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Worth Attention meningioma Retrospective

Progesterone exposure was associated with visual deficits in women with meningioma

Unopposed progesterone use was associated with eightfold higher odds of tumor-related visual deficit among women referred for meningioma radiotherapy.

RadOncToday · ·1 min read

KEY POINTS

  • This retrospective case-control analysis included 70 women aged 18–55 years referred for meningioma radiotherapy at one academic center between 2012 and 2025. Median age was 45 years, 73% had skull-base tumors, 44% had WHO grade ≥2 disease and 81% had undergone surgery.
  • Thirty women (43%) had used unopposed progesterone, excluding combined estrogen-progestin products. Twenty had used medroxyprogesterone acetate and 16 (23%) had received injectable depot medroxyprogesterone acetate.
  • Tumor-related visual deficits were present before radiotherapy in 38 of 70 patients (54%), including reduced acuity in 17 patients, unilateral blindness in seven, diplopia in 13, exophthalmos/papilledema in 16, hemianopia in 11 and ptosis in six.
  • Progesterone exposure was markedly more common among women with visual deficits: 63% versus 19% (p<0.001). After multivariable adjustment, unopposed progesterone remained associated with visual deficit (OR 8.3; p=0.001), alongside skull-base location (OR 10.3; p=0.003) and Black race (OR 5.4; p=0.024).
  • Timing supported—but does not prove—a possible causal relationship: among the 24 progesterone-exposed patients with visual deficits, 22 (92%) had progesterone exposure before the deficit developed or worsened. Depot medroxyprogesterone use was present in 37% of patients with visual deficits versus 2% without, and 14 of the 16 exposed women developed a visual deficit.
  • Hormone-receptor testing was rarely part of the original pathology report: only 5 of 57 specimens (9%) had ER/PR information. After additional staining, 42 tumors had evaluable data; 40 of 42 (95%) were progesterone-receptor positive, while only one was estrogen-receptor positive. PR staining percentage showed a nonsignificant association with visual deficit (OR 1.03; p=0.068).
  • The study included only relatively young women ultimately referred for radiotherapy, many with skull-base or higher-risk disease. Hormone exposure was retrospectively reconstructed from medical records, visual deficit was used as a surrogate for clinically aggressive behavior, and unmeasured confounding could explain part of the association.

CLINICAL TAKEAWAY

Medication history deserves attention in younger women with meningioma, particularly exposure to potent progesterone-only agents such as depot medroxyprogesterone. The eightfold adjusted association is difficult to ignore, but this study does not establish that stopping progesterone prevents progression or visual loss.

SOURCE

International Journal of Radiation Oncology, Biology, Physics