{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:14:30Z","timestamp":1792134870478,"version":"4.4.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Hospital"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>\n              <jats:italic>Treatment-refractory meningioma<\/jats:italic> is a widely used term but lacks standardized criteria, impairing research comparability and treatment evaluation. The aim of this study was to assess the heterogeneity of patient populations labeled as <jats:italic>treatment-refractory<\/jats:italic> and to explore recommendations for better consistency.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We systematically reviewed 69 studies published before 2024 and analyzed individual participant data from 15 cohorts (<jats:italic>n<\/jats:italic>\u2009=\u2009211) that included <jats:italic>treatment-refractory<\/jats:italic> patients who underwent experimental therapy with somatostatin receptor (SSTR)-targeted therapies. A reference cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009102) with newly diagnosed WHO-3 meningiomas was used descriptively for comparison. Progression and death were the primary endpoints. Hazard rate ratios were estimated via Poisson regression, and inter-study heterogeneity was quantified using I\u00b2 statistics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Definitions of treatment-refractory varied substantially across previous studies. WHO-1 patients showed high statistical inter-study variability, particularly for the long-acting SSTR-analogues group when assessing progression (I\u00b2 = 81.7%) and death (I\u00b2 =74.8%). Patients with <jats:italic>treatment-refractory<\/jats:italic> WHO-2 and WHO-3 meningioma exhibited more consistency across endpoints and SSTR-targeted therapies (I\u00b2 percentages \u2264 16.0%). Risk of progression and death differed significantly by WHO grade, regardless of SSTR-targeted therapy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Our findings demonstrate an inconsistent use of the term <jats:italic>treatment-refractory<\/jats:italic> and substantial variability of effect estimates dependeing on the individual cohorts. Pooling patients across WHO grades is unfeasible for assessing treatment effects. Based on the present study and prior evidence, we outline recommendations to improve consistency in future trial design and enable more meaningful comparisons across studies. The recommendations are grouped into four categories: radiographic evaluation, endpoints, clinical core elements, and molecular classification.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11060-025-05154-2","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T18:04:53Z","timestamp":1754330693000},"page":"599-610","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The concept, intention, and evaluation of the term treatment-refractory meningioma"],"prefix":"10.1007","volume":"175","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6931-4399","authenticated-orcid":false,"given":"Lasse Rehn\u00e9","family":"Jensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5930-0636","authenticated-orcid":false,"given":"Andrea Daniela","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2236-6719","authenticated-orcid":false,"given":"Tareq A.","family":"Juratli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6975-9945","authenticated-orcid":false,"given":"St\u00e9phane","family":"Goutagny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-7668","authenticated-orcid":false,"given":"Luca","family":"Bertero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5627-8181","authenticated-orcid":false,"given":"Thomas","family":"Graillon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Brokinkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejpal","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8345-6852","authenticated-orcid":false,"given":"Sverre Helge","family":"Torp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9134-1537","authenticated-orcid":false,"given":"Roberta","family":"Rud\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7600-0806","authenticated-orcid":false,"given":"Paul M.","family":"Clement","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2257-1651","authenticated-orcid":false,"given":"Martijn","family":"van