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1.
Chin Clin Oncol ; 13(Suppl 1): AB051, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39295369

RESUMO

BACKGROUND: Cranial irradiation has well-known long-term side effects, including radiation-induced neoplasms and vasculopathy. This report describes a case of aggressive and rapid-growing multiple meningiomas developed outside the radiation field after the treatment of medulloblastoma. CASE DESCRIPTION: A 6-year-old boy underwent surgery (gross total resection) and radiotherapy (19.8 Gy for posterior fossa only) against medulloblastoma in the 4th ventricle. The patient could not receive further craniospinal irradiation because of ventriculoperitoneal shunt-related complications. Eighteen years after the radiotherapy, the first meningioma developed in the right temporal convexity, without recurrence of medulloblastoma. It was left untreated because it was asymptomatic. Three years later, the meningioma grew from 0.6 to 6.3 cm3 in volume and another large meningioma (22.1 cm3) developed in the left temporal convexity with additional small meningioma in the right frontal convexity. The left large temporal meningioma showed aggressive nature invading the adjacent temporal bone and temporalis muscle. It was completely resected and the histology revealed as transitional meningioma with 2% of Ki-67. Another new meningioma was identified on the right cerebellar convexity three years post-craniotomy. Subsequent follow-up indicated a progressive increase in the tumor size and gamma knife radiosurgery was performed with right frontal convexity small meningioma. The patient is currently under ongoing surveillance through follow-up assessments. CONCLUSIONS: For patients who received radiotherapy at a young age, clinicians should consider the possibility of secondary neoplasm development even outside the radiation field. Careful imaging follow-up and surgical management are warranted because of the aggressive nature of secondary tumors even though benign in histology.


Assuntos
Irradiação Craniana , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/patologia , Meningioma/etiologia , Meningioma/radioterapia , Masculino , Criança , Irradiação Craniana/efeitos adversos , Irradiação Craniana/métodos , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/patologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/etiologia
2.
Front Endocrinol (Lausanne) ; 15: 1407615, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38919490

RESUMO

Acromegaly is a rare endocrine disorder caused by hypersecretion of growth hormone (GH) from a pituitary adenoma. Elevated GH levels stimulate excess production of insulin-like growth factor 1 (IGF-1) which leads to the insidious onset of clinical manifestations. The most common primary central nervous system (CNS) tumors, meningiomas originate from the arachnoid layer of the meninges and are typically benign and slow-growing. Meningiomas are over twice as common in women as in men, with age-adjusted incidence (per 100,000 individuals) of 10.66 and 4.75, respectively. Several reports describe co-occurrence of meningiomas and acromegaly. We aimed to determine whether patients with acromegaly are at elevated risk for meningioma. Investigation of the literature showed that co-occurrence of a pituitary adenoma and a meningioma is a rare phenomenon, and the majority of cases involve GH-secreting adenomas. To the best of our knowledge, a systematic review examining the association between meningiomas and elevated GH levels (due to GH-secreting adenomas in acromegaly or exposure to exogenous GH) has never been conducted. The nature of the observed coexistence between acromegaly and meningioma -whether it reflects causation or mere co-association -is unclear, as is the pathophysiologic etiology. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022376998.


Assuntos
Acromegalia , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/complicações , Meningioma/etiologia , Meningioma/patologia , Meningioma/epidemiologia , Acromegalia/complicações , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/patologia , Hormônio do Crescimento Humano/metabolismo , Hormônio do Crescimento Humano/sangue , Fatores de Risco , Adenoma/complicações , Adenoma/metabolismo , Adenoma/patologia , Adenoma/epidemiologia
3.
Environ Int ; 185: 108552, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38458118

RESUMO

BACKGROUND: Each new generation of mobile phone technology has triggered discussions about potential carcinogenicity from exposure to radiofrequency electromagnetic fields (RF-EMF). Available evidence has been insufficient to conclude about long-term and heavy mobile phone use, limited by differential recall and selection bias, or crude exposure assessment. The Cohort Study on Mobile Phones and Health (COSMOS) was specifically designed to overcome these shortcomings. METHODS: We recruited participants in Denmark, Finland, the Netherlands, Sweden, and the UK 2007-2012. The baseline questionnaire assessed lifetime history of mobile phone use. Participants were followed through population-based cancer registers to identify glioma, meningioma, and acoustic neuroma cases during follow-up. Non-differential exposure misclassification was reduced by adjusting estimates of mobile phone call-time through regression calibration methods based on self-reported data and objective operator-recorded information at baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for glioma, meningioma, and acoustic neuroma in relation to lifetime history of mobile phone use were estimated with Cox regression models with attained age as the underlying time-scale, adjusted for country, sex, educational level, and marital status. RESULTS: 264,574 participants accrued 1,836,479 person-years. During a median follow-up of 7.12 years, 149 glioma, 89 meningioma, and 29 incident cases of acoustic neuroma were diagnosed. The adjusted HR per 100 regression-calibrated cumulative hours of mobile phone call-time was 1.00 (95 % CI 0.98-1.02) for glioma, 1.01 (95 % CI 0.96-1.06) for meningioma, and 1.02 (95 % CI 0.99-1.06) for acoustic neuroma. For glioma, the HR for ≥ 1908 regression-calibrated cumulative hours (90th percentile cut-point) was 1.07 (95 % CI 0.62-1.86). Over 15 years of mobile phone use was not associated with an increased tumour risk; for glioma the HR was 0.97 (95 % CI 0.62-1.52). CONCLUSIONS: Our findings suggest that the cumulative amount of mobile phone use is not associated with the risk of developing glioma, meningioma, or acoustic neuroma.


