New publication in the Revue Neurosurgie!
Graillon et al. From the Timone CHU to Marseille have just published their experience in the management of meningomes under synthetic progestins.
They find an over-representation of meningiomas from the base of the skull as well as transitional morphology.
In addition, they find a decrease in the volume of meningiomas greater in patients after stopping cyproterone acetate only after stopping numegestrol acetate or chlormaudinone acetate.

Objective

The objective of this study was to describe the characteristics and prognosis of meningiomas associated with progestins, as well as their management.

Material and methods

We included 53 patients operated and/or followed in the service for meningioma with a progestogen plug more than one year and with a recent treatment of treatment.

Results

Cyproterone acetate (CPA), Nomestrol (Noma) acetate and chlormadinone acetate (CHLA) were involved in most cases. The average duration of the taking of progestins was 17.5 years.

Tumors were multiple in 66 % of cases and located at the anterior and medial base of the skull in 71 % of cases. The transitional subtype represented 16/25 tumors; 19 Méningiomes were grade I of WHO and 6 of Grade II.

The transitional subtype and location rates of the skull base were significantly higher than in the general population of operated meningiomas. No difference was observed in the WHO custody. But the KI67 proliferation index tended to be lower and 5/6 of the MEMB Méningiomes of the WHO were classified in grade II due to a cerebral invasion.

A strong expression of progesterone receptors has been observed in most cases.

After stopping the treatment with progestin, spontaneous visual recovery was observed in 6/10 patients. Under CPA ( n = 24) and CHLA/NOMA ( n = 11), tumor volume decreased in 71 % and 18 % of patients, stabilized in 25 % and 64 % of patients and increased in 4 % and 18 % of patients, respectively. Volumetric evolution was variable depending on the tumor location.

Conclusions

The result at the end of the progestins is favorable but different by comparing CPA versus Chla-Noma and the tumor location. Long -term follow -up is necessary.

In most cases, surveillance is recommended and surgery can be avoided.

Link to the study here: https://www.sciencedirect.com/Science/article/ABS/PII/S0028377021001454?via%3Dihub#!