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

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 O.
• Sanson Marc
• Kalamarides Michel
• Loiseau Hugues
• Peyre Matthieu

keywords

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

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.

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