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


  • 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


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

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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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