Assuntos
Neoplasias Encefálicas , Uso do Telefone Celular , Telefone Celular , Glioma , Neoplasias Meníngeas , Meningioma , Neuroma Acústico , Humanos , Meningioma/epidemiologia , Meningioma/etiologia , Estudos de Coortes , Neuroma Acústico/epidemiologia , Neuroma Acústico/etiologia , Estudos Prospectivos , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/etiologia , Glioma/epidemiologia , Glioma/etiologia , Campos Eletromagnéticos , Inquéritos e Questionários , Estudos de Casos e Controles
4.
World Neurosurg ; 184: e784-e793, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38360207

RESUMO

OBJECTIVE: Clear cell meningiomas (CCM) are an uncommon meningioma subtype marked by aggressive growth and high rates of recurrence despite initial resection. The present study evaluates the adjuvant benefit of stereotactic radiosurgery (SRS) for residual or recurrent tumors. METHODS: After review of our prospectively maintained database, we identified 6 patients (3 female) with histologically confirmed Grade 2 CCMs. The median age of the patients at the time of SRS was 45 years. Five patients had undergone prior gross total surgical resection and 1 patient had subtotal resection before SRS. The median SRS treatment volume was 4.7 cc and the median radiosurgical margin dose was 13 Gy (range: 10-15 Gy). RESULTS: The median follow-up time was 35.5 months (range 6-168 months). Three patients achieved tumor control after the first SRS procedure. Three patients experienced tumor progression at 4, 22, and 32 months after initial SRS. Tumor control was obtained in 2 of these patients after additional SRS. One patient with multiple SRS procedures had suspected adverse radiation effect that was successfully treated with corticosteroids followed by bevacizumab. CONCLUSIONS: Tumor control was maintained in 5 of 6 patients after one or more SRS procedures. SRS should be considered for early intervention after surgical resection of CCM. To maximize the tumor control rate, patients with diagnosed CCM should be treated more generously and higher margin dose should be prescribed. Patients with CCM should be counselled that more than one SRS may be necessary to provide sustained tumor control.


Assuntos
Neoplasias Meníngeas , Meningioma , Radiocirurgia , Humanos , Feminino , Pessoa de Meia-Idade , Meningioma/radioterapia , Meningioma/cirurgia , Meningioma/etiologia , Radiocirurgia/métodos , Resultado do Tratamento , Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/etiologia , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/etiologia , Estudos Retrospectivos , Seguimentos
5.
Br J Cancer ; 130(6): 976-986, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38243010

RESUMO

BACKGROUND: Childhood cancer survivors are at risk of subsequent gliomas and meningiomas, but the risks beyond age 40 years are uncertain. We quantified these risks in the largest ever cohort. METHODS: Using data from 69,460 5-year childhood cancer survivors (diagnosed 1940-2008), across Europe, standardized incidence ratios (SIRs) and cumulative incidence were calculated. RESULTS: In total, 279 glioma and 761 meningioma were identified. CNS tumour (SIR: 16.2, 95% CI: 13.7, 19.2) and leukaemia (SIR: 11.2, 95% CI: 8.8, 14.2) survivors were at greatest risk of glioma. The SIR for CNS tumour survivors was still 4.3-fold after age 50 (95% CI: 1.9, 9.6), and for leukaemia survivors still 10.2-fold after age 40 (95% CI: 4.9, 21.4). Following cranial radiotherapy (CRT), the cumulative incidence of a glioma in CNS tumour survivors was 2.7%, 3.7% and 5.0% by ages 40, 50 and 60, respectively, whilst for leukaemia this was 1.2% and 1.7% by ages 40 and 50. The cumulative incidence of a meningioma after CRT in CNS tumour survivors doubled from 5.9% to 12.5% between ages 40 and 60, and in leukaemia survivors increased from 5.8% to 10.2% between ages 40 and 50. DISCUSSION: Clinicians following up survivors should be aware that the substantial risks of meningioma and glioma following CRT are sustained beyond age 40 and be vigilant for symptoms.


