Oncological Care for Patients With Meningioma (ATYPICMENING)

Postoperative Oncological Care for Patients With Meningioma With Malignant Components

Meningiomas with malignant components include grade II meningiomas (GIIM, the most common ones) and grade III meningiomas (GIIIM). They represent 5-35% of all meningiomas. Histological diagnosis of GIIM criteria were changed in 2007 and might be viewed by some as being quite subjective. "Standards of care" and consensus do not exist for GIIM, particularly in regards to performing, or not, radiotherapy after surgery. One other limitation in the literature is lack of data on health-related quality of life (HRQoL). Clinical trials for GIIM are very difficult to conduct. No results have been made available. Here, we propose to study clinical, pathological, radiological and therapeutic factors of an exhaustive population of GIIM and GIIIM patients, at national level. The main objective (for GIIM) is to assess the impact of postoperative radiotherapy, or the absence of postoperative radiotherapy, on overall survival and on quality of life

Study Overview

• Status: Recruiting
• Conditions: Atypical Meningioma; Anaplastic Meningioma; Clear-cell Meningioma; Chordoid Meningioma; Rhabdoid Meningioma; Papillary Meningioma

Detailed Description

Meningiomas with malignant components include grade II meningiomas (GIIM, the most common ones) and grade III meningiomas (GIIIM). They represent 5-35% of all meningiomas. Histological diagnosis of GIIM criteria were changed in 2007 and might be viewed by some as being quite subjective. "Standards of care" and consensus do not exist for GIIM, particularly in regards to performing, or not, radiotherapy after surgery. One other limitation in the literature is lack of data on health-related quality of life (HRQoL). Clinical trials for GIIM are very difficult to conduct. No results have been made available.

Main objective: to assess the impact of postoperative radiotherapy after GIIM surgery on overall survival (OS) in a population-setting study.

Secondary objectives (for GIIM and GIIIM):

• Evaluate the recurrence/progression free survival (PFS), volumetric velocity of the tumor growth (VVTG) after surgery and other treatment.
• Evaluate long term HRQoL.
• Evaluate the relevance and impact of histopathological review in a population setting.
• Looking for prognostic (clinical, radiological and biological) factors.
• Proposing therapeutic decision trees in general or for certain categories of patients.
• Identifying relevant cases to conduct further studies to identify new therapeutic targets.
• Perspectives for the TUCERA network to help design specific prospective projects.
• Looking for disparities in care management, survival and HRQoL in the various regions of France.

Design of the study: nationwide population-based study analysis and patterns of care/quality of care study, for all cases of incident GIIM and GIIIM operated in Metropolitan France during the 2007-2010 period.

The methodology used is based on a multidisciplinary national network already established by the French Brain Tumor DataBase (FBTDB), with the active participation of societies involved in the French neuro-oncology and the "Inter Groupe Coopérateur en Neuro-Oncologie", labeled by the French National Cancer Institute.

The FBTDB has already identified all incident cases of GIIM (n=1046) and GIIIM (n=158) operated in Metropolitan France from 2007 to 2010.

The study proposed is a retrospective study based on the medical charts of all these patients.

Furthermore, for all surviving patients not lost to follow-up, the follow-up consultations will include a prospective HRQoL evaluation (cutoff date: 2019/11/30).

It will be conducted a systematic pathological review (with eventually additional biological work-up), and a study of prognostic factors (clinical, radiological, biological), treatments administered, OS, PFS.

Primary endpoint: OS. The statistical analysis (to answer to the main question) will concern all GIIM only.

Hypothesis:

Experimental group: Group of GIIM with postoperative radiotherapy (n=314). Control group: Group of GIIM with postoperative follow-up only (n=732). With a bilateral type I error of 5% (two-sided) and a statistical power of 80% we will be able to demonstrate that postoperative radiotherapy will be associated with a Hazard ratio (mortality risk) of 0.80.

Secondary endpoints (for GIIM and GIIIM):

• PFS, VVTG after surgery and other treatment.
• HRQoL will be assessed using EORTC QLQ-C30, BN20 questionnaires, Europol EQ5D, and with a questionnaire on professional and social activities (HRQoL will be assessed for all patients alive, every six months, since inclusion, for an 18-month period).
• Mapping between HRQoL questionnaires.
• Concordance/discordance analysis between the initial histological diagnosis and the diagnosis of the pathological review.
• Conduct an inventory of cryopreserved material available for translational research.

