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Hormonal Effect On Meningioma Growth: Perspectives
Hormonal Effect On Meningioma Growth: Perspectives
Hormonal Effect On Meningioma Growth: Perspectives
Commentary on:
Intracranial Meningiomas in Patients with
Uterine Sarcoma Treated with Long-Term
Megestrol Acetate Therapy
by Gruber et al. pp. 477.E16-477.E20.
he impact of growth-promoting hormones on meningioma formation and progression has been the subject of
discussions over many years. Isolated observations that
link hormonal surge, such as during pregnancy, to rapid growth of
meningiomas, and the identification of various hormonal receptors in meningioma prompted numerous investigations into this
area.
Meningiomas, which account for approximately 35% of all primary brain tumors, are mostly benign, slow-growing tumors with
a median age of 63 years at diagnosis. The incidence of meningiomas was found to be significantly higher in females than
males (8.87 vs. 3.91/100,000) (4).
Key words
Epidemiology
Hormones
Meningioma
Risk factor
412
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From the 1Department of Neurosurgery, Tel Aviv Sourasky Medical Center, and
2
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
To whom correspondence should be addressed: Zvi Ram, M.D. [E-mail: zviram@inter.net.il]
Citation: World Neurosurg. (2011) 76, 5:412-414.
DOI: 10.1016/j.wneu.2011.05.007
PERSPECTIVES
REFERENCES
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JS, Shapiro WR, Selker RG, Inskip PD: Personal hair
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option for meningioma by demonstrating inhibition of meningioma growth in cell cultures, as well as in animal models. In
clinical studies, Grunberg et al. (9) studied the effect of long-term
oral therapy of mifepristone (RU486) in 14 patients with unresectable meningiomas. The response rate was partial and minor
and was associated with fatigue, hot flashes, gynecomastia,
partial alopecia, and menstrual disturbances. In a recent study by
Grunberg et al. (8), 28 patients received daily oral mifepristone
(RU486) for a median duration of therapy of 35 months with a
minor response rate and with similar profile of side effects as
previously reported. However, in this group of longer treatment
duration, endometrial hyperplasia or polyps were documented in
three patients and peritoneal adenocarcinoma developed in one
patient 9 years after therapy. In another study, evaluating tamoxifen (7) (an antiestrogen agent) as a hormonal therapy for the
treatment of meningioma in 21 patients, only one patient demonstrated a partial response and two patients demonstrated
minor response on imaging. The other patients remained stable
(6 patients) or progressed (10 patients) over a median follow-up
of 31 months. The authors have concluded that a definite
recommendation for the use of tamoxifen as an anti-meningioma
therapy cannot be made from the study (7).
In conclusion, the current literature offers limited evidence for
the associated risk of developing meningiomas with the use of
exogenous female sex steroids. Although it appears that a subset
of women may be more sensitive to the effects of sex hormones
in either promoting meningiomas or enhancing their growth, no
unequivocal statistical evidence is present for an increased risk
for meningiomas among oral contraceptive users. A possible, but
inconclusive, increased risk for meningiomas may occur with
long-term hormonal replacement therapy. The current report by
Gruber et al. suggests a possible link between long-term treatment with megestrol acetate and meningioma development.
Their observation, along with the previously described data,
suggests that administration of long-term sex hormones, or their
agonists, to women who had been previously diagnosed with a
meningioma should be taken with care. However, the recommendation for screening patients who are treated with long-term
hormonal therapies by brain imaging appears to be premature
and unsubstantiated by the isolated cases reported so far.
www.WORLDNEUROSURGERY.org
413
PERSPECTIVES
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meningioma and ionizing radiation in medical and
414
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Citation: World Neurosurg. (2011) 76, 5:412-414.
DOI: 10.1016/j.wneu.2011.05.007
Journal homepage: www.WORLDNEUROSURGERY.org
Available online: www.sciencedirect.com
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