Assuntos
Neoplasias do Sistema Nervoso Central , Glioma , Leucemia , Neoplasias Meníngeas , Meningioma , Segunda Neoplasia Primária , Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Meningioma/etiologia , Meningioma/complicações , Fatores de Risco , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Neoplasias do Sistema Nervoso Central/epidemiologia , Glioma/epidemiologia , Sobreviventes , Leucemia/epidemiologia , Europa (Continente)/epidemiologia , Neoplasias Meníngeas/epidemiologia , Incidência
6.
Cancer Rep (Hoboken) ; 7(1): e1944, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38009808

RESUMO

BACKGROUND: Lifestyle is associated with meningioma risk in the general population. AIMS: We assessed longitudinal associations between lifestyle-associated factors and subsequent meningiomas in childhood cancer survivors. METHODS AND RESULTS: Childhood cancer survivors age ≥18 years in the St. Jude Lifetime Cohort Study were evaluated for body composition, self-reported physical activity, cardiopulmonary fitness, muscle strength, smoking, and alcohol consumption at baseline. Time to first meningioma analyses were performed, adjusted for sex, age at diagnosis and baseline assessment, treatment decade, and childhood cancer treatment exposures. The study included 4,072 survivors (47% female; [mean (SD)] 9 (6) years at diagnosis; 30 (8.5) years at the start of follow-up, with 7.0 (3.3) years of follow-up). 30% of the participants were survivors of acute lymphoblastic leukemia and 29% of the participants had received cranial radiation. During follow-up, 90 participants developed ≥1 meningioma, of whom 73% were survivors of acute lymphoblastic leukemia, with cranial radiation being the strongest risk factor (relative risk [RR] 29.7, 95% confidence interval [CI] 10.6-83.2). Muscle strength assessed by knee extension was associated with a lower risk of developing a meningioma in the adjusted analyses (RR 0.5, 95% CI 0.2-1.0, p = 0.04 for quartiles 3-4 vs. 1). No other lifestyle-associated variable was associated with subsequent meningioma. CONCLUSION: Independent of cranial radiation, muscle strength was associated with a lower risk of developing a subsequent meningioma in childhood cancer survivors.


Assuntos
Sobreviventes de Câncer , Neoplasias Meníngeas , Meningioma , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Criança , Feminino , Adolescente , Masculino , Meningioma/epidemiologia , Meningioma/etiologia , Meningioma/terapia , Estudos de Coortes , Estilo de Vida , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/etiologia , Neoplasias Meníngeas/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia
7.
Crit Rev Oncol Hematol ; 191: 104114, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37683814

RESUMO

AIMS: Aim of the present analysis was to report results of a systematic review of the literature in the setting of patients treated with hypoF PT for benign lesions of the central nervous system (CNS). METHODS: The methodology complied with the PRISMA recommendations. PubMed, EMBASE and Scopus databases were interrogated in September 2022. RESULTS: Twelve papers have been selected including patients treated for base of the skull meningiomas (6 papers), vestibular schwannoma (3 papers) and pituitary adenomas (3 papers). Clinical outcomes were evaluated with both radiologic images and clinical parameters. Long-term toxicity was reported in all but one series with an incidence ranging from 2 % to 7 % in patients treated for base of skull meningioma and 1-9 % for schwannoma. CONCLUSIONS: HypoF PT is a safe and effective treatment in selected benign tumors of the CNS. Further dosimetric and clinical comparisons are required to better refine the patients' selection criteria.


Assuntos
Neoplasias Meníngeas , Meningioma , Terapia com Prótons , Humanos , Terapia com Prótons/efeitos adversos , Terapia com Prótons/métodos , Meningioma/radioterapia , Meningioma/etiologia , Meningioma/patologia , Sistema Nervoso Central/patologia , Resultado do Tratamento , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/etiologia , Neoplasias Meníngeas/patologia
8.
World Neurosurg ; 180: 123-133, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37774783

RESUMO

BACKGROUND: Meningiomas are one of the most common benign primary brain tumors; however, there is a paucity of literature on potential preventability. This comprehensive review aimed to explore the existing evidence for the potential risk factors that may contribute to meningioma development and to discuss early prevention strategies. METHODS: Literature search was conducted via MEDLINE, Embase, Web of Science, and Cochrane Database to retrieve existing literature on various environmental exposures and lifestyle behaviors that are potential risk factors for the development of meningiomas. RESULTS: Significant risk factors included exposure to ionizing radiation and certain environmental chemicals. Notably, this study also identified that cigarette smoking and obesity are associated with the development of meningiomas. To date, wireless phone usage, hormonal exposures, dietary factors, and traumatic brain injury remain inconclusive. Early prevention strategies should primarily be family-driven, community-based, and public health-endorsed strategies. Targeting unhealthy behaviors through healthcare organizations could execute a pivotal role in the maintenance of an optimum lifestyle, reducing the development of risk factors pertinent to meningiomas. CONCLUSIONS: To our knowledge, this is the first study that offers a perspective on prevention of meningiomas. A causal relationship of risk factors in developing meningiomas cannot be directly established with the current evidence. We are aware of the limitations of the hypothesis, but we believe that this study will raise more awareness and our findings could potentially be endorsed by organizations promoting health across the globe. Further prospective and retrospective studies will shed more light on this topic and help establish a definitive relationship.


