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33778930
Multimodal management of surgery- and radiation-refractory meningiomas: an analysis of the French national tumor board meeting on meningiomas cohort.

J Neurooncol, 2021/5;153(1):55-64.

Le Van T[1], Graillon T[2], Jacob J[3], Vauleon E[4], Feuvret L[3], Boch AL[5], Boetto J[6], Boone M[7], Bronnimann C[8], Caire F[9], De Barros A[10], Delaitre M[11], Di Stefano AL[12], Dore M[13], Ducray F[14], Dufour C[15], Engelhardt J[16], Fontaine D[17], Froelich S[18], Helleringer M[19], Huchet A[20], Joncour A[21], Jouanneau E[22], Mallereau CH[23], Monfilliette A[24], Le Fur E[25], Zemmoura I[26], Chinot O[27], Sanson M[28], Kalamarides M[5], Loiseau H[17], Peyre M[29, 30]

Affiliations

PMID: 33778930DOI: 10.1007/s11060-021-03741-7

Impact factor: 4.506

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.

Keywords: Atypical meningioma; Bevacizumab; Disease-Free Survival; Everolimus; High-grade meningioma; Malignant meningioma; Meningioma; Radiation therapy; Treatment Outcome

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