neurosurgery - evidence based surgery
TRANSCRIPT
MACQUARIE NEUROSURGERYEvidence Based Surgery
Dr Michael Mulcahy
25th of August, 2016
Radiation-Induced Meningiomas
Case 1- JH
Case - JH
Case 2 - MM
Searchable Question (PICO)
P - Radiation-induced meningiomasI - NilC - Spontaneous meningiomasO - grade, brain invasion, proliferation index, recurrence, multiplicity
Q: Are radiation-induced meningiomas more aggressive?
Search Strategy
Search for all studies that could provide surgical and pathologic data on
radiation-induced meningiomas
Search: medline, embase
Scopus review
Reference check
Include case series, cohort studies.
Exclude case reports and review articles.
Medline
Medline
Embase
PRIS
MA
Results
RadiationType
Cases Grade MIB-1 Multiple Meningiomas
Recurrence
Morgenstern 2016
Previous malignancy
30 21 surgical
12/21 (57%) G19/21 (43%) G2
Mean 5.4% for grade 1
10/30 (33%) 4/21 (20%)(mean follow up 6yrs)
Felicetti2015
Previous malignancy
1510 surgical
5/9 (56%) G14/9 (44%) G2 -
4/15 (27%) 5/9 (56%)(unknown follow-up)
Godlewski2012
Previous malignancy
2620 surgical
20/23 (87%) G13/23 (13%) G2 -
10/26 (38%) 4/23 (17%)(follow up 6months - 16yrs)
Lillehei2008
Mixed 2015 surgical
10/15 (67%) G13/15 (20%) G22/15 (13%) G3
-6/20 (30%) 6/15 (38%)
2 had a second recurrence(unknown follow-up)
Goshen2007
Previous malignancy
1612 surgical
11/12 (92%) G11/12 (8%) G2 -
3/16 (19%) 1/12 (8%)(unknown follow-up)
Al-Mefty2004
Previous malignancy
16 surgical 10/16 (63%)5/16 (31%)1/16 (6%)
-5/16 (31%) 13/16 (81%) (mean F/U 6 years)
8 had a second recurrence2 had a third recurrence3 not followed up
Sadetzki2002
Tinea capitis cohort
253220 surgical - -
40/253 (16%) 46/220 (18%) (mean follow up 10 years)
Salvati1997
Previous malignancy
10 surgical 6/10 G14/10 G2 -
0 1/10 (unknown follow-up)
Musa1995
Previous malignancy
10 surgical 8/10 G12/10 G3 -
1/10 (10%) 1/10 (had 4 recurrences)(unknown follow-up)
Rubenstein1984
Tinea capitis cohort
43 surgical 1 “malignant”-
2/43 (5%) 11/43 (26%)5 (12%) had a second recurrence
Soffer1983
Tinea capitis cohort
42 surgical 6 “malignant” 6/42 (14%) 6/42 (14%)2 had a second recurrence1 had a third recurrence
Results
RadiationType
Cases Grade MIB-1 Multiple Meningiomas
Recurrence
Morgenstern 2016
Previous malignancy
30 21 surgical
12/21 (57%) G19/21 (43%) G2
Mean 5.4% for grade 1
10/30 (33%) 4/21 (20%)(mean follow up 6yrs)
Felicetti2015
Previous malignancy
1510 surgical
5/9 (56%) G14/9 (44%) G2 -
4/15 (27%) 5/9 (56%)(unknown follow-up)
Godlewski2012
Previous malignancy
2620 surgical
20/23 (87%) G13/23 (13%) G2 -
10/26 (38%) 4/23 (17%)(follow up 6months - 16yrs)
Lillehei2008
Mixed 2015 surgical
10/15 (67%) G13/15 (20%) G22/15 (13%) G3
-6/20 (30%) 6/15 (38%)
2 had a second recurrence(unknown follow-up)
Goshen2007
Previous malignancy
1612 surgical
11/12 (92%) G11/12 (8%) G2 -
3/16 (19%) 1/12 (8%)(unknown follow-up)
Al-Mefty2004
Previous malignancy
16 surgical 10/16 (63%)5/16 (31%)1/16 (6%)
-5/16 (31%) 13/16 (81%) (mean F/U 6 years)
8 had a second recurrence2 had a third recurrence3 not followed up
Sadetzki2002
Tinea capitis cohort
253220 surgical - -
40/253 (16%) 46/220 (18%) (mean follow up 10 years)
Salvati1997
Previous malignancy
10 surgical 6/10 G14/10 G2 -
0 1/10 (unknown follow-up)
Musa1995
Previous malignancy
10 surgical 8/10 G12/10 G3 -
1/10 (10%) 1/10 (had 4 recurrences)(unknown follow-up)
Rubenstein1984
Tinea capitis cohort
43 surgical 1 “malignant”-
2/43 (5%) 11/43 (26%)5 (12%) had a second recurrence
Soffer1983
Tinea capitis cohort
42 surgical 6 “malignant” 6/42 (14%) 6/42 (14%)2 had a second recurrence1 had a third recurrence
Results
Grade 1 - 68/96 (71%) or 82/106 (77%)
Grade 2 - 25/96 (26%) or 29/106 (27%)
Grade 3 - 3/96 (3%) or 5/106 (5%)
WHO 2016: 20-25% grade 2 1-6% grade 3
Results
Multiple meningiomas:
87/481 (18%)
Recurrence:
98/422 (23%)
Summary and Conclusions
•More likely to be multiple
•More likely to recur
•Can’t say more likely to have higher grade
•Surveillance for irradiated children, and patient’s with RIM, unanswered
•Further studies would be beneficial
References
Morgenstern PF, Shah K, Dunkel IJ, et al. Meningioma after radiotherapy for malignancy. J Clin Neurosci. 2016;30:93-7.
Felicetti F, Fortunati N, Garbossa D, et al. Meningiomas after cranial radiotherapy for childhood cancer: a single institution experience. J Cancer Res Clin Oncol. 2015;141:1277-82.
Godlewski B, Drummond KJ, Kaye AH. Radiation-induced meningiomas after high-dose cranial irradiation. J Clin Neurosci. 2012;19:1627-35.
Lillehei KO, Donson AM, Kleinschmidt-DeMasters BK. Radiation-induced meningiomas: clinical, cytogenetic, and microarray features. Acta Neuropathol. 2008;116:289-301.
Goshen Y, Stark B, Kornreich L, et al. High incidence of meningioma in cranial irradiated survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:294-7.
Al-Mefty O, Topsakal C, Pravdenkova S, et al. Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics. J Neurosurg. 2004;100:1002-13.
Sadetzki S, Flint-Richter P, Ben-Tal T, et al. Radiation-induced meningioma: a descriptive study of 253 cases. J Neurosurg. 2002;97:1078-82.
Salvati M, Cervoni L, Puzzilli F, et al. High-dose radiation-induced meningiomas. Surg Neurol. 1997;47:435-41.
Musa BS, Pople IK, Cummins BH. Intracranial meningiomas following irradiation--a growing problem? Br J Neurosurg. 1995;9:629-37.
Rubinstein AB, Shalit MN, Cohen ML, et al. Radiation-induced cerebral meningioma: a recognizable entity. J Neurosurg. 1984;61:966-71.
Soffer D, Pittaluga S, Feiner M, et al. Intracranial meningiomas following low-dose irradiation to the head. J Neurosurg. 1983;59:1048-53.