Assuntos
Neoplasias Encefálicas , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/etiologia , Meningioma/prevenção & controle , Meningioma/patologia , Estudos Retrospectivos , Neoplasias Encefálicas/complicações , Fatores de Risco , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/etiologia , Neoplasias Meníngeas/prevenção & controle
9.
Radiologie (Heidelb) ; 63(8): 603-608, 2023 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-37432425

RESUMO

PROBLEM: There is a risk of developing secondary central nervous system (CNS) tumors after cranial radiation therapy. Meningiomas and pituitary tumors are also increasingly treated with radiation therapy, which means that the risk of secondary tumors from radiation in children and adults must be communicated. METHODS: Studies in children show that radiation causes a 7- to 10-fold increase in subsequent CNS tumors with a cumulative incidence over 20 years ranging from 1.03 to 28.9. The latency period for the occurrence of secondary tumors ranged from 5.5 to 30 years, with gliomas developing after 5-10 years and meningiomas around 15 years after irradiation. The latency period for secondary CNS tumors in adults ranged from 5 to 34 years. CONCLUSION: After radiation treatment, tumors can rarely occur as secondary sequelae, mostly meningiomas and gliomas, but also cavernomas. The treatment and long-term results of radiation-induced CNS tumors showed no worse results than primary CNS tumors over the course of time.


Assuntos
Neoplasias Encefálicas , Neoplasias do Sistema Nervoso Central , Glioma , Hemangioma Cavernoso , Neoplasias Meníngeas , Meningioma , Neoplasias Induzidas por Radiação , Criança , Adulto , Humanos , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/radioterapia , Incidência , Meningioma/etiologia , Meningioma/complicações , Neoplasias do Sistema Nervoso Central/epidemiologia , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/complicações , Glioma/complicações , Hemangioma Cavernoso/etiologia , Hemangioma Cavernoso/complicações , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/complicações
10.
Adv Exp Med Biol ; 1416: 159-173, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37432626

RESUMO

While the majority of meningiomas encountered clinically are sporadic, there is a rare subset that arises due to early life or childhood irradiation. Sources of this radiation exposure may be due to treatment of other cancers such as acute childhood leukemia, other central nervous system tumors such as medulloblastoma, the treatment of tinea capitis (rarely and historically), or environmental exposures, as seen in some of the Hiroshima and Nagasaki atomic bomb survivors. Regardless of their etiology, however, radiation-induced meningiomas (RIMs) tend to be highly biologically aggressive irrespective of WHO grade and are usually refractory to the conventional treatment modalities of surgery and/or radiotherapy. In this chapter, we will discuss these RIMs in their historical context, their clinical presentation, their genomic features and ongoing efforts to better understand these tumors from a biological standpoint in order to develop better, more efficacious therapies for these patients.


Assuntos
Neoplasias Cerebelares , Leucemia , Meduloblastoma , Meningioma , Neoplasias Induzidas por Radiação , Humanos , Criança , Meningioma/etiologia , Neoplasias Induzidas por Radiação/epidemiologia
11.
Strahlenther Onkol ; 199(4): 404-411, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36471065

