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

• Published in: Journal of neuro-oncology 2021-05, Vol.153 (1), p.55-64
• Main Authors: Le Van, Tuan, Graillon, Thomas, Jacob, Julian, Vauleon, Elodie, Feuvret, Loic, Boch, Anne-Laure, Boetto, Julien, Boone, Mathieu, Bronnimann, Charlotte, Caire, François, De Barros, Amaury, Delaitre, Mariette, Di Stefano, Anna Luisa, Dore, Mélanie, Ducray, François, Dufour, Christelle, Engelhardt, Julien, Fontaine, Denys, Froelich, Sebastien, Helleringer, Matthieu, Huchet, Aymeri, Joncour, Anthony, Jouanneau, Emmanuel, Mallereau, Charles-Henry, Monfilliette, Apolline, Le Fur, Emmanuelle, Zemmoura, Ilyess, Chinot, Olivier, Sanson, Marc, Kalamarides, Michel, Loiseau, Hugues, Peyre, Matthieu
• Format: Article
• Language: English
• Subjects: Bevacizumab; Brain cancer; Cancer; Central nervous system; Chemotherapy; Clinical Study; Combined Modality Therapy; Everolimus; Follow-Up Studies; Humans; Life Sciences; Medicine; Medicine & Public Health; Meningeal Neoplasms - radiotherapy; Meningeal Neoplasms - surgery; Meningioma - radiotherapy; Meningioma - surgery; Monoclonal antibodies; Neurology; Neurons and Cognition; Octreotide; Oncology; Radiation therapy; Radiosurgery; Retrospective Studies; Surgery; Targeted cancer therapy; Treatment Outcome; Tumors
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-021-03741-7

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.