Treatment Of Recurrent Meningiomas Research Articles

Resection of Anaplastic Meningioma via Combined Craniofacial Approach

Introduction: Meningiomas are common and mostly benign intracranial tumors but may show a histological progression to malignancy. The mechanism of malignant transformation remains unclear. Malignant meningiomas usually bear a high recurrence rate and unfavorable prognosis; hence, multiple surgical resections are required for the treatmentCase Presentation: A 41-year-old woman with a prior history of craniotomy at another center six years ago with Meningioma Grade 1 presented to our institution with new neurological symptoms. The magnetic resonance image demonstrated a large frontal base mass that extended to the nasal cavity with diffuse contrast enhancement and extensive surrounding edema. A craniofacial approach combined with a bifrontal approach was performed in multistage tumor resection. The tumor and the infiltrated dura were radically removed. The histopathology demonstrated an Anaplastic Meningioma. The patient also underwent radiation therapy.Conclusion: Treatment of recurrent meningioma with anaplastic histology remains challenging because recurrence rates remain high with a poor prognosis.

Intracranial meningiomas: clinical, intrascopic and pathomorphological causes of recurrence (literature review)

Introduction. Meningiomas are the second most common central nervous system (CNS) tumors in adults. most meningiomas are benign tumors. Anaplastic and atypical meningiomas account for 25% and have a high recurrence rate even after radical tumor resection and radiotherapy. The prognosis of patients with anaplastic meningiomas remains disappointing; most of them die within the first 2 to 5 years after surgery. Purpose: to discuss the challenges in diagnosis and treatment of recurrent meningiomas, to identify the causes of tumor progression, and to assess the clinical features and radiographic findings as well as specific pathomorphological and molecular genetic characteristics. material and methods. We searched for publications in the Pubmed, EMBASE, Cohrane Library and eLibrary databases published between January 2000 and January 2019 on the issue of recurrent intracranial meningiomas, in particular atypical and anaplastic meningiomas. Results. The review systematizes data on the prognostic factors for survival, relapse-free period, and disease progression. particular attention was paid to the radical resection of the tumor and the assessment of the grade of anaplasia. The current data on radiotherapy and drug therapy were presented. the controversial issues of approaches to the assessment of morphological prognostic criteria were discussed. The current knowledge on the most common genetic mutations in meningiomas, the prospects for their study and use for targeted therapy were presented. Conclusion. The management of meningioma still presents some unresolved issues. There are no optimal standards for diagnosis and treatment of patients with meningiomas that would take into account biological characteristics, including growth characteristics and molecular genetic profile. There are no clear prognostic criteria for recurrence and continuity in further management after surgical treatment, which affects the mortality rate and quality of life in this category of patients. New fundamental data that will determine a different strategy in the treatment of intracranial meningiomas are needed.

P06.08 * SYSTEMIC TREATMENT OF MENINGIOMAS: IS THERE A ROLE FOR LONG-ACTING SOMATOSTATIN?

BACKGROUND: Meningiomas are the most common primary brain tumors. Resection and/or radiation therapy are the treatments of choice. Medical therapies have been investigated for inoperable, recurrent and aggressive meningiomas (grade III), but the optimal medical treatment is yet to be defined. Among biologic agents somatostatin has been found to inhibit meningioma growth due to the presence of somatostatin receptors on the surface of the tumors. AIM: We retrospectively reviewed our experience with sandostatin to assess the efficacy and toxicity in the treatment of recurrent meningiomas failing standard treatments. PATIENTS AND METHOD: A total of 17 patients (7 women and 10 men, median age 65 years) with recurrent grade I or II or III meningiomas have been studied. All patients had already been treated with multiple surgeries or radiation treatments, and all had an overexpression of somatostatin receptors by octreotide scintigraphy. Before treatment KPS ranged from 60 to 90. The patients received long-acting somatostatin on a monthly administration schedule. Radiographic response on MRI has been assessed by MacDonald Criteria. RESULTS: Patients received 3 to 18 cycles (median 9) of somatostatin. Response was as follows: PR in 1 patient, MR in 1 patient, SD in 2 patients and PD in 13 patients. Progression-free survival at 6 months was 56%, while PFS ranged from 3 to 25 months with a median of 6 months. Toxicity was uncommon (2 patients) and manageable. CONCLUSION: Long acting somatostatin displays only minor activity as salvage treatment for recurrent meningiomas after surgery and radiation therapy.