RESUMO

BACKGROUND: In addition to local tumor control, the aim of any curative radio-oncological treatment is to maintain quality of life. In the treatment of patients with meningioma with a close relationship to optical structures, the preservation of visual performance is a particular challenge. Use of proton therapy can reduce the dose burden to organs at risk immediately adjacent to the tumor. The aim of this study was to score the subjective assessment of visual performance in patients with meningioma involving the optical structures before and after proton therapy. METHODS: All proton-treated patients with meningioma WHO I whose planning target volumes (PTV) included parts of the optic nerve and/or chiasm were included in this study. Subjective assessment of visual performance was evaluated using the Visual Disorder Scale (VDS) of the EORTC QLQ-BN20 questionnaire. This scale includes values from 0 to 100, whereby high values reflect a high degree of subjective symptom burden and thus subjective visual impairment. The visual acuity in externally performed eye tests at baseline and follow-ups (FU) was also evaluated. The timepoints for testing were before the start of radiotherapy, at the end of treatment, and 3, 6, 12, and 24 months in FU (times t1-t6). All patients with at least the first annual postradiation FU at the time of the evaluation were included. The correlation between VDS changes and potential influencing factors such as previous therapies, dosimetric data, initial tumor volume, and tumor shrinkage 1 year after treatment was assessed. RESULTS: A total of 56 patients (45 female/11 male) aged 24-82 years (mean ± SD = 53.9 ± 13.3) treated between March 2017 and September 2019 were included in the analysis. The prescription dose was 54.0 Gy (RBE) with active scanned proton therapy. The mean/D2% dose ± SD for the optic chiasm and ipsilateral optic nerve was 43.4 ± 8.9 Gy (RBE)/49.9 ± 7.1 Gy (RBE) and 35.6 ± 11.7 Gy (RBE)/51.7 ± 4.8 Gy (RBE); the mean/D2% dose ± SD of the contralateral optic nerve was 18.8 ± 12.1 Gy (RBE)/42.4 ± 14.6 Gy (RBE), respectively. A total of 302 data collections were available (t1/t2/t3/t4/t5/t6: n = 56/56/48/56/52/34). Median observation time was 23.6 months. Mean symptom burden decreased over time (mean VDS: t1 29.8 ± 27.9; t2 25.0 ± 27.9; t3 21.8 ± 26.0; t4 22.2 ± 26.0; t5 21.4 ± 26.2; t6 17.3 ± 23.6) with statistically significant improvement at 3­ and 6­month FU as well as 1 year after proton therapy (p = 0.0205; p = 0.0187; p = 0.0054). Objective eye tests available in 41/52 patients confirm the trend towards improved visual acuity (97.5% stable/improved until 24-month FU). However, no potential predictor for VDS changes was revealed. CONCLUSION: Proton treatment of patients with meningioma WHO I with involvement of optical structures does not impair subjective visual performance. After treatment, there is a significant improvement in perceived visual performance.


Assuntos
Neoplasias Meníngeas , Meningioma , Terapia com Prótons , Humanos , Masculino , Feminino , Meningioma/radioterapia , Meningioma/etiologia , Meningioma/patologia , Terapia com Prótons/efeitos adversos , Prótons , Qualidade de Vida , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/etiologia , Neoplasias Meníngeas/patologia , Organização Mundial da Saúde , Planejamento da Radioterapia Assistida por Computador
12.
J Neurooncol ; 161(2): 259-266, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36222952

RESUMO

PURPOSE: Data on the efficacy and safety of stereotactic radiosurgery (SRS) for treatment of radiation-induced meningiomas (RIMs) are limited. METHODS: A single institution database of Cobalt-60 SRS cases from 08/1999 to 10/2020 was reviewed. Radiation-induced meningiomas were identified using Cahan's criteria. Endpoints included overall survival (OS), progression free survival (PFS), local control (LC), treatment failure, and treatment toxicity. Univariate and multivariate analyses were performed using cox proportional hazard models. RESULTS: A total of 29 patients with 86 RIM lesions were identified. Median follow-up after SRS was 59 months. The median dose prescribed to the 50% isodose line was 14 Gy (range 12-20 Gy). The actuarial 5-yr OS and PFS were 96% and 68%, respectively. Patients treated for recurrent RIMs had a significantly lower PFS (45% vs 94% at 3 yr, p < 0.005) than patients treated in the upfront setting. Patients with presumed or WHO grade I RIMs had a significantly greater PFS (3-year PFS 96% vs 20%) than patients with WHO grade II RIMs (p < 0.005). On a per-lesion basis, local control (LC) at 1-, 3-, and 5-yrs was 82%, 76%, 74%, respectively. On multivariate analysis, female gender was associated with improved LC (p < 0.001), while marginal doses > 14 Gy were associated with worse local control (p < 0.001). Grade I-III toxicity following treatment was 9.0%. CONCLUSIONS: Stereotactic radiosurgery is a safe and effective treatment option for radiographic RIMs, WHO grade I RIMs, or lesions treated in the upfront setting. WHO grade II lesions and recurrent lesions are at increased risk for disease progression.


Assuntos
Neoplasias Meníngeas , Meningioma , Radiocirurgia , Humanos , Feminino , Meningioma/etiologia , Meningioma/radioterapia , Neoplasias Meníngeas/etiologia , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/patologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Seguimentos
13.
JAMA Oncol ; 8(12): 1756-1764, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36201196

