Gillespie, Conor
(2021)
Residual meningioma: Volumetric growth and progression following surgical resection.
Master of Philosophy thesis, University of Liverpool.
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Abstract
Introduction: Meningiomas are the most common primary brain tumour, with the primary management strategy being surgery. A residual tumour is identified in approximately 25% of operated meningioma. They have a higher progression rate than if no residual is present. The precise growth rates of these tumours on long-term follow up, using accurate and verified 3D volume measuring tools, remains unclear. This uncertainty has implications for patient management, and stratification of treatment paradigms. Previous literature has used small sample sizes, and different definitions to define an increase in meningioma volume after surgery. There is a need for a large study delineating the volumetric growth of residual meningioma, using uniform progression definitions. The aims of this thesis were to conduct a systematic review, followed by a highly powered study measuring the volumetric growth of residual meningioma. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using six scientific databases. After audit approval, a retrospective cohort study of 236 patients with residual meningioma was completed, analysing the tumour volume using manual segmentation at every MRI follow up scan, and conducted non-linear regression analysis of the growth trajectories of residual tumour. Results: The systematic review revealed only four studies available in the literature, with variable growth rates and factors associated with growth identified. The retrospective study revealed a low rate of tumour growth after surgery, both in absolute and relative tumour volume (0.11cm3 and 4.3% per year respectively). More than half patients (55.9%) on long-term follow up demonstrated sufficient volumetric growth to satisfy a definition of tumour progression, and most patients were managed conservatively for this (73.7%). Multivariable analysis revealed skull base location (Hazard ratio [HR] 1.58, 95% Confidence interval (CI) 1.02-2.44), adjuvant fRT (HR 1.72, 95% CI 1.03-2.89) and elevated Ki-67 index (HR 3.62, 95% CI 1.25-10.48) to be associated with high volumetric growth. Regression analysis revealed that most residual tumours exhibit exponential, logistic, and gompertz growth patterns. Conclusions: Residual meningioma is a commonly encountered clinical entity, but volumetric growth rates are scarcely reported. In our retrospective cohort of 236 meningiomas, the absolute and relative growth rate was low, yet over a long period of follow up most met a Response Assessment in Neuro-Oncology (RANO) definition of progression. Further clinical studies of WHO grade 2 meningiomas, and studies that use a uniform growth definition are required to delineate growth rates, and substantiate the findings of this work.
| Item Type: | Thesis (Master of Philosophy) |
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| Divisions: | Faculty of Health and Life Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Feb 2022 14:49 |
| Last Modified: | 18 Jan 2023 21:32 |
| DOI: | 10.17638/03134840 |
| Supervisors: |
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| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3134840 |
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