Abstract
Purpose
Meningiomas represent the most frequent tumor of the central nervous system in adults. While most meningiomas are efficiently treated by surgery and radiotherapy/radiosurgery, there is a small portion of radiation- and surgery-refractory tumors for which there is no clear recommendation for optimal management. The French National Tumor Board Meeting on Meningiomas (NTBM) offers a glimpse on the current management of such patients.
Methods
We retrospectively reviewed the charts of patients presented to the multidisciplinary Meeting between 2016 and 2019. We selected patients with a progressive disease after at least two treatments, including surgery and radiotherapy.
Results
In this multicentric cohort of 86 cases, patients harbored 17 (19.8%) WHO Grade I, 48 (55.8%) WHO Grade II and 21 (24.4%) WHO Grade III tumors. The median number of treatments received before inclusion was 3 (range: 2 – 11). Following the Board Meeting, 32 patients (37.2%) received chemotherapy, 11 (12.8%) surgery, 17 (19.8%) radiotherapy, 14 (16.3%) watchful observation and 12 (13.9%) palliative care. After a mean follow-up of 13 months post-inclusion, 32 patients (37.2%) had died from their disease. The mean progression free survival was 27 months after radiotherapy, 10 months after surgery, 8.5 months after chemotherapy (Bevacizumab: 9 months – Octreotide/Everolimus: 8 months).
Conclusions
Surgery- and radiation-refractory meningiomas represent a heterogeneous group of tumors with a majority of WHO Grade II cases. If re-irradiation and redo-surgery are not possible, bevacizumab and octreotide-everolimus appear as a valuable option in heavily pre-treated patients considering the current EANO guidelines.
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Acknowledgements
We would like to thank all clinicians that have participated to the French National Tumor Board Meeting on Meningiomas over the past 5 years.
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No funding was received to assist with the preparation of this manuscript.
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TLV reviewed patient charts, gathered missing information on clinical parameters and outcome, established the clinical database and wrote the first draft of the manuscript. TG initiated the study and critically reviewed the manuscript. MK and HL critically reviewed the manuscript. MP supervised the study and wrote the manuscript. All other authors helped gathering information on patients from their respective centers included in the study and reviewed the manuscript.
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The authors have no conflict of interest to disclose.
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The Ethics in Research Committee of the French National College of Neurosurgeons approved this retrospective chart review (NOIRB00011687).
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Informed consent was obtained from all individual participants included in the study.
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Le Van, T., Graillon, T., Jacob, J. et al. Multimodal management of surgery- and radiation-refractory meningiomas: an analysis of the French national tumor board meeting on meningiomas cohort. J Neurooncol 153, 55–64 (2021). https://doi.org/10.1007/s11060-021-03741-7
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DOI: https://doi.org/10.1007/s11060-021-03741-7