RESUMO

Importance: Meningioma is the most common subsequent neoplasm following cranial irradiation among survivors of childhood cancer, but there are still uncertainties regarding the magnitude of the radiation dose-response association, potential modifiers of radiation risks, and the role of chemotherapy. Objective: To evaluate meningioma risk in survivors of childhood cancer following radiotherapy and chemotherapy and identify possible modifying factors of radiation-associated risk. Design, Setting, and Participants: This international case-control study pooled data from 4 nested case-control studies of survivors of childhood cancer diagnosed between 1942 and 2000, followed through 2016. Cases were defined as participants diagnosed with a subsequent meningioma. Controls were matched to cases based on sex, age at first cancer diagnosis, and duration of follow-up. Data were analyzed from July 2019 to June 2022. Exposures: Radiation dose (Gy) to the meningioma site and cumulative chemotherapy doses, including intrathecal and systemic methotrexate doses. Main Outcomes and Measures: The main outcome was subsequent meningioma, assessed using odds ratios (ORs) and excess odds ratios per gray (EOR/Gy). Results: The analysis included 273 survivors of childhood cancer who developed meningioma (cases) and 738 survivors who did not (controls), with a total of 1011 individuals (median [IQR] age at first cancer diagnosis 5.0 [3.0-9.2] years; 599 [59.2%] female). Median (IQR) time since first cancer was 21.5 (15.0-27.0) years. Increasing radiation dose was associated with increased risk of meningioma (EOR/Gy, 1.44; 95% CI, 0.62-3.61), and there was no evidence of departure from linearity (P = .90). Compared with survivors who were not exposed to radiation therapy, those who received doses of 24 Gy or more had more than 30-fold higher odds of meningioma (OR, 33.66; 95% CI, 14.10-80.31). The radiation dose-response association was significantly lower among patients treated at age 10 years or older compared with those treated before age 10 years (EOR/Gy, 0.57; 95% CI, 0.18-1.91 vs 2.20; 95% CI, 0.87-6.31; P for heterogeneity = .03). Risk associated with radiation remained significantly elevated 30 years after exposure (EOR/Gy, 3.76; 95% CI, 0.77-29.15). We found an increased risk of meningioma among children who had received methotrexate (OR, 3.43; 95% CI, 1.56-7.57), but no evidence of a dose-response association or interaction with radiation dose. Conclusions and Relevance: These findings suggest that the meninges are highly radiosensitive, especially for children treated before age 10 years. These results support the reduction in whole-brain irradiation over recent decades and the prioritization of approaches that limit radiation exposure in healthy tissue for children. The persistence of elevated risks of meningiomas for 30 years after cranial radiotherapy could help inform surveillance guidelines.


Assuntos
Neoplasias Meníngeas , Meningioma , Criança , Humanos , Feminino , Pré-Escolar , Masculino , Meningioma/epidemiologia , Meningioma/etiologia , Estudos de Casos e Controles , Metotrexato/efeitos adversos , Sobreviventes , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/etiologia
14.
Pediatr Neurosurg ; 57(6): 396-406, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36252549

RESUMO

INTRODUCTION: Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have undergone cranial irradiation having an increased risk of acquiring radiation-induced meningioma (RIM), there is no widely used standard guideline for meningioma screening. METHODS: At a single institution, we reviewed three adult survivors of childhood cancer who were treated for RIM between 2010 and 2020. We recorded age at diagnosis for the primary lesion, the radiation dose, age at RIM diagnosis, and tumor characteristics including treatment, pathology, and outcome. Two had had T-cell acute lymphocytic leukemia and one a rhabdomyosarcoma. The age of diagnosis of the RIM ranged from 20 to 40 years, with latencies ranging from 18 to 33 years. All lesions were classified as WHO Grade I meningiomas, and only 1 patient had a subsequent recurrence. A literature search identified articles that address RIM: a total of 684 cases were identified in 36 publications. RESULTS: Mean radiation doses ranged from 1.4 gray to 70 gray. Mean age of diagnosis for secondary meningioma ranged from 8 to 53.4 years old, with latency periods ranging from 2.8 to 44 years. Given variability in the way that investigators have published their results, it is difficult to make a single recommendation for RIM screening. Using our experience and the literature, we devised two different screening protocols and calculated their expense. CONCLUSIONS: We recommend that data be standardized in a registry to provide greater insight into the clinical and resource allocation questions, especially as long-term survival of children with pediatric cancer into full adulthood becomes more commonplace worldwide.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias Induzidas por Radiação , Leucemia-Linfoma Linfoblástico de Células Precursoras , Criança , Adulto , Humanos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Meningioma/etiologia , Meningioma/patologia , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/diagnóstico , Irradiação Craniana/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiologia , Neoplasias Meníngeas/radioterapia
15.
Sci Rep ; 12(1): 13663, 2022 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-35953695

RESUMO

Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.


