TY - JOUR
T1 - Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas
T2 - an international, multicenter matched cohort study
AU - Mantziaris, Georgios
AU - Pikis, Stylianos
AU - Samanci, Yavuz
AU - Peker, Selcuk
AU - Nabeel, Ahmed M
AU - Reda, Wael A
AU - Tawadros, Sameh R
AU - El-Shehaby, Amr M N
AU - Abdelkarim, Khaled
AU - Emad, Reem M
AU - Delabar, Violaine
AU - Mathieu, David
AU - Lee, Cheng-Chia
AU - Yang, Huai-Che
AU - Liscak, Roman
AU - Hanuska, Jaromir
AU - Alvarez, Roberto Martinez
AU - Moreno, Nuria Martinez
AU - Tripathi, Manjul
AU - Speckter, Herwin
AU - Albert, Camilo
AU - Benveniste, Ronald J
AU - Bowden, Greg N
AU - Patel, Dev N
AU - Kondziolka, Douglas
AU - Bernstein, Kenneth
AU - Lunsford, L Dade
AU - Jenkinson, Michael D
AU - Islim, Abdurrahman I
AU - Sheehan, Jason
N1 - © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - Humans
KW - Meningioma/pathology
KW - Radiosurgery/methods
KW - Retrospective Studies
KW - Skull Base Neoplasms/pathology
KW - Treatment Outcome
KW - Watchful Waiting
U2 - 10.1007/s11060-021-03923-3
DO - 10.1007/s11060-021-03923-3
M3 - Article
C2 - 35067846
SN - 1573-7373
VL - 156
SP - 509
EP - 518
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 3
ER -