Essen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4430-9806","authenticated-orcid":false,"given":"Mar\u00eda Dolores","family":"Tabernero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Gousias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9421-7830","authenticated-orcid":false,"given":"\u00c1lvaro Otero","family":"Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1509-9800","authenticated-orcid":false,"given":"Jong Hee","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3375-7072","authenticated-orcid":false,"given":"Chang-Ok","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1361-3514","authenticated-orcid":false,"given":"Andr\u00e9s Felipe","family":"Cardona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1164-3779","authenticated-orcid":false,"given":"Oscar","family":"Arrieta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1274-9273","authenticated-orcid":false,"given":"Alejandro","family":"Ruiz-Pati\u00f1o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9680-9060","authenticated-orcid":false,"given":"Daniela A.","family":"Bota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4627-9177","authenticated-orcid":false,"given":"Maya","family":"Hrachova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8692-1198","authenticated-orcid":false,"given":"David","family":"Scheie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6352-0826","authenticated-orcid":false,"given":"Bjarne Winther","family":"Kristensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5938-000X","authenticated-orcid":false,"given":"Tina N\u00f8rgaard","family":"Munch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9644-7496","authenticated-orcid":false,"given":"Ian","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1520-7122","authenticated-orcid":false,"given":"K\u00e5re","family":"Fugleholm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6595-0873","authenticated-orcid":false,"given":"Torstein Ragnar","family":"Meling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8258-3681","authenticated-orcid":false,"given":"Julia","family":"Furtner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3541-2315","authenticated-orcid":false,"given":"Matthias","family":"Preusser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6487-5349","authenticated-orcid":false,"given":"Martin Alexander","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9463-1919","authenticated-orcid":false,"given":"Tiit","family":"Mathiesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6801-0123","authenticated-orcid":false,"given":"Christian","family":"Mirian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"5154_CR1","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1093\/neuonc\/not330","volume":"16","author":"T Kaley","year":"2014","unstructured":"Kaley T, Barani I, Chamberlain M, McDermott M, Panageas K, Raizer J et al (2014) Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review. Neuro Oncol 16:829\u2013840. https:\/\/doi.org\/10.1093\/neuonc\/not330","journal-title":"Neuro Oncol"},{"key":"5154_CR2","doi-asserted-by":"publisher","DOI":"10.1093\/NEUONC\/NOAF009","author":"R Kotecha","year":"2025","unstructured":"Kotecha R, Akdemir EY, Kutuk T, Ilgin C, Ahluwalia MS, Bi WL et al (2025) Benchmarking the efficacy of salvage systemic therapies for recurrent meningioma: A RANO group systematic review and Meta-analysis to guide clinical trial design. Neuro Oncol. https:\/\/doi.org\/10.1093\/NEUONC\/NOAF009","journal-title":"Neuro Oncol"},{"key":"5154_CR3","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1093\/neuonc\/noab150","volume":"23","author":"R Goldbrunner","year":"2021","unstructured":"Goldbrunner R, Stavrinou P, Jenkinson MD, Sahm F, Mawrin C, Weber DC et al (2021) EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol 23:1821\u20131834. https:\/\/doi.org\/10.1093\/neuonc\/noab150","journal-title":"Neuro Oncol"},{"key":"5154_CR4","doi-asserted-by":"publisher","unstructured":"Huang RY, Bi WL, Weller M, Kaley T, Blakeley J, Dunn I et al Neuro-Oncology proposed response assessment and endpoints for meningioma clinical trials: report from the response assessment in neuro-Oncology Working Group 