2486 - Progesterone Contraception and Tumor-Related Visual Impairment in Premenopausal Women with Meningioma Referred for Radiation

M. M. Bailey¹, C. Avery², L. E. Pater¹, T. D. Struve III¹, R. E. Vatner¹, A. J. Frankart¹, S. M. C. Sittenfeld³, K. Shiue⁴, L. Yogendran⁵, R. Chaudhary⁶, J. Forbes⁷, N. Andaluz⁷, M. Hagen⁸, A. Kendler⁸, R. Rossi², J. C. Breneman¹, and K. Wang¹; ¹Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, ²Department of Obstetrics & Gynecology, University of Cincinnati, Cincinnati, OH, ³Department of Radiation Oncology, University of Cincinnati Cancer Center, Cincinnati, OH, ⁴Department of Radiation Oncology, Indiana University, Indianapolis, IN, ⁵Department of Neurology, University of Cincinnati, Cincinnati, OH, ⁶Department of Medicine, Division of Oncology, University of Cincinnati, Cincinnati, OH, ⁷Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, ⁸Department of Pathology, University of Cincinnati, Cincinnati, OH

Purpose/Objective(s): Meningiomas express estrogen and progesterone receptors, but hormonal risk is poorly characterized and not always considered by treating neurosurgeons and radiation oncologists. We hypothesized that hormonal contraceptives lead to tumor-related visual deficits in premenopausal women referred for radiation. Materials/

Methods: We performed a retrospective case-control study with the primary endpoint of visual deficit prior to receipt of radiation for intracranial meningioma in women age =55. Records were reviewed to determine key risk factors including age, grade, skull base location, hormonal supplementation / contraception, and neurofibromatosis / prior radiation (NF/PriorRT). Univariate and multivariate (including factors with p<0.05 on univariate) logistic regression was performed to analyze associations with visual deficit.
Results: The final cohort comprised of 64 women age =55 (median 46), out of a total 253 patients who received radiation for meningioma between 2012 and 2024 at one center. 24 patients (38%) had meningioma grade =2; 45 (70%) had skull base tumors; 6 (9%) had NF/PriorRT. 33 women (52%) had used estrogen or progesterone, and 23 (36%) had used unopposed progesterone only, of whom 15 used medroxyprogesterone acetate (Provera). Visual deficit was present in 35 patients (55%) and was strongly and independently associated with both skull base location (p=0.002, OR 11.5) and unopposed progesterone only use (p=0.008, OR 12) but not estrogen or progesterone use on multivariate analysis (see table). Proportion with history of progesterone only use was 57% vs. 11% in patients with vs. without visual deficit, respectively (chi-sq p<0.001). ER/PR status was reported in 5 of 51 cases (10%) with available pathology; PR was positive in 3 (all with visual deficits and history of Provera use) and negative in 2 (neither with visual deficits nor hormone use). At time of radiation, 13 women (20%) were actively using progesterone. At time of analysis, 13 women (20%) were still using progesterone, 17 women have been contacted for risk counseling, and 4 have discontinued progesterone as a result.
Conclusion: Progesterone use is a significant risk factor for meningioma-related visual deficits in premenopausal women referred for radiotherapy, with a disproportionate number on Provera specifically. These data highlight the importance of age-appropriate counseling, consistent pathologic assessment of ER/PR status, and greater awareness of this issue amongst neurosurgeons and radiation oncologists.

Endpoint: Pre-RT visual deficit	Univariate p (OR)	Multivariate p (OR)
Age	0.74 (0.99)
Tumor grade =2	0.95 (0.97)
Skull base location	<0.001 (13.13)	0.002 (11.54)
NF/PriorRT	0.28 (0.38)
Estrogen or progesterone	0.049 (2.77)	0.76 (0.78)
Unopposed progesterone only	<0.001 (11.56)	0.008 (12.00)