Abstract
Simple SummaryMeningioma, a type of brain tumor, is a common incidental finding on brain imaging. The best management approach for patients with an incidental meningioma remains unclear. This retrospective multi-center study investigated the outcomes of patients with an incidental meningioma in a frontobasal location, who were managed with active surveillance (n = 28) compared to stereotactic radiosurgery (SRS) (n = 84). Within 5 years of follow-up, SRS improved the radiological control of incidental frontobasal meningiomas (0% vs. 52%), but no symptoms occurred in either group. In the active surveillance cohort, 12% underwent an intervention for tumor growth. The findings of this study provide information to enable shared decision making between clinicians and patients with incidental frontobasal meningiomas.Meningioma is a common incidental finding, and clinical course varies based on anatomical location. The aim of this sub-analysis of the IMPASSE study was to compare the outcomes of patients with an incidental frontobasal meningioma who underwent active surveillance to those who underwent upfront stereotactic radiosurgery (SRS). Data were retrospectively collected from 14 centres. The active surveillance (n = 28) and SRS (n = 84) cohorts were compared unmatched and matched for age, sex, and duration of follow-up (n = 25 each). The study endpoints included tumor progression, new symptom development, and need for further intervention. Tumor progression occurred in 52.0% and 0% of the matched active surveillance and SRS cohorts, respectively (p < 0.001). Five patients (6.0%) treated with SRS developed treatment related symptoms compared to none in the active monitoring cohort (p = 0.329). No patients in the matched cohorts developed symptoms attributable to treatment. Three patients managed with active surveillance (10.7%, unmatched; 12.0%, matched) underwent an intervention for tumor growth with no persistent side effects after treatment. No patients subject to SRS underwent further treatment. Active monitoring and SRS confer a similarly low risk of symptom development. Upfront treatment with SRS improves imaging-defined tumor control. Active surveillance and SRS are acceptable treatment options for incidental frontobasal meningioma.
Highlights
The prevalence of incidental findings has increased due to the wider availability of brain magnetic resonance imaging (MRI)
Three patients managed with active surveillance (10.7%, unmatched; 12 patients underwent gross total resection of WHO grade 1 meningiomas with no recurrence matched) intervention for tumor growthcomplications after a meanoccurred
No patients subject to SRS underwent sur Discussion or further radiotherapy. In this sub-analysis of the IMPASSE study, upfront treatment with stereotactic radiosurgery reduced the risk of radiological progression of incidental frontobasal meningiomas
Summary
The prevalence of incidental findings has increased due to the wider availability of brain magnetic resonance imaging (MRI). After discovery of an incidental meningioma, active clinical and MRI surveillance is the recommended first line management strategy until radiological progression or development of neurological signs or symptoms ensue [3]. This is justified by the indolent nature of these tumors. Frontobasal meningiomas are frequently non-NF2 mutated and harbor TRAF7, KLF4, AKT1, and SMO genetic alterations, which render their behavior nearly always indolent [7]. Their proximity to critical neurovascular structures, such as the optic pathway, warrants consideration of early intervention before growth and development of symptoms. Since most incidental meningiomas are smaller than 10 cm3 [9], early intervention with stereotactic radiosurgery (SRS) is an alternative management choice
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