Researchers at the University Health Network‘s (UHN) Krembil Brain Institute and the University of Toronto are focussing on improving treatment of different types of meningioma. Their latest findings aim to predict and improve treatment methods for these brain tumours, helping those diagnosed live longer and better lives.
They published their findings in Nature Medicine last month.
Meningiomas and their treatment
Meningiomas are the most common primary brain tumour in adults, accounting for approximately 30% of diagnoses.
Many of these tumours can be removed successfully with surgery.
Radiotherapy is the only alternative treatment for these tumours. Doctors often use it as a secondary treatment for aggressive, proliferative meningiomas to prevent tumour regrowth after surgery or when tumours cannot be surgically removed.
A tumour’s response to surgery and radiotherapy varies significantly between people. This is because the biology of each meningioma can be so different. Meningiomas are classified into different groups known as ‘molecular groups’. These are based on the genetic make up of the tumour, which in turn plays a role in how it responds to treatment.
This research is so urgently needed to find the best way to treat each person facing this diagnosis.
Response to surgery and radiotherapy varies considerably between different patients with meningiomas due to the individual tumour’s biology. The role of molecular biomarkers in being able to accurately predict treatment outcomes has not been fully explored, and this is what we tried to do with our research.
Dr. Justin Wang – senior neurosurgery resident and lead author of this study.
Meningioma Research
This research focussed on understanding molecular biomarkers – which act as clues about a tumour. They help predict how the tumour is likely to respond to treatment. This follows on from the team’s work on predicting what makes some meningiomas clinically aggressive.
Researchers used the largest meningioma data set to date. This included more than 2,800 tumours, including molecular data on 1,500 tumours collected around the world and 100 tumours from a phase 2 clinical trial. This information was then used to explore and understand these tumours and the molecular biomarkers in response to treatment.
In this study, we set out to analyse whether the biology of the tumour can predict how well a patient would respond to treatment. What we found will build on our understanding of the biological underpinnings of disease and take it a step further, to actually help improve patient outcomes.
Dr. Farshad Nassiri – staff neurosurgeon and co-senior author of the study.
Dr. Farshad Nassiri – staff neurosurgeon and co-senior author of this study.
Their key findings were:
- 1. That the removal of the whole meningioma reduces the likelihood of the tumour growing back. This was true across different molecular groups of meningioma. But the benefit was less in the most clinically aggressive, proliferative meningiomas
- 2. These proliferative meningiomas appeared to be resistant to radiotherapy, unlike meningiomas from other molecular groups which may benefit from the addition of radiation after surgery
- 3. Completely removing the most aggressive proliferative meningiomas during surgery improves overall survival of those facing this diagnosis
- 4. In addition to complete resection, removal or heat treatment of the edges of the meningioma which are in contact with the dura mater (the thick outer layer covering the brain and spine) helps to prevent the tumour from growing back as quickly
- 5. Molecular biomarkers appeared to accurately predict the tumour’s response to radiotherapy. This led the researchers to create a model to predict radiotherapy response. The model predicts responses better than standard of care classifications
This work builds on previous work from this research group which identified four distinct molecular groups of meningioma. These are recognised by different genetic changes and biomarkers which helps to predict how the tumour may behave and what the clinical outcomes for patients may be.
This recent research moves knowledge on a step further by being able to predict how a tumour may respond to treatment and help tailor surgical and radiotherapy approaches. We hope this will improve the lives of those facing a meningioma diagnosis. It could also help inform clinical trial approaches in the future.
One of the most challenging clinical decisions to make in the care of meningioma patients is deciding which patients should receive radiation treatment after surgery for their tumour. This research could help us in this decision, which could help improve patient’s lives.
Dr Gelareh Zadeh – neurosurgeon and co-supervisor of this study
Find out more about Gelareh’s research
Dr Gelareh Zadeh
Dr Zadeh is the Head of the Division of Neurosurgery at the University Health Network’s Sprott Department of Surgery, and Dan Family Chair and Professor of Neurosurgery at the University of Toronto, Canada. Her work focusses on finding new and better ways to understand meningiomas and how to treat them.