Celecoxib inhibits meningioma tumor growth in a mouse xenograft model

Treatments for recurrent meningiomas are limited. We previously demonstrated universal expression of COX-2 in meningiomas and dose-dependent growth inhibition in vitro with celecoxib, a COX-2 inhibitor. We therefore tested the effects of celecoxib on meningioma growth in a mouse xenograft model. Meningioma cell lines (IOMM-Lee, CH157-MN, WHO grade I primary cultured tumor) were transplanted into flanks of nude mice fed mouse chow with celecoxib at varying concentrations (0, 500, 1000, 1500 ppm) ad libitum. Tumors were measured biweekly and processed for MIB-1, Factor VIII, COX-2, and VEGF, and assayed with transferase-mediated dUTP-biotin nick-end labeling (TUNEL). Celecoxib reduced growth of mean tumor volume by 66% (P < .05), 25% (P > .05), and 65% (P < .05) compared with untreated controls in IOMM-Lee, CH157-MN, and benign tumors, respectively. IOMM-Lee tumors removed from celecoxib treatment regained a growth rate similar to the control. Blood vessel density decreased and apoptotic cells increased in treated flank tumors. Diminished COX-2 expression and VEGF were observed in treated IOMM-Lee tumors. Mean plasma celecoxib levels were 845, 1540, and 2869 ng/mL, for low-, medium-, and high-dose celecoxib, respectively. Celecoxib inhibits meningioma growth in vivo at plasma levels achievable in humans. Celecoxib-treated tumors were less vascular with increased apoptosis. IOMM-Lee tumors treated with celecoxib showed decreased COX-2 and VEGF expression. COX-2 inhibitors may have a role in the treatment of recurrent meningiomas.

Ubiquitous expression of cyclooxygenase-2 in meningiomas and decrease in cell growth following in vitro treatment with the inhibitor celecoxib: potential therapeutic application

Meningiomas are the second most common symptomatic primary central nervous system tumor in adults. Findings of epidemiological studies link meningiomas with a history of head trauma, indicating a causal relationship between the inflammatory response and meningioma tumorigenesis. Cyclooxygenase-2 (COX-2), an inducible inflammatory enzyme, converts arachidonic acid to prostaglandins, which have angiogenic, cell-proliferative, and antiapoptotic effects. The authors investigated COX-2 expression in meningiomas and the effects of celecoxib, a COX-2 inhibitor, on meningioma cell growth in vitro. Four meningioma surgical specimens were immunohistochemically stained and graded (0 to 4) for COX-2. In addition, a Western blot analysis was performed to detect the presence of COX-2. Human meningioma cells grown in cell culture were treated with vehicle or celecoxib (0.25-1 mM). An immunohistochemical analysis of COX-2, a methylthiotetrazole cell proliferation assay, a TUNEL apoptosis assay, and a Western blot analysis for the proapoptotic protein BAX were performed in vitro. One hundred eleven (87%) of 128 benign meningiomas and six (86%) of seven atypical meningiomas displayed a high COX-2 immunoreactivity (Grade 4 staining). In the Western blot analysis all four surgical specimens (100%) stained positive for a 70-kD band consistent with COX-2. Celecoxib inhibited cell growth in a dose-dependent fashion and induced apoptosis by Day 2, with no change noted in the expression of the BAX protein. The COX-2 enzyme is universally expressed in meningiomas. Celecoxib inhibits meningioma growth in vitro in a dose-dependent fashion, with evidence of apoptosis. Inhibitors of COX-2 may have a role in the treatment of recurrent meningiomas.

Malignant transformation of recurrent meningioma with pulmonary metastases

A patient presented with a histologically benign intracranial meningioma which, after multiple recurrences, underwent malignant transformation. The patient survived 18 years following initial presentation. Pulmonary metastases were present over the final 8 years. Eleven subtotal resections of the meningioma were performed, including exenteration of the right eye and a thoracotomy. Radiation therapy and chemotherapy were relatively ineffective. The problem and treatment of recurrent meningiomas is briefly reviewed.