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Variations in screening and management practices for subsequent asymptomatic meningiomas in childhood, adolescent and young adult cancer survivors

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Abstract

Introduction

Childhood, adolescent and young adult (CAYA) cancer survivors treated with cranial radiotherapy are at risk for developing subsequent meningiomas. There is insufficient evidence concerning the benefits and harms of screening for subsequent meningiomas, and uncertainty about the most appropriate clinical management of asymptomatic meningiomas. Data describing current clinical decision-making is essential to formulate surveillance recommendations.

Methods

We created an online survey to identify the current international clinical practice regarding screening for and management of subsequent asymptomatic meningiomas among CAYA cancer survivors. Fifty-nine physicians from North America and Europe with expertise relevant to meningiomas were invited to participate.

Results

Thirty-four physicians (58%) completed the survey. The reported number of CAYA cancer survivors that physicians are willing to screen to detect one meningioma varied widely from 0 to 750 (median 50). Physicians expressed concerns regarding harms from MRI screening, including risks of unnecessary interventions (n = 25, 73%) and overdiagnosis (n = 19, 56%). Growth pattern (n = 33, 97%), location (n = 31, 91%) and size (n = 29, 85%) were endorsed as the most important factors influencing the decision to treat asymptomatic meningiomas. A challenging location (n = 14, 52%), indolent tumor growth pattern (n = 13, 48%), and absence of symptoms (n = 12, 44%) were endorsed as the main reasons to monitor without intervention.

Conclusions

There is international variation in opinions and clinical practice regarding screening for subsequent asymptomatic meningiomas among at risk CAYA cancer survivors. Decision-making regarding interventions of asymptomatic meningiomas are largely driven by clinical characteristics. These valuable insights into current clinical practice will inform surveillance guidelines for CAYA cancer survivors.

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Acknowledgements

We gratefully acknowledge the kind participation of colleagues who anonymously contributed insight and professional opinion/experience relevant for cancer survivors at risk for subsequent meningioma. The information in this manuscript was previously presented as a poster at the North American Symposium on Late Complications after Childhood Cancer in Atlanta, Georgia in June 2019.

Funding

This work was funded by the Children Cancer Free Foundation (KiKa, Grant No. 246 title: Radiotherapy-related meningiomas, cerebrovascular events, and cataract in childhood cancer survivors: a DCOG-LATER project). Dr. Ronckers was supported by the Dutch Cancer Society (Jr Group Leader Funding, Grant No. 2012-5517).

Author information

Author notes

  1. Leontine C. M. Kremer and Renée L. Mulder shared last authorship.

Authors and Affiliations

  1. Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands

    Lisanne C. Verbruggen, Cécile M. Ronckers, Eelco W. Hoving, Geert O. Janssens, Helena J. H. van der Pal, Leontine C. M. Kremer & Renée L. Mulder

  2. Departments of Epidemiology and Cancer Control, and Oncology, St. Jude Children’s Research Hospital, Memphis, USA

    Melissa M. Hudson & Gregory T. Armstrong

  3. Department of Pediatric Hematology-Oncology, UT Southwestern Medical Center, Dallas, USA

    Daniel C. Bowers

  4. Institute for Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany

    Cécile M. Ronckers

  5. Department of Paediatric and Adolescent Haematology/Oncology and Children’s Haemopoietic Stem Cell Transplant Unit, Great North Children’s Hospital and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK

    Roderick Skinner

  6. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

    Geert O. Janssens

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  1. Lisanne C. Verbruggen
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Contributions

All authors contributed to the development of the survey. The survey was conducted by LV and RM. Analysis of the data was performed by LV, RM and LK. All authors contributed to interpretation of the data and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lisanne C. Verbruggen.

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Verbruggen, L.C., Hudson, M.M., Bowers, D.C. et al. Variations in screening and management practices for subsequent asymptomatic meningiomas in childhood, adolescent and young adult cancer survivors. J Neurooncol 147, 417–425 (2020). https://doi.org/10.1007/s11060-020-03436-5

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