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An Exploratory Analysis of the Association Between Progesterone Use and Tumor-related Visual Deficit in Women With
Morgan M Bailey1, Chace Avery2, Matthew C Hagen3
1Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Purpose:
Meningiomas may express estrogen/progesterone receptors (ERs/PRs), but hormonal risk is poorly characterized. We characterized the association between progesterone supplementation and tumor-related visual deficits in premenopausal women receiving radiation for meningioma.
Methods And Materials:
We performed a retrospective case-control study with a primary endpoint of visual deficit prior to radiation for intracranial meningioma in women aged ≤55 years receiving radiation at 1 academic center from 2012 to 2025. Records were reviewed to determine risk factors including age, race, grade, neurofibromatosis/prior radiation, gravida, unopposed progesterone use, skull base location, and time from diagnosis to radiation. All available pathology specimens were tested for ER/PR expression. Logistic regression was performed to analyze associations with visual deficit.
Results:
Seventy women with median age 45 were included. Thirty-two patients (44%) had meningioma grade ≥2, 51 (73%) had skull base tumors, and 8 (11%) had neurofibromatosis or prior radiation therapy. Thirty women (43%) had used unopposed progesterone; 16 (23%) used depo-medroxyprogesterone acetate specifically. Visual deficit was present in 38 patients (54%) and was associated with unopposed progesterone use (P = .001, odds ratio [OR] 8.3), Black race (P = .024, OR 5.4), and skull base location (P = .003, OR 10.3) on multivariable analysis. Proportion using unopposed progesterone was 63% versus 19% in patients with versus without visual deficit, respectively (χ2P < .001). In patients with visual deficit, 92% of progesterone exposures preceded visual deficit. Only 5 of 57 (9%) original pathology reports discussed ER/PR status, 42 after pathologic reanalysis. PR was positive in 40 (95%) and ER in 1 (2%). In this subset, there was a nonsignificant trend to an association between PR staining percentage and visual deficit on multivariable analysis (P = .068, OR 1.03).
Conclusions:
Progesterone use was associated with meningioma-related visual deficit in women referred for radiation therapy. Providers should be aware of this potential risk factor, and further study is warranted.