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A retrospective comparison of active surveillance to stereotactic radiosurgery for the management of elderly patients with an incidental meningioma

H. Hallak, G. Mantziaris, S. Pikis, AI. Islim, S. Peker, Y. Samanci, AM. Nabeel, WA. Reda, SR. Tawadros, AMN. El-Shehaby, K. Abdelkarim, RM. Emad, D. Mathieu, CC. Lee, R. Liscak, RM. Alvarez, D. Kondziolka, M. Tripathi, H. Speckter, GN. Bowden,...

. 2025 ; 167 (1) : 37. [pub] 20250206

Language English Country Austria

Document type Journal Article, Comparative Study

Persistent link   https://www.medvik.cz/link/bmc25009930

INTRODUCTION: Management for elderly patients (> 65yo) with incidental meningiomas remains unclear. This study aims to characterize the functional and tumor outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma elderly patients. METHODS: Using retrospectively collected data from 14 centers, SRS outcomes were compared to radiographic and clinical observation of asymptomatic meningiomas in elderly patients following propensity score matching. RESULTS: Following propensity score matching, 114 patients were in each cohort. Tumor control was achieved at 97.37% in the SRS cohort, and no meningioma growth was seen 71.93% of the observation cohorts (p < 0.01; OR 14.44 [95% CI 4.27-48.78]). New neurological deficits developed in 1.39% of the SRS cohort but in none of the patients managed conservatively. 3.5% of patients underwent resection in the active surveillance matched cohort compared to 0.9% of patients in the SRS cohort (p = 0.063; OR 0.135 [95% CI 0.163-1.117]). The all-cause mortality rate was almost half in the SRS group (9.65%) compared to the observation group (18.42%) (p = 0.06; OR 0.47 [95% CI .22-1.03]). CONCLUSION: SRS achieves superior radiological tumor control compared to surveillance but with a slightly increased the risk of new SRS-related neurological deficits in elderly patients with asymptomatic meningiomas. Although SRS reduces meningioma progression, the need for of an open neurosurgical procedure and mortality were not significantly reduced. Furthermore, mortality in the observation group was not directly related to the meningioma in any of the patients.

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$a INTRODUCTION: Management for elderly patients (> 65yo) with incidental meningiomas remains unclear. This study aims to characterize the functional and tumor outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma elderly patients. METHODS: Using retrospectively collected data from 14 centers, SRS outcomes were compared to radiographic and clinical observation of asymptomatic meningiomas in elderly patients following propensity score matching. RESULTS: Following propensity score matching, 114 patients were in each cohort. Tumor control was achieved at 97.37% in the SRS cohort, and no meningioma growth was seen 71.93% of the observation cohorts (p < 0.01; OR 14.44 [95% CI 4.27-48.78]). New neurological deficits developed in 1.39% of the SRS cohort but in none of the patients managed conservatively. 3.5% of patients underwent resection in the active surveillance matched cohort compared to 0.9% of patients in the SRS cohort (p = 0.063; OR 0.135 [95% CI 0.163-1.117]). The all-cause mortality rate was almost half in the SRS group (9.65%) compared to the observation group (18.42%) (p = 0.06; OR 0.47 [95% CI .22-1.03]). CONCLUSION: SRS achieves superior radiological tumor control compared to surveillance but with a slightly increased the risk of new SRS-related neurological deficits in elderly patients with asymptomatic meningiomas. Although SRS reduces meningioma progression, the need for of an open neurosurgical procedure and mortality were not significantly reduced. Furthermore, mortality in the observation group was not directly related to the meningioma in any of the patients.
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$a Mantziaris, Georgios $u Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA
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$a Pikis, Stylianos $u Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA
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$a Islim, Abdurrahman I $u TheWalton Centre NHS Foundation Trust, Liverpool, UK
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$a Peker, Selcuk $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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$a Samanci, Yavuz $u Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
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$a Nabeel, Ahmed M $u Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
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$a Reda, Wael A $u Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
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$a Tawadros, Sameh R $u Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
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$a El-Shehaby, Amr M N $u Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
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$a Abdelkarim, Khaled $u Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
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$a Emad, Reem M $u Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
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$a Mathieu, David $u Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
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$a Lee, Cheng-Chia $u Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
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$a Liscak, Roman $u Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Alvarez, Roberto Martinez $u Department of Radiosurgery, Rúber International Hospital, Madrid, Spain
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$a Kondziolka, Douglas $u Department of Neurosurgery, New York University, New York, NY, USA $u Department of Radiation Oncology, New York University, New York, NY, USA
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$a Tripathi, Manjul $u Department of Neurosurgery and Radiotherapy, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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$a Speckter, Herwin $u Department of Radiology, Dominican Gamma Knife Centerand, CEDIMAT, Santo Domingo, Pepillo Salcedo, Dominican Republic
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$a Bowden, Greg N $u Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada
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$a Benveniste, Ronald J $u Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
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$a Lunsford, Lawrence Dade $u Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
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$a Jenkinson, Michael D $u TheWalton Centre NHS Foundation Trust, Liverpool, UK
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$a Sheehan, Jason $u Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA. jsheehan@virginia.edu
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