2018. https:\/\/doi.org\/10.1093\/neuonc\/noy137","DOI":"10.1093\/neuonc\/noy137"},{"key":"5154_CR5","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s00401-020-02188-w","volume":"140","author":"P Sievers","year":"2020","unstructured":"Sievers P, Hielscher T, Schrimpf D, Stichel D, Reuss DE, Berghoff AS et al (2020) CDKN2A\/B homozygous deletion is associated with early recurrence in meningiomas. Acta Neuropathol 140:409\u2013413. https:\/\/doi.org\/10.1007\/s00401-020-02188-w","journal-title":"Acta Neuropathol"},{"key":"5154_CR6","doi-asserted-by":"publisher","unstructured":"Mirian C, Duun-Henriksen AK, Juratli T, Sahm F, Spiegl-Kreinecker S, Peyre M et al Poor prognosis associated with TERT gene alterations in meningioma is independent of the WHO classification: an individual patient data meta-analysis. J Neurol Neurosurg Psychiatry 2020:jnnp-2019-322257. https:\/\/doi.org\/10.1136\/jnnp-2019-322257","DOI":"10.1136\/jnnp-2019-322257"},{"key":"5154_CR7","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/S1470-2045(17)30155-9","volume":"18","author":"F Sahm","year":"2017","unstructured":"Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S et al (2017) DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 18:682\u2013694. https:\/\/doi.org\/10.1016\/S1470-2045(17)30155-9","journal-title":"Lancet Oncol"},{"key":"5154_CR8","doi-asserted-by":"publisher","DOI":"10.1093\/NEUONC\/NOAE253","author":"F Sahm","year":"2024","unstructured":"Sahm F, Bertero L, Brandner S, Capper D, Goldbrunner R, Jenkinson MD et al (2024) EANO guideline on molecular testing of meningiomas for targeted therapy selection. Neuro Oncol. https:\/\/doi.org\/10.1093\/NEUONC\/NOAE253","journal-title":"Neuro Oncol"},{"key":"5154_CR9","doi-asserted-by":"publisher","unstructured":"Behling F, Fodi C, Skardelly M, Renovanz M, Castaneda S Differences in the expression of SSTR1\u20135 in meningiomas and its therapeutic potential 2021. https:\/\/doi.org\/10.1007\/s10143-021-01552-y","DOI":"10.1007\/s10143-021-01552-y"},{"key":"5154_CR10","doi-asserted-by":"publisher","first-page":"507","DOI":"10.2967\/jnumed.120.249607","volume":"62","author":"C Mirian","year":"2021","unstructured":"Mirian C, Duun-Henriksen AK, Maier A, Pedersen MM, Jensen LR, Bashir A et al (2021) Somatostatin Receptor-Targeted radiopeptide therapy in Treatment-Refractory meningioma: individual patient data Meta-analysis. J Nucl Med 62:507\u2013513. https:\/\/doi.org\/10.2967\/jnumed.120.249607","journal-title":"J Nucl Med"},{"key":"5154_CR11","doi-asserted-by":"publisher","first-page":"3067","DOI":"10.1007\/s10143-022-01849-6","volume":"45","author":"LR Jensen","year":"2022","unstructured":"Jensen LR, Maier AD, Lomstein A, Graillon T, Hrachova M, Bota D et al (2022) Somatostatin analogues in treatment-refractory meningioma: a systematic review with meta-analysis of individual patient data. Neurosurg Rev 45:3067\u20133081. https:\/\/doi.org\/10.1007\/s10143-022-01849-6","journal-title":"Neurosurg Rev"},{"key":"5154_CR12","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1038\/S41588-022-01061-8","volume":"54","author":"A Choudhury","year":"2022","unstructured":"Choudhury A, Magill ST, Eaton CD, Prager BC, Chen WC, Cady MA et al (2022) Meningioma DNA methylation groups identify biological drivers and therapeutic vulnerabilities. Nat Genet 54:649\u2013659. https:\/\/doi.org\/10.1038\/S41588-022-01061-8","journal-title":"Nat Genet"},{"key":"5154_CR13","doi-asserted-by":"publisher","unstructured":"M\u00fcther M, Roll W, Brokinkel B, Zinnhardt B, Sporns PB, Seifert R et al (2020) Response assessment of somatostatin receptor targeted radioligand therapies for progressive intracranial meningioma. NuklearMedizin. https:\/\/doi.org\/10.1055\/a-1200-0989","DOI":"10.1055\/a-1200-0989"},{"key":"5154_CR14","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1093\/neuonc\/now060","volume":"18","author":"K Seystahl","year":"2016","unstructured":"Seystahl K, Stoecklein V, Schuller U, Rushing E, Nicolas G, Schafer N et al (2016) Somatostatin receptor-targeted radionuclide therapy for progressive meningioma: benefit linked to 68Ga-DOTATATE\/-TOC uptake. Neuro Oncol 18:1538\u20131547. https:\/\/doi.org\/10.1093\/neuonc\/now060","journal-title":"Neuro