.35%; p = 0.016). Conclusions Cranial meningiomas that occur outside of the skull base are more likely to have a higher MIB-1 labeling index and recur with a higher grade than those within the skull base, suggesting that non–skull base cranial tumors may have a more aggressive biology than skull base tumors.

scholarly journals EPID-25. SKULL BASE MENINGIOMAS ARE ASSOCIATED WITH OBESITY IN MALES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii83-ii84
Author(s):  
Maryam Shahin ◽  
Brittany Stedelin ◽  
Christian Lopez Ramos ◽  
Ali Rae ◽  
Jared Edwards ◽  
...  
Keyword(s):  
Skull Base ◽  
Progesterone Receptors ◽  
Consecutive Series ◽  
Who Grade ◽  
Hormone Synthesis ◽  
Skull Base Meningioma ◽  
Prevalence Of Obesity ◽  
Grade Ii ◽  
Male Patients ◽  
Skull Base Meningiomas

Abstract BACKGROUND The female predominance of meningiomas may reflect hormonal influences on meningioma development, with known presence of estrogen and progesterone receptors. Progestin-associated meningiomas demonstrate a shift in the mutational landscape and are more frequently located at the skull base. Obesity and increased adipocytes increase aromatase and affect male hormone synthesis, thus increases circulating estrogen. OBJECTIVE Report prevalence of obesity in a consecutive series of male patients presenting with meningioma and the interaction with obesity. METHODS A retrospective review (20012019) was performed of male patients diagnosed with meningioma. Body mass index (BMI) &gt;30 kg/m2 was considered obese. Obese male meningioma patients were characterized and compared to nonobese male meningioma patients. RESULTS Of 239 male patients with meningioma, 97 (40.6%) were obese at the time of surgery with overall mean BMI (30.0 kg/m2). This is above the age-adjusted baseline prevalence of obesity for males in Oregon, which was 34.8% between 2015–2016. Mean age at diagnosis for obese males was 55.3 years and 57.0 years for nonobese males. Within the obese group, most lesions were located on the skull base (48.5% n=47) compared to 34.0% convexity (n=33), 15.4% falx (n=16) and 1.0% multiple (n=1). Tumors were WHO grade I (73.6%), grade II (25.6%) or grade III (1.2%). Of the men in our series, patients with skull base meningiomas were more likely to be obese (OR: 1.7, 95% CI: 1.01–2.9, p=0.0309). CONCLUSIONS There is likely a hormonal influence on the pathogenesis of meningioma, and many men diagnosed with this disease are obese. Of 239 male patients with meningioma in our series, 97 (40.6%) were obese which exceeds the 34% age-adjusted baseline prevalence of obesity for males in Oregon. Patients with skull base meningiomas were more likely to be obese, consistent with prior series and suggestive of a hormone-driven association with skull base meningioma.

scholarly journals Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1451
Author(s):  
Michele Da Broi ◽  
Paola Borrelli ◽  
Torstein R. Meling
Keyword(s):  
Skull Base ◽  
Clinical Outcomes ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Advanced Age ◽  
Final Visit ◽  
Subtotal Resection ◽  
Who Grade ◽  
Skull Base Meningiomas

Background: Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990–2010 were investigated. Results: Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. Conclusions: Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.

scholarly journals The Outcome of Chemotherapy for Metastatic Extramammary Paget’s Disease

2021 ◽  
Vol 10 (4) ◽  
pp. 739
Author(s):  
Hiroki Hashimoto ◽  
Yumiko Kaku-Ito ◽  
Masutaka Furue ◽  
Takamichi Ito
Keyword(s):  
Adverse Events ◽  
Response Rate ◽  
Paget’S Disease ◽  
Progression Free Survival ◽  
Paget's Disease ◽  
Extramammary Paget’S Disease ◽  
Conventional Chemotherapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Extramammary Paget's Disease

The efficacy and survival impact of conventional chemotherapies for metastatic extramammary Paget’s disease (EMPD) have not been fully elucidated. This study examined the long-term outcome of chemotherapy for this indication. We conducted a retrospective review of 21 patients with distant metastatic EMPD (14 patients treated with chemotherapy and 7 patients treated without chemotherapy). The response rate of chemotherapy and patient survival were statistically analyzed. Among the 14 patients treated with chemotherapy, 12, 1, and 1 patient received docetaxel, paclitaxel, and low-dose 5-fluorouracil plus cisplatin, respectively, as the first-line treatment. The response rate was 50.0% (7/14), and the disease control rate was 64.3% (9/14). The median progression-free survival (PFS) and overall survival (OS) were 16.8 and 27.9 months, respectively. Multivariate analyses revealed that chemotherapy was a significant factor for prolonged PFS (hazard ratio (HR) 0.22, p = 0.038) but not for OS (HR = 1.71, p = 0.54). Ten patients (71.4%) had severe (grade 3 or 4) hematological adverse events. Although conventional chemotherapy improved PFS, we failed to show a significantly improved OS. Considering the frequent adverse events of conventional chemotherapy, targeted therapy may become a mainstay for the treatment of metastatic EMPD.

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