Assuntos
Neoplasias Meníngeas , Meningioma , Radiocirurgia , Edema/etiologia , Seguimentos , Humanos , Neoplasias Meníngeas/etiologia , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/etiologia , Meningioma/radioterapia , Meningioma/cirurgia , Necrose/etiologia , Necrose/cirurgia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
16.
Medicine (Baltimore) ; 101(28): e29671, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35839051

RESUMO

RATIONALE: Intracranial brain surgeries, including ventriculostomy, burr hole, craniotomy, and craniectomy, are the most common causes of acquired dural arteriovenous fistula (dAVF). Here we report a case of acquired dAVF after a cerebellopontine angle meningioma surgery. PATIENT CONCERNS: A 51-year-old woman was diagnosed with a 40-mm cerebellopontine angle meningioma. The patient underwent surgery via a retrosigmoid suboccipital approach. A small craniotomy and an additional craniectomy were performed. At 7 months after the surgery, she presented with pulsating tinnitus and headache. DIAGNOSIS: Magnetic resonance imaging and digital subtraction angiography showed a dAVF that was fed by the occipital artery and drained into transverse and sigmoid sinuses. INTERVENTIONS: We performed Onyx® (Irvine, CA) embolization. OUTCOMES: The patient's symptoms completely improved. LESSONS: Craniectomy defects, partially exposed sinuses, and incomplete cranioplasty might be risk factors for iatrogenic dAVF after a retrosigmoid suboccipital craniotomy or craniectomy. Complete reconstructive cranioplasty is an essential procedure to prevent a direct connection between the venous sinus and the external carotid artery.


Assuntos
Fístula Arteriovenosa , Malformações Vasculares do Sistema Nervoso Central , Neoplasias Cerebelares , Embolização Terapêutica , Neoplasias Meníngeas , Meningioma , Neuroma Acústico , Fístula Arteriovenosa/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Neoplasias Cerebelares/complicações , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Cavidades Cranianas/patologia , Embolização Terapêutica/métodos , Feminino , Humanos , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/etiologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Neuroma Acústico/complicações
17.
Adv Med Sci ; 67(2): 229-233, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35594764

RESUMO

PURPOSE: Recent increase in incidence of meningiomas suggests the need to search for new risk factors. Leptin, a potentially pro-angiogenic and proliferative agent, could be a candidate for this role, as its expression correlates with body mass index (BMI). Because development of meningioma has also been linked to sex hormones, bisphenol A (BPA), a known xenoestrogen, can also be taken into consideration as a potential risk factor. The aim of this study was to determine plasma concentrations of both substances in patients with meningiomas and to match it to patients with gliomas - a group of brain tumors less hormone- and BMI-dependent. MATERIALS & METHODS: Concentrations of BPA and leptin were measured in plasma of 24 patients with low grade meningioma and in 29 patients with glioma, using gas chromatography-mass spectrometry (GC-MS) and ELISA kits, respectively. The concentrations of both substances in patients with neoplasms were interpreted in relation to their concentration in healthy population, published in recent reports. RESULTS: Free and conjugated BPA were present in both meningioma and glioma patients. Moreover, their concentrations far exceeded those reported in the healthy population. Nevertheless, the level of leptin revealed to be significantly higher in meningioma patients than in glioma patients. CONCLUSIONS: Occurrence of both meningioma and glioma may be accompanied by increased concentrations of leptin and BPA. Further large-scale studies are needed to clarify whether the presence of both substances may play a role in pathogenesis or influence clinical course in patients with brain neoplasms.


Assuntos
Neoplasias Encefálicas , Glioma , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/etiologia , Meningioma/patologia , Projetos Piloto , Leptina , Glioma/etiologia , Glioma/patologia , Neoplasias Encefálicas/patologia , Hormônios Esteroides Gonadais , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia
18.
World Neurosurg ; 164: e280-e289, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35526813

RESUMO

BACKGROUND: Gamma Knife radiosurgery (GKS) is a promising treatment option for meningioma. However, the incidence of peritumoral edema (PTE) following GKS has been reported to be 7%-38%. This study aimed to develop a predictive model for post-GKS PTE using a deep neural network (DNN) algorithm. METHODS: Patients treated with GKS for meningioma between November 2012 and February 2020 at a single tertiary center were reviewed. The primary outcome was newly developed or aggravated PTE after GKS. Clinical data, including radiosurgical parameters, were collected, and imaging data obtained at the time of GKS were incorporated into the model using a 50-layered residual neural network, ResNet50. Consequently, the model efficiency was evaluated considering the accuracy and area under the receiver operating curve (AUC) values. RESULTS: A total of 202 patients were included in this study. The median tumor volume was 2.3 mL, and the median prescription dose was 13 Gy. PTE was observed before GKS in 22 patients. Post-GKS PTE was evident in 28 patients (13.9%), which further evolved to radiation necrosis in 5 patients. The accuracy and AUC values of the hybrid data model based on both clinical and imaging data were 0.725 and 0.701, respectively. The performance of the hybrid data model was superior to that of the other models based on clinical or image data only. CONCLUSIONS: The DNN-based model using both clinical and imaging data exhibited fair results in predicting post-GKS PTE in meningioma treatment. Predictive models using imaging data may be helpful in prognostic research.