Oncol"},{"key":"5154_CR15","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1089\/cbr.2013.1599","volume":"29","author":"F Minutoli","year":"2014","unstructured":"Minutoli F, Amato E, Sindoni A, Cardile D, Conti A, Herberg A et al (2014) Peptide receptor radionuclide therapy in patients with inoperable meningiomas: our experience and review of the literature. Cancer Biother Radiopharm 29:193\u2013199. https:\/\/doi.org\/10.1089\/cbr.2013.1599","journal-title":"Cancer Biother Radiopharm"},{"key":"5154_CR16","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1007\/s00259-009-1115-z","volume":"36","author":"M Bartolomei","year":"2009","unstructured":"Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E et al (2009) Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging 36:1407\u20131416. https:\/\/doi.org\/10.1007\/s00259-009-1115-z","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"5154_CR17","first-page":"1599","volume":"47","author":"M van Essen","year":"2006","unstructured":"van Essen M, Krenning EP, Kooij PP, Bakker WH, Feelders RA, de Herder WW et al (2006) Effects of therapy with [177Lu-DOTA0, Tyr3]octreotate in patients with paraganglioma, meningioma, small cell lung carcinoma, and melanoma. J Nucl Med 47:1599\u20131606","journal-title":"J Nucl Med"},{"key":"5154_CR18","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.2967\/jnumed.115.155853","volume":"56","author":"K Gerster-Gillieron","year":"2015","unstructured":"Gerster-Gillieron K, Forrer F, Maecke H, Mueller-Brand J, Merlo A, Cordier D (2015) 90Y-DOTATOC as a therapeutic option for complex recurrent or progressive meningiomas. J Nucl Med 56:1748\u20131751. https:\/\/doi.org\/10.2967\/jnumed.115.155853","journal-title":"J Nucl Med"},{"key":"5154_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2020.03.002","author":"PE Hartrampf","year":"2020","unstructured":"Hartrampf PE, H\u00e4nscheid H, Kertels O, Schirbel A, Kreissl MC, Flentje M et al (2020) Long-term results of multimodal peptide receptor radionuclide therapy and fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma. Clin Transl Radiat Oncol. https:\/\/doi.org\/10.1016\/j.ctro.2020.03.002","journal-title":"Clin Transl Radiat Oncol"},{"key":"5154_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0217340","volume":"14","author":"AF Cardona","year":"2019","unstructured":"Cardona AF, Ruiz-Pati\u00f1o A, Zatarain-Barr\u00f3n ZL, Hakim F, Jim\u00e9nez E, Mej\u00eda JA et al (2019) Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between octreotide in combination with everolimus and Sunitinib. PLoS ONE 14:1\u201313. https:\/\/doi.org\/10.1371\/journal.pone.0217340","journal-title":"PLoS ONE"},{"key":"5154_CR21","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1212\/01.wnl.0000271382.62776.b7","volume":"69","author":"M Chamberlain","year":"2007","unstructured":"Chamberlain M, Glantz MJ, Fadul CE (2007) Recurrent meningioma - Salvage therapy with long-acting somatostain analogue. Neurology 69:969\u2013973","journal-title":"Neurology"},{"key":"5154_CR22","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1093\/neuonc\/nov183","volume":"18","author":"J Furtner","year":"2016","unstructured":"Furtner J, Sch\u00f6pf V, Seystahl K, Le Rhun E, Rud\u00e0 R, Roelcke U et al (2016) Kinetics of tumor size and peritumoral brain edema before, during, and after systemic therapy in recurrent WHO grade II or III meningioma. Neuro Oncol 18:401\u2013407. https:\/\/doi.org\/10.1093\/neuonc\/nov183","journal-title":"Neuro Oncol"},{"key":"5154_CR23","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1158\/1078-0432.CCR-19-2109","volume":"26","author":"T Graillon","year":"2020","unstructured":"Graillon T, Sanson M, Campello C, Idbaih A, Peyre M, Peyriere H et al (2020) Everolimus and octreotide for patients with recurrent meningioma: results from the phase II CEVOREM trial. Clin Cancer Res 26:552\u2013557. https:\/\/doi.org\/10.1158\/1078-0432.CCR-19-2109","journal-title":"Clin Cancer Res"},{"key":"5154_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fneur.2020.00373","volume":"11","author":"M Hrachova","year":"2020","unstructured":"Hrachova M, Nguyen ENT, Fu BD, Dandekar MJ, Kong XT, Cadena G et al (2020) A retrospective interventional cohort study to assess the safety and efficacy of sandostatin LAR for