P09.04 Natural history of meningiomas: review with meta-analyses. (6th September 2019)

• Record Type: Journal Article
• Authors: Nakasu, S; Nakasu, Y
• Is Part Of: Neuro-oncology. Volume 21(2019)Supplement 3
• Page Start: iii39
• Page End: iii39
• Publication Date: 2019-09-06
• Subjects: Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noz126.136
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: BACKGROUND: A recent investigation using MRI showed 2.5% frequency of meningioma as an incidental finding in the population-based neuroimaging study. Although observation has been a mainstay in asymptomatic meningiomas, it may increase the risk of surgery due to enlargement of the tumors and aging of patients. It is important to characterize tumors that will grow to be symptomatic in order to select appropriate treatments and radiological follow-up. MATERIAL AND METHODS: We reviewed 26 studies (3 from the same institute) that analyzed natural courses in asymptomatic or untreated meningiomas. Radiological progression of tumor was redefined as tumor growth by 15% of initial volume or more whenever possible. To adjust the difference of follow-up interval in each study, the percentages of growing tumors in each study were compared with each mean follow-up period. Individual data were extracted from seven studies for univariate or multivariate analyses. Weighted meta-analyses were performed using the 25 studies. RESULTS: In time-growth rate analysis, nearly 70% of meningiomas showed radiological progression defined by a volume criteria and the rate approached plateau at 5–6 years. Meta-analyses showed that each radiological progression, growth speed (annual volume change (AVC) or relative growth rate (RGR)) and symptomatic progression had different factors related to their progression. Age, calcification and high intensity on T2 weighted image related to radiological progression and growth speed but not to clinical progression. In individual data analyses, tumor size (diameter 2.6cm (AUC 0.773; specificity 0.759, sensitivity 0.800), volume 5.6cm 3 (AUC 0.775, specificity 0.717, sensitivity 0.800)) was a possible marker for symptomatic growth.AVC (>= 2.1cm 3 /year) was the strongest indicator for clinical progression. In the group of >=2.1cm 3 /year, Kaplan-Meier analysis showed that progression free rate was 69.3% at 3 years, and reached to 55.4% at 6 years whereas 100% in slower growth group. CONCLUSION: Radiological features may not be very much useful for prediction of clinical progression except for perifocal edema. This may be due to dynamic changes of these radiological markers in a long term. Initial quantitative tumor size and growth speed especially AVC were reliable factors for decision of treatment for asymptomatic meningiomas.