Volumetric Growth and Growth Curve Analysis of Residual Intracranial Meningioma. Issue 4 (14th April 2023)

• Record Type: Journal Article
• Authors: Gillespie, Conor S.; Richardson, George E.; Mustafa, Mohammad A.; Taweel, Basel A.; Bakhsh, Ali; Kumar, Siddhant; Keshwara, Sumirat M.; Islim, Abdurrahman I.; Mehta, Shaveta; Millward, Christopher P.; Brodbelt, Andrew R.; Mills, Samantha J.; Jenkinson, Michael D.
• Is Part Of: Neurosurgery. Volume 92:Issue 4(2023)
• Page Start: 734
• Page End: 744
• Publication Date: 2023-04-14
• Subjects: Growth -- Meningioma -- RANO -- Residual -- Simpson grade -- Surgery -- Volume; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002268
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: After meningioma surgery, approximately 1 in 3 patients will have residual tumor that requires ongoing imaging surveillance. The precise volumetric growth rates of these tumors are unknown. OBJECTIVE: To identify the volumetric growth rates of residual meningioma, growth trajectory, and factors associated with progression. METHODS: Patients with residual meningioma identified at a tertiary neurosurgery center between 2004 and 2020 were retrospectively reviewed. Tumor volume was measured using manual segmentation, after surgery and at every follow-up MRI scan. Growth rates were ascertained using a linear mixed-effects model and nonlinear regression analysis of growth trajectories. Progression was defined according to the Response Assessment in Neuro-Oncology (RANO) criteria (40% volume increase). RESULTS: There were 236 patients with residual meningioma. One hundred and thirty-two patients (56.0%) progressed according to the RANO criteria, with 86 patients being conservatively managed (65.2%) after progression. Thirteen patients (5.5%) developed clinical progression. Over a median follow-up of 5.3 years (interquartile range, 3.5–8.6 years), the absolute growth rate was 0.11 cm 3 per year and the relative growth rate 4.3% per year. Factors associated with residual meningioma progression in multivariable Cox regression analysis were skull base location (hazard ratio [HR] 1.60, 95% CI 1.02–2.50) and increasing Ki-67 index (HR 3.43, 95% CI 1.19–9.90). Most meningioma exhibited exponential and logistic growth patterns (median R 2 value 0.84, 95% CI 0.60–0.90). CONCLUSION: Absolute and relative growth rates of residual meningioma are low, but most meet the RANO criteria for progression. Location and Ki-67 index can be used to stratify adjuvant treatment and surveillance paradigms. Abstract :