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 as the primary treatment, 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) 2
- Symptomatic or growing meningiomas: surgical removal as the primary treatment, with the goal of complete resection when possible, followed by radiation therapy if necessary 2, 3
- Radiation therapy: may be used for tumors that cannot be completely removed surgically, are in difficult locations, or for recurrent tumors 2, 3 ### Diagnostic Tools
- SSTR-directed PET imaging: useful for detecting meningiomas, especially in cases of ambiguous MRI, and for delineating tumor borders 1
- MRI scans: useful for monitoring tumor growth and detecting recurrence 2 ### Therapeutic Options
- Peptide receptor radionuclide therapy (PRRT): an investigational treatment that may be considered for patients with recurrent or refractory meningiomas, with potential clinical benefit 4, 5
- Targeted radionuclide therapy: requires adherence to national legislation, local requirements, and ethical standards governing human studies, and should be conducted by trained medical staff with nursing support and a medical physics expert 5
From the Research
Meningioma Treatment Options
- Meningiomas are extra-axial CNS tumors that can be treated with various methods, including surgery, radiotherapy, and stereotactic radiosurgery 6, 7, 8, 9, 10
- Complete surgical resection is often curative, but stereotactic radiosurgery (SRS) is an effective treatment option for patients with meningiomas eligible for complete resection, providing reliable long-term local tumor control with low rates of mild morbidity 6
- Radiotherapy may be administered as either conventional external beam irradiation or stereotactically by linear accelerator, gamma knife, or cyberknife radiosurgery, and is often used for incompletely resected or recurrent tumors not previously irradiated 7, 8, 9
Stereotactic Radiosurgery
- Stereotactic radiosurgery has become an important primary or adjuvant minimally invasive management strategy for patients with intracranial meningiomas, with the goals of long-term tumor growth prevention and maintenance of patient neurological function 10
- The overall control rate for patients with benign meningiomas (World Health Organization Grade I) was 93%, and tumor control was 97% in those without previous histological confirmation 10
- Delayed resection after radiosurgery was necessary in 5% of patients, and the overall morbidity rate was 7.7% 10
Radiation Therapy
- Radiation therapy is an option as a primary treatment for small meningiomas and for treatment of recurrences after surgery, with advanced technology using image guidance and stereotactic methods to define the target location 9
- Different forms of treatment include protons and photons, both delivered using multiple beam paths converging on the target, and radiation delivered in multiple sessions or as radiosurgery 9