From the Guidelines
Meningioma treatment should be guided by tumor size, symptoms, and WHO grade, with observation, surgery, and radiation therapy being key components, as outlined in the most recent guidelines. When considering treatment options for meningiomas, it's crucial to assess the tumor's size, location, and symptoms, as well as its WHO grade, which categorizes the tumor's biological behavior [ 1 ].
Key Considerations
- Tumor size plays a significant role in determining the treatment approach, with small tumors (< 30 mm) often being observed or surgically removed if accessible, while larger tumors (≥ 30 mm) may require surgery followed by radiation therapy if they are symptomatic or of a higher WHO grade [ 1 ].
- Symptomatic tumors, regardless of size, typically require surgical intervention, with radiation therapy considered for higher-grade tumors or those with incomplete resection [ 1 ].
- The WHO grading system is essential in guiding treatment, with higher grades (II and III) necessitating more aggressive management, including radiation therapy [ 1 ].
Treatment Options
- Observation with regular MRI monitoring is a viable option for small, asymptomatic meningiomas, allowing for intervention if the tumor grows or becomes symptomatic [ 1 ].
- Surgical resection is the primary treatment for many meningiomas, aiming for complete removal when possible, with radiation therapy used adjunctively for tumors in difficult locations, incomplete resections, or recurrent tumors [ 1 ].
- Radiation therapy, including stereotactic radiosurgery and conventional external-beam radiation, is tailored to the tumor's size, location, and grade, as well as the patient's overall health and preferences [ 1 ].
From the Research
Meningioma Diagnosis
- Meningiomas are extraaxial central nervous system tumors most often discovered in middle to late adult life, and are more often seen in women 2
- Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant 2
- Meningiomas can be classified in the World Health Organization system as grade I, II, or III, depending on various histological features 3
Meningioma Treatment
- Complete resection is often curative for meningiomas 2
- For the majority of incompletely resected or recurrent tumors not previously irradiated, radiotherapy is administered 2
- Radiotherapy may be administered as either conventional external-beam radiation therapy or stereotactically by linear accelerator, Leksell Gamma Knife, or Cyberknife radiosurgery 2
- Stereotactic radiosurgery (SRS) is a highly effective alternative to surgical resection that has been used as a primary therapy for benign meningiomas as well as an adjuvant treatment for residual or recurrent tumors 4
- 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 5
Treatment Options
- Surgery with or without adjuvant radiation is the standard therapy for meningiomas, depending on the tumor grade and the degree of resection 3
- Stereotactic radiotherapy is useful for larger meningiomas (> 3-3.5 cm) and those closely approximating critical structures, such as the optic chiasm and brainstem 6
- Hormonal therapy or chemotherapy may be considered when the meningioma is unresectable or all other treatments (surgery and radiotherapy) have failed 2
- Hydroxyurea has been modestly successful in patients with recurrent meningiomas 2
Stereotactic Radiosurgery
- The 5-year tumor control rates for stereotactic radiosurgery are equivalent to gross-total resection with lower morbidity than surgery, especially for skull base lesions 4
- Adjuvant treatment of subtotally resected tumors results in tumor control rates equivalent to gross-total resection 4
- Stereotactic radiosurgery has been used extensively for the treatment of small and medium sized skull base meningiomas 4