Assuntos
Neoplasias Meníngeas , Meningioma , Radiocirurgia , Edema/etiologia , Seguimentos , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/etiologia , Meningioma/radioterapia , Redes Neurais de Computação , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos Retrospectivos , Resultado do Tratamento
19.
J Neurosurg ; 136(1): 109-114, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34144518

RESUMO

OBJECTIVE: The management of neurofibromatosis type 2 (NF2)-associated meningiomas is challenging. The role of Gamma Knife radiosurgery (GKRS) in the treatment of these tumors remains to be fully defined. In this study, the authors aimed to examine the role of GKRS in the treatment of NF2-associated meningiomas and to evaluate the outcomes and complications after treatment. METHODS: Seven international medical centers contributed data for this retrospective cohort. Tumor progression was defined as a ≥ 20% increase from the baseline value. The clinical features, treatment details, outcomes, and complications were studied. The median follow-up was 8.5 years (range 0.6-25.5 years) from the time of initial GKRS. Shared frailty Cox regression was used for analysis. RESULTS: A total of 204 meningiomas in 39 patients treated with GKRS were analyzed. Cox regression analysis showed that increasing the maximum dose (p = 0.02; HR 12.2, 95% CI 1.287-116.7) and a lower number of meningiomas at presentation (p = 0.03; HR 0.9, 95% CI 0.821-0.990) were predictive of better tumor control in both univariable and multivariable settings. Age at onset, sex, margin dose, location, and presence of neurological deficit were not predictive of tumor progression. The cumulative 10-year progression-free survival was 94.8%. Radiation-induced adverse effects were noted in 4 patients (10%); these were transient and managed medically. No post-GKRS malignant transformation was noted in 287 person-years of follow-up. CONCLUSIONS: GKRS achieved effective tumor control with a low and generally acceptable rate of complications in NF2-associated meningiomas. There did not appear to be an appreciable risk of post-GKRS-induced malignancy in patients with NF2-treated meningiomas.


Assuntos
Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/cirurgia , Meningioma/etiologia , Meningioma/cirurgia , Neurofibromatose 2/complicações , Radiocirurgia/métodos , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
20.
Radiol Oncol ; 55(3): 274-283, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34384013

RESUMO

INTRODUCTION: Radiation-induced cavernomas (RIC) after cranial radiotherapy have an unknown risk of hemorrhage. Zabramski magnetic resonance imaging (MRI) classification is touted as being able to indicate non-radiation-induced cavernomas hemorrhage risk. The aim of our study was to assess the hemorrhage risk of RIC during long-term follow-up of childhood cancer survivors based on brain MRI examinations. PATIENTS AND METHODS: We analyzed retrospectively long-term follow-up data of 36 childhood cancer survivors after initial diagnosis with acute leukemia (n = 18) or brain tumor (n = 18), all treated with cranial radiotherapy. Detected RIC in long-term follow-up brain MRI (1.5 or 3 Tesla) were classified following the Zabramski MRI classification and were categorized into "high" (Zabramski type I, II or V) or "low" (type III or IV) risk of hemorrhage. RESULTS: 18 patients (50%) showed RIC with a significant relation to the original tumor entity (p = 0.023) and the cumulative radiation dose to the brain (p = 0.016): all 9 childhood cancer survivors diagnosed with medulloblastoma developed RIC. We classified RIC in only 3/36 childhood cancer survivors (8%) (1 patient with acute lymphoblastic leukemia [Zabramski type II] and 2 patients with medulloblastoma [type I and type II]) as high risk for hemorrhage, the remaining RIC were classified as Zabramski type IV with low risk for hemorrhage. None of the childhood cancer survivors with RIC showed symptomatic hemorrhages. CONCLUSIONS: RIC are common late effects in childhood cancer survivors treated with cranial radiotherapy affecting half of these patients. However, only a few RIC (occurring in 8% of all reviewed childhood cancer survivors) were classified as high risk for hemorrhage and none of the childhood cancer survivors with RIC developed symptomatic hemorrhages. Thus, we conclude that RIC are low-risk findings in brain MRI and the course is mainly benign.


Assuntos
Sobreviventes de Câncer , Irradiação Craniana/efeitos adversos , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Doença Aguda , Adolescente , Neoplasias Encefálicas/radioterapia , Hemorragia Cerebral/classificação , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Hemangioma Cavernoso do Sistema Nervoso Central/classificação , Hemangioma Cavernoso do Sistema Nervoso Central/etiologia , Humanos , Lactente , Leucemia Mieloide Aguda/radioterapia , Masculino , Meduloblastoma/radioterapia , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/etiologia , Meningioma/diagnóstico por imagem , Meningioma/etiologia , Neoplasias Induzidas por Radiação/classificação , Neoplasias Induzidas por Radiação/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Doses de Radiação , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
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