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Evolution of the neurosurgical management of progestin‐associated meningiomas: a 23-year single‐center experience

  • Clinical Study
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Abstract

Purpose

The improving knowledge of interactions between meningiomas and progestin refines the management of this specific condition. We assessed the changes over time of the management of progestin-associated meningiomas.

Methods

We retrospectively studied consecutive adult patients who had at least one meningioma in the context of progestin intake (October 1995–October 2018) in a tertiary adult Neurosurgical Center.

Results

71 adult women with 125 progestin-associated meningiomas were included. The number of progestin-associated meningioma patients increased over time (0.5/year before 2008, 22.0/year after 2017). Progestin treatment was an approved indication in 27.0%. A mean of 1.7 ± 1.2 meningiomas were discovered per patient (median 1, range 1–6). Surgery was performed on 36 (28.8%) meningiomas and the histopathologic grading was WHO grade 1 in 61.1% and grade 2 in 38.9%. The conservative management of meningiomas increased over time (33.3% before 2008, 64.3% after 2017) and progestin treatment withdrawal increased over time (16.7% before 2008, 95.2% after 2017). Treatment withdrawal varied depending on the progestin derivative used (88.9% with cyproterone acetate, 84.6% with chlormadinone acetate, 28.6% with nomegestrol acetate, 66.7% with progestin derivative combination). The main reason for therapeutic management of meningiomas was the presence of clinical signs. Among the 54 meningiomas managed conservatively for which the progestin had been discontinued, MRI follow-up demonstrated a regression in 29.6%, a stability in 68.5%, and an ongoing growth in 1.9% of cases.

Conclusions

Conservative management, including progestin treatment discontinuation, has grown over time with promising results in terms of efficacy and safety.

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Data availability

Anonymized data will be shared per request from any qualified investigator.

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Author information

Author notes

  1. Thomas Samoyeau, Marc Zanello, Alexandre Roux, and Joseph Benzakoun have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France

    Henri Malaize, Marc Zanello, Alexandre Roux, Gilles Zah-Bi, Edouard Dezamis, Eduardo Parraga & Johan Pallud

  2. Université de Paris, Paris, France

    Henri Malaize, Thomas Samoyeau, Marc Zanello, Alexandre Roux, Joseph Benzakoun, Gilles Zah-Bi, Myriam Edjlali, Arnault Tauziede-Espariat, Edouard Dezamis, Eduardo Parraga, Fabrice Chrétien, Pascale Varlet, Catherine Oppenheim & Johan Pallud

  3. Department of Neuroradiology, GHU site Sainte-Anne, Paris, France

    Thomas Samoyeau, Joseph Benzakoun, Myriam Edjlali & Catherine Oppenheim

  4. Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France

    Marc Zanello, Alexandre Roux, Joseph Benzakoun, Myriam Edjlali, Pascale Varlet, Catherine Oppenheim & Johan Pallud

  5. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA

    Sophie Peeters

  6. Department of Neuropathology, GHU site Sainte-Anne, Paris, France

    Arnault Tauziede-Espariat, Fabrice Chrétien & Pascale Varlet

  7. Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, INSERM U1153, Paris-Descartes University, Paris, France

    Geneviève Plu-Bureau

  8. Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, APHP, Paris, France

    Geneviève Plu-Bureau

Authors
  1. Henri Malaize
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  2. Thomas Samoyeau
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  6. Sophie Peeters
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  9. Arnault Tauziede-Espariat
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  14. Geneviève Plu-Bureau
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  15. Catherine Oppenheim
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Contributions

HM, TS, JB, and JP did the data collection. HM, TS, MZ, AR, JB, and JP did the data analysis. HM, TS, MZ, AR, JB, GZB, ME, ATE, ED, EP, FC, PV, GPB, CO, and JP did the data interpretation. HM, JB, SP, and JP wrote the report. HM, TS, MZ, AR, JB, GZB, ME, ATE, ED, EP, FC, PV, GPB, CO, SP, and JP reviewed and approved the paper.

Corresponding author

Correspondence to Johan Pallud.

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Conflict of interest

The authors declares that they have no conflict of interest to disclose.

Consent to participate

The requirement to obtain informed consent was waived for this observational retrospective study according to French legislation.

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All co-authors have seen and agree with the contents of the manuscript.

Ethical approval

This study received required authorizations (IRB #1: 2020/08) of the institutional review board (IRB00011687). The requirement to obtain informed consent was waived for this observational retrospective study according to French legislation.

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Malaize, H., Samoyeau, T., Zanello, M. et al. Evolution of the neurosurgical management of progestin‐associated meningiomas: a 23-year single‐center experience. J Neurooncol 152, 279–288 (2021). https://doi.org/10.1007/s11060-021-03696-9

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  • DOI: https://doi.org/10.1007/s11060-021-03696-9

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