It is expected to:

• Define subgroups of patients, according to prognostic factors, which would benefit from postoperative radiotherapy in GIIM.
• Define subgroups of patients, according to their prognostic factors, which would benefit from not having postoperative radiotherapy in GIIM.
• Propose personalized therapeutic attitudes according to prognostic factors (clinical, radiological, and biological) in general, but also for specific categories of patients such as elderly subjects.
• Define subgroups of GIIM and GIIIM that will justify conducting trials in the framework of the TUCERA network.
• Evaluate in population settings, the relevance and impact of a systematic histopathological review.
• Develop HRQoL evaluation in population settings.
• Acquire better knowledge of prognostic factors (clinical, radiological and biological) for GIIM and GIIIM, their natural history, and maybe help determine elements able to differentiate GIIM that will progress to GIIIM, from those that will remain GIIM.
• Build a clinical-biological database to identify and/or develop new therapeutic targets in GIIM and GIIIM.
• Evaluate potential disparities in terms of survival and HRQoL in the different French regions, and if some disparities are found, look for eventual causes.

• Study Type: Observational
• Enrollment (Anticipated): 1204

Contacts and Locations

• Study Contact: Name: LUC BAUCHET, MD, PhD; Phone Number: 33 467337205; Email: l-bauchet@chu-montpellier.fr
• Study Contact Backup: Name: Frank BONNETAIN

Study Locations

• France
  • Montpellier, France, 34295
    • Recruiting
    • UH Montpellier
    • Contact: LUC BAUCHET, MD, PhD; Phone Number: 33 467337205; Email: l-bauchet@chu-montpellier.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients with a histological diagnosis of GIIM and GIIIM in metropolitan France

Description

Inclusion Criteria :Patient with a GIIM incident (atypical, chordidic and clear cell meningiomas) and GIIIM (anaplastic, papillary and rhabdoid meningiomas) operated in metropolitan France during the period 2007-2010

Exclusion Criteria :

• Patient with GIM
• Non-operated meningioma patient

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
overall survival	Description: Assessing the impact of postoperative radiotherapy after surgery on overall survival (OS) in population-based study of GIIM patients. Overall survival, the primary endpoint of this study, is defined as the time from surgery (histological diagnosis) to the time of death from any cause. Alive Patients at the time of the final analysis or who became lost to follow-up will be censored at their last date of giving news	up to 10 years, since diagnosis

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the tumor growth	The tumor growth after surgery and other treatment (based on successive MRIs) will be determined by the volumetric velocity of the tumor growth (mm3/year)	up to 10 years, since diagnosis
Progression/Recurrence Free Survival, will be measured by month		up to 10 years, since diagnosis

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluation of the quality of life	Change from baseline in patients with a I and II grade glioma, defined by quality-of-life parameters Health related Quality of Life will be assessed using EORTC QlQ C30 and BN 20 questionnaires, Europol EQ5D, and a specific questionnaire on professional and social activities. -EORTC QLQ-C30: Score at baseline, The change in the EORTC QLQ-C30 score from baseline to endpoint -EORTC QLQ-BN20: Score at baseline, The change in the EORTC QLQ-C30 score from baseline to endpoint; Europol EQ5D Score at baseline, The change in the EORTC QLQ-C30 score from baseline to endpoint; Specific questionnaire on professional and social activities: Score at baseline, The change in the Specific questionnaire on professional and social activities score from baseline to endpoint	baseline, 6 months, 12 months 18 months
diagnosis of the central pathological review.	Concordance/discordance analysis between the initial histological diagnosis and the diagnosis of the central pathological review.	1 day

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier
• Collaborators: Centre Hospitalier Universitaire de Besancon
• Investigators: Study Director: LUC BAUCHET, MD, PhD, UH Montpellier

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2019
• Primary Completion (Anticipated): July 1, 2023
• Study Completion (Anticipated): December 30, 2023

Study Registration Dates

• First Submitted: October 17, 2016
• First Submitted That Met QC Criteria: November 21, 2016
• First Posted (Estimate): November 25, 2016

Study Record Updates

• Last Update Posted (Actual): April 14, 2022
• Last Update Submitted That Met QC Criteria: April 13, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Keywords: Meningioma grade II; Meningioma grade III
• Additional Relevant MeSH Terms: Nervous System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Neoplasms, Nerve Tissue; Central Nervous System Neoplasms; Nervous System Neoplasms; Neoplasms, Vascular Tissue; Meningeal Neoplasms; Meningioma
• Other Study ID Numbers: UF9759

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided