Massey researcher leads team to improve data reporting of meningioma treatment outcomes nationwide
A new study led by VCU Massey Cancer Center physician-researcher Leland Rogers, M.D., found that clinical trials to treat the most common primary brain tumor, meningioma, lack uniform guidelines for how physicians should determine whether treatment is effective at shrinking the tumor. The study was published in the Journal of Neurosurgery.
Accounting for nearly 34 percent of all brain tumors, a majority of meningioma cases are benign, but a minority (less than 3 percent) are diagnosed as malignant with a median overall survival of two to three years. The current standard treatment options include surgery and radiation therapy. Medical therapies have been tried, but to date have not proved effective. Clinical trials are currently being conducted around the world to test new systemic therapies that could potentially provide more effective treatment options. However, there are no standardized guidelines for how these trials should be conducted, or how results should be reported. Additionally, there are no evidence-based guidelines to determine at what point a treatment should be determined ineffective, or how often and over what duration a meningioma patient on a clinical trial should be observed after treatment.
A group known as RANO (Response Assessment in Neuro-Oncology) has created guidelines, in frequent use, for other central nervous system tumors. Rogers led a global team of radiation oncologists, neurologists, neuro-oncologists and neurosurgeons who sought to lay the groundwork for RANO to improve and standardize meningioma clinical trials.
The team conducted a PubMed search for all English-language publications from 2000 until 2013 that reported clinical outcomes for patients with surgically or radiotherapeutically treated meningiomas. Their search found 47 publications that were reviewed for various criteria including the number of patients, treatment technique, tumor location, histological grade and outcome measures.
“We found there are no completed prospective, randomized trials to test treatment outcomes with either surgery or radiation therapy, and response criteria for any management strategy are poorly defined,” said Rogers, who is a member of the Radiation Biology and Oncology research program and a radiation oncologist at Massey.
This discovery provided evidence of a need to standardize clinical trial protocols and management and defined the need for an improved implementation of World Health Organization tumor grading criteria.
“With this publication, we are preparing detailed guideline documents for the diagnosis and treatment of patients with meningioma,” Rogers said, who is also a professor of radiation oncology at the VCU School of Medicine.
In a parallel study, Rogers and the RANO review team are developing two additional RANO documents. These additional publications will recommend standard guidelines for conducting meningioma clinical trials, and will establish a minimal benchmark definition for when a meningioma tumor is “progressing,” or growing, and not responsive to treatment. They are also preparing a formal RANO Guideline manuscript, which is expected to publish late this year or early next year.