Treatment decision making based on the published natural history and growth rate of small meningiomas

A review and meta-analysis

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Object

Definitive data allowing clinicians to predict which meningioma patients will fail to respond to conservative management are lacking. To address this need, the authors systematically reviewed the published literature regarding the natural history of small, untreated meningiomas.

Methods

The authors performed a systematic review of the existing literature on untreated meningiomas that were followed with serial MR imaging. They summarize the published linear rates of tumor growth, and the risk factors for development of new or worsened symptoms during follow-up by using a stratified chi-square test.

Results

The search methods identified 22 published studies reporting on 675 patients with untreated meningiomas followed by serial MR imaging. Linear growth rates varied significantly: no growth was the most common rate, although reports of more aggressive tumors noted growth rates of up to a 93% linear increase in size per year. The authors found that few patients with initial tumor diameters < 2 cm went on to develop new or worsened symptoms over a median follow-up period of 4.6 years. Patients with initial tumor diameters of 2–2.5 cm demonstrated a marked difference in the rate of symptom progression if their tumors grew > 10% per year, compared with those tumors growing ≤ 10% per year (42% vs 0%; p < 0.001, chi-square test). Patients with tumors between > 2.5 and 3 cm in initial size went on to develop new or worsened symptoms 17% of the time.

Conclusions

This systematic review of the literature regarding the clinical behavior of untreated meningiomas suggests that most meningiomas ≤ 2.5 cm in diameter do not proceed to cause symptoms in the approximately 5-year period following their discovery. Those that do cause symptoms can usually be predicted with close radiographic follow-up. Based on these findings, the authors suggest the importance of observation in the early course of treatment for small asymptomatic meningiomas, especially those with an initial diameter < 2 cm.

Abbreviation used in this paper: SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Andrew T. Parsa, M.D., Ph.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, California 94143. email: parsaa@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online April 30, 2010; DOI: 10.3171/2010.3.JNS091966.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph representing the data presented in Table 5. Data are presented for 6 growth rates for tumors with initial sizes of 1 cm (A), 1.5 cm (B), and 2 cm (C). The horizontal dashed lines depict the size threshold for radiosurgery. The vertical dashed lines indicate the timing of the first annual MR image after the decision was made to observe a tumor with an unknown growth rate.

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