1. Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas: an international, multicenter matched cohort study
- Author
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Ahmed M. Nabeel, Abdurrahman I. Islim, Violaine Delabar, Selçuk Peker, Douglas Kondziolka, Yavuz Samanci, Roberto Martínez Álvarez, Khaled Abdelkarim, Ronald J. Benveniste, Michael D. Jenkinson, Reem M Emad, Manjul Tripathi, Kenneth E. Bernstein, Greg Bowden, Dade Lunsford, Georgios Mantziaris, Herwin Speckter, David Mathieu, Jaromir Hanuska, Nuria Martinez Moreno, Sameh R. Tawadros, Amr M N El-Shehaby, Camilo Albert, Cheng-Chia Lee, Stylianos Pikis, Huai-Che Yang, Jason P. Sheehan, Dev N Patel, Roman Liscak, Wael A. Reda, Peker, Selçuk (ORCID 0000-0003-3057-3355 & YÖK ID 11480), Samancı, Yavuz, Mantziaris, Georgios, Pikis, Stylianos, Nabeel, Ahmed M., Reda, Wael A., Tawadros, Sameh R., El-Shehaby, Amr M. N., Abdelkarim, Khaled, Emad, Reem M., Delabar, Violaine, Mathieu, David, Lee, Cheng-chia, Yang, Huai-che, Liscak, Roman, Hanuska, Jaromir, Alvarez, Roberto Martinez, Moreno, Nuria Martinez, Tripathi, Manjul, Speckter, Herwin, Albert, Camilo, Benveniste, Ronald J., Bowden, Greg N., Patel, Dev N., Kondziolka, Douglas, Bernstein, Kenneth, Lunsford, L. Dade, Jenkinson, Michael D., Islim, Abdurrahman I., Sheehan, Jason, Koç University Hospital, and School of Medicine
- Subjects
medicine.medical_specialty ,Cancer Research ,medicine.medical_treatment ,Radiosurgery ,Skull Base Neoplasms ,Asymptomatic ,Matched cohort ,parasitic diseases ,medicine ,Humans ,Watchful Waiting ,Retrospective Studies ,business.industry ,Oncology ,Clinical neurology ,Skull ,Treatment Outcome ,medicine.anatomical_structure ,Neurology ,Radiology ,Neurology (clinical) ,medicine.symptom ,Meningioma ,business ,Skull-base ,Stereotactic - Abstract
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., NA
- Published
- 2022
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