treatment of recurrent and\/or refractory meningiomas. Front Neurol 11:1\u201311. https:\/\/doi.org\/10.3389\/fneur.2020.00373","journal-title":"Front Neurol"},{"key":"5154_CR25","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1093\/NEUONC\/NOR044","volume":"13","author":"DR Johnson","year":"2011","unstructured":"Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W et al (2011) Phase II study of subcutaneous octreotide in adults with recurrent or progressive meningioma and meningeal Hemangiopericytoma. Neuro Oncol 13:530\u2013535. https:\/\/doi.org\/10.1093\/NEUONC\/NOR044","journal-title":"Neuro Oncol"},{"key":"5154_CR26","doi-asserted-by":"publisher","first-page":"E11","DOI":"10.3171\/2011.1.FOCUS111","volume":"30","author":"C Schulz","year":"2011","unstructured":"Schulz C, Ulm B, Kunz U, Mathieu R, Kunz U, Mauer UM (2011) Treatment of unresectable skull base meningiomas with somatostatin analogs. Neurosurg Focus 30:E11. https:\/\/doi.org\/10.3171\/2011.1.FOCUS111","journal-title":"Neurosurg Focus"},{"key":"5154_CR27","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1007\/s00280-014-2422-z","volume":"73","author":"M Sim\u00f3","year":"2014","unstructured":"Sim\u00f3 M, Argyriou AA, Maci\u00e0 M, Plans G, Maj\u00f3s C, Vidal N et al (2014) Recurrent high-grade meningioma: A phase II trial with somatostatin analogue therapy. Cancer Chemother Pharmacol 73:919\u2013923. https:\/\/doi.org\/10.1007\/s00280-014-2422-z","journal-title":"Cancer Chemother Pharmacol"},{"key":"5154_CR28","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/jrsm.12","volume":"1","author":"M Borenstein","year":"2010","unstructured":"Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 1:97\u2013111. https:\/\/doi.org\/10.1002\/jrsm.12","journal-title":"Res Synth Methods"},{"key":"5154_CR29","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","volume":"327","author":"JPT Higgins","year":"2003","unstructured":"Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557\u2013560. https:\/\/doi.org\/10.1136\/bmj.327.7414.557","journal-title":"BMJ"},{"key":"5154_CR30","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/S11060-024-04572-Y\/FIGURES\/2","volume":"166","author":"C Mirian","year":"2024","unstructured":"Mirian C, Jensen LR, Juratli TA, Maier AD, Torp SH, Shih HA et al (2024) The importance of considering competing risks in recurrence analysis of intracranial meningioma. J Neurooncol 166:503\u2013511. https:\/\/doi.org\/10.1007\/S11060-024-04572-Y\/FIGURES\/2","journal-title":"J Neurooncol"},{"key":"5154_CR31","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/S00280-015-2927-0","volume":"77","author":"E Mazza","year":"2016","unstructured":"Mazza E, Brandes A, Zanon S, Eoli M, Lombardi G, Faedi M et al (2016) Hydroxyurea with or without Imatinib in the treatment of recurrent or progressive meningiomas: a randomized phase II trial by gruppo Italiano cooperativo Di Neuro-Oncologia (GICNO). Cancer Chemother Pharmacol 77:115\u2013120. https:\/\/doi.org\/10.1007\/S00280-015-2927-0","journal-title":"Cancer Chemother Pharmacol"},{"key":"5154_CR32","doi-asserted-by":"publisher","first-page":"4093","DOI":"10.1200\/JCO.2015.61.6490","volume":"33","author":"Y Ji","year":"2015","unstructured":"Ji Y, Rankin C, Grunberg S, Sherrod AE, Ahmadi J, Townsend JJ et al (2015) Double-Blind phase III randomized trial of the antiprogestin agent mifepristone in the treatment of unresectable meningioma: SWOG S9005 listen to the podcast by Dr Maher at www.jco.org.podcasts. J Clin Oncol 33:4093\u20134098. https:\/\/doi.org\/10.1200\/JCO.2015.61.6490","journal-title":"J Clin Oncol"},{"key":"5154_CR33","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1093\/NEUONC\/NOAB243","volume":"24","author":"M Preusser","year":"2022","unstructured":"Preusser M, Silvani A, Le Rhun E, Soffietti R, Lombardi G, Sepulveda JM et al (2022) Trabectedin for recurrent WHO grade 2 or 3 meningioma: A randomized phase II study of the EORTC brain tumor group (EORTC-1320-BTG). Neuro Oncol 24:755\u2013767. https:\/\/doi.org\/10.1093\/NEUONC\/NOAB243","journal-title":"Neuro Oncol"},{"key":"5154_CR34","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1093\/NEUONC\/NOX231","volume":"20","author":"M Peyre","year":"2018","unstructured":"Peyre