From the Guidelines
Meningiomas should be treated based on their size, location, and symptoms, with small, asymptomatic tumors being monitored with regular MRI scans, and symptomatic or growing tumors undergoing surgical removal, followed by radiation therapy if necessary, as recommended by the most recent guidelines 1.
Treatment Options
- Small, asymptomatic meningiomas: monitor with regular MRI scans (watchful waiting) 1
- Symptomatic or growing meningiomas: surgical removal, followed by radiation therapy if necessary 1
- Recurrent or malignant meningiomas: consider peptide receptor radionuclide therapy (PRRT) 1
Diagnosis and Staging
- Use radiolabeled somatostatin receptor ligands for PET imaging to diagnose and stage meningiomas 1
- SSTR PET is particularly valuable in cases of ambiguous MRI and for delineating meningiomas located in regions where morphologic tumor borders are difficult to assess by MRI 1
Prognosis and Follow-up
- The prognosis is generally favorable, with most patients having good outcomes after treatment 1
- Regular follow-up is necessary as these tumors can recur even years later 1
Recent Guidelines
- The joint EANM/ENNO/RANO/SNMMI practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor ligands recommend PRRT as a potential treatment option for patients with recurrent or refractory meningiomas 1
From the Research
Treatment Options for Meningioma
- Complete resection is recommended as first-line treatment for meningiomas, while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable 2
- Radiosurgery can be done for small tumors, or fractionated radiotherapy in large or previously treated tumors 3
- Radiation therapy is an option as a primary treatment for small meningiomas and for treatment of recurrences after surgery 4
Efficacy and Safety of Stereotactic Radiosurgery
- SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity 2
- The overall control rate for patients with benign meningiomas (World Health Organization Grade I) was 93% 5
- Actuarial local control at one year was 95,71, and 0% for WHO grade 1, WHO grade 2, and WHO grade 3, respectively 6
Adverse Events and Morbidity
- Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1-2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1-2; one case grade 3) 2
- The overall morbidity rate was 7.7% 5
- Symptomatic peritumoral imaging changes developed in 4% of the patients at a mean of 8 months 5