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Stereotactic radiosurgery versus active surveillance for asymptomatic, skull-based meningiomas: an international, multicenter matched cohort study
G. Mantziaris, S. Pikis, Y. Samanci, S. Peker, AM. Nabeel, WA. Reda, SR. Tawadros, AMN. El-Shehaby, K. Abdelkarim, RM. Emad, V. Delabar, D. Mathieu, CC. Lee, HC. Yang, R. Liscak, J. Hanuska, RM. Alvarez, NM. Moreno, M. Tripathi, H. Speckter, C....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie
- MeSH
- lidé MeSH
- meningeom * patologie radioterapie MeSH
- nádory baze lební * patologie radioterapie MeSH
- pozorné vyčkávání * MeSH
- radiochirurgie * metody MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
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.
Ain Shams University Cairo Egypt
Department of Neurological Surgery University of Virginia Health System Charlottesville VA USA
Department of Neurosurgery Benha University Benha Egypt
Department of Neurosurgery Koc University School of Medicine Istanbul Turkey
Department of Neurosurgery New York University New York USA
Department of Neurosurgery The Walton Centre NHS Foundation Trust Liverpool UK
Department of Neurosurgery University of Alberta Edmonton Canada
Department of Neurosurgery University of Miami Miller School of Medicine Miami USA
Department of Neurosurgery University of Pittsburgh Pittsburgh USA
Department of Radiation and Stereotactic Neurosurgery Na Homolce Hospital Prague Czech Republic
Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt
Department of Radiation Oncology New York University New York USA
Department of Radiology Dominican Gamma Knife Center and CEDIMAT Santo Domingo Dominican Republic
Department of Radiosurgery Rúber International Hospital Madrid Spain
Gamma Knife Center Cairo Nasser Institute Giza Egypt
Institute of Systems and Molecular Biology University of Liverpool Liverpool UK
Citace poskytuje Crossref.org
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- $a Mantziaris, Georgios $u Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA $1 https://orcid.org/0000000233898836
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- $a 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.
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