M, Gauchotte G, Giry M, Froehlich S, Pallud J, Graillon T et al (2018) De Novo and secondary anaplastic meningiomas: a study of clinical and histomolecular prognostic factors. Neuro Oncol 20:1113. https:\/\/doi.org\/10.1093\/NEUONC\/NOX231","journal-title":"Neuro Oncol"},{"key":"5154_CR35","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1093\/neuonc\/noab259","volume":"24","author":"F Nassiri","year":"2022","unstructured":"Nassiri F, Wang JZ, Au K, Barnholtz-Sloan J, Jenkinson MD, Drummond K et al (2022) Consensus core clinical data elements for meningiomas (v2021.1). Neuro Oncol 24:683\u2013693. https:\/\/doi.org\/10.1093\/neuonc\/noab259","journal-title":"Neuro Oncol"},{"key":"5154_CR36","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1093\/NEUONC\/NOZ061","volume":"21","author":"F Nassiri","year":"2019","unstructured":"Nassiri F, Mamatjan Y, Suppiah S, Badhiwala JH, Mansouri S, Karimi S et al (2019) DNA methylation profiling to predict recurrence risk in meningioma: development and validation of a nomogram to optimize clinical management. Neuro Oncol 21:901\u2013910. https:\/\/doi.org\/10.1093\/NEUONC\/NOZ061","journal-title":"Neuro Oncol"},{"key":"5154_CR37","doi-asserted-by":"publisher","unstructured":"Sahm F, Aldape KD, Brastianos PK, Brat DJ, Dahiya S, von Deimling A et al (2025) cIMPACT-NOW update 8: clarifications on molecular risk parameters and recommendations for WHO grading of meningiomas. Neuro Oncol 27. https:\/\/doi.org\/10.1093\/NEUONC\/NOAE170","DOI":"10.1093\/NEUONC\/NOAE170"},{"key":"5154_CR38","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1111\/NAN.12700","volume":"47","author":"R Banan","year":"2021","unstructured":"Banan R, Abbetmeier-Basse M, Hong B, Dumitru CA, Sahm F, Nakamura M et al (2021) The prognostic significance of clinicopathological features in meningiomas: microscopic brain invasion can predict patient outcome in otherwise benign meningiomas. Neuropathol Appl Neurobiol 47:724\u2013735. https:\/\/doi.org\/10.1111\/NAN.12700","journal-title":"Neuropathol Appl Neurobiol"},{"key":"5154_CR39","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/S00401-016-1598-1","volume":"132","author":"P Baumgarten","year":"2016","unstructured":"Baumgarten P, Gessler F, Schittenhelm J, Skardelly M, Tews DS, Senft C et al (2016) Brain invasion in otherwise benign meningiomas does not predict tumor recurrence. Acta Neuropathol 132:479\u2013481. https:\/\/doi.org\/10.1007\/S00401-016-1598-1","journal-title":"Acta Neuropathol"},{"key":"5154_CR40","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/S11060-019-03312-X","volume":"145","author":"A Biczok","year":"2019","unstructured":"Biczok A, Jungk C, Egensperger R, von Deimling A, Suchorska B, Tonn JC et al (2019) Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome. J Neurooncol 145:469\u2013477. https:\/\/doi.org\/10.1007\/S11060-019-03312-X","journal-title":"J Neurooncol"},{"key":"5154_CR41","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.wneu.2016.06.055","volume":"93","author":"DC Spille","year":"2016","unstructured":"Spille DC, He\u00df K, Sauerland C, Sanai N, Stummer W, Paulus W et al (2016) Brain invasion in meningiomas: incidence and correlations with clinical variables and prognosis. World Neurosurg 93:346\u2013354. https:\/\/doi.org\/10.1016\/j.wneu.2016.06.055","journal-title":"World Neurosurg"}],"container-title":["Journal of Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-025-05154-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11060-025-05154-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-025-05154-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T06:58:54Z","timestamp":1757487534000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11060-025-05154-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["5154"],"URL":"https:\/\/doi.org\/10.1007\/s11060-025-05154-2","relation":{},"ISSN":["0167-594X","1573-7373"],"issn-type":[{"value":"0167-594X","type":"print"},{"value":"1573-7373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,4]]},"assertion":[{"value":"13 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"As the manuscript relies entirely on published and fully anonymized material, ethical approval was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}