Volumetric Growth and Growth Curve Analysis of Residual Intracranial Meningioma

Author:

Gillespie Conor S.12ORCID,Richardson George E.12ORCID,Mustafa Mohammad A.12ORCID,Taweel Basel A.12ORCID,Bakhsh Ali12ORCID,Kumar Siddhant12ORCID,Keshwara Sumirat M.1ORCID,Islim Abdurrahman I.12ORCID,Mehta Shaveta13ORCID,Millward Christopher P.12ORCID,Brodbelt Andrew R.12,Mills Samantha J.14ORCID,Jenkinson Michael D.12ORCID

Affiliation:

1. Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK;

2. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK;

3. Department of Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK;

4. Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK

Abstract

BACKGROUND: After meningioma surgery, approximately 1 in 3 patients will have residual tumor that requires ongoing imaging surveillance. The precise volumetric growth rates of these tumors are unknown. OBJECTIVE: To identify the volumetric growth rates of residual meningioma, growth trajectory, and factors associated with progression. METHODS: Patients with residual meningioma identified at a tertiary neurosurgery center between 2004 and 2020 were retrospectively reviewed. Tumor volume was measured using manual segmentation, after surgery and at every follow-up MRI scan. Growth rates were ascertained using a linear mixed-effects model and nonlinear regression analysis of growth trajectories. Progression was defined according to the Response Assessment in Neuro-Oncology (RANO) criteria (40% volume increase). RESULTS: There were 236 patients with residual meningioma. One hundred and thirty-two patients (56.0%) progressed according to the RANO criteria, with 86 patients being conservatively managed (65.2%) after progression. Thirteen patients (5.5%) developed clinical progression. Over a median follow-up of 5.3 years (interquartile range, 3.5–8.6 years), the absolute growth rate was 0.11 cm3 per year and the relative growth rate 4.3% per year. Factors associated with residual meningioma progression in multivariable Cox regression analysis were skull base location (hazard ratio [HR] 1.60, 95% CI 1.02–2.50) and increasing Ki-67 index (HR 3.43, 95% CI 1.19–9.90). Most meningioma exhibited exponential and logistic growth patterns (median R2 value 0.84, 95% CI 0.60–0.90). CONCLUSION: Absolute and relative growth rates of residual meningioma are low, but most meet the RANO criteria for progression. Location and Ki-67 index can be used to stratify adjuvant treatment and surveillance paradigms.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference43 articles.

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