From the Guidelines
The treatment for brain meningiomas should be based on the WHO grade of the tumor, with WHO grade 1 and 2 meningiomas potentially being treated with fractionated conformal radiotherapy or stereotactic radiosurgery, and WHO grade 3 meningiomas requiring more aggressive treatment with higher doses of radiation. When considering treatment options, several factors such as size, location, symptoms, and growth rate of the meningioma are taken into account 1. For small WHO grade 1 meningiomas, treatment with stereotactic radiosurgery doses of 12-15 Gy in a single fraction may be appropriate 1. In cases where the meningioma is larger or of a higher grade, fractionated conformal radiotherapy with doses of 45-54 Gy for WHO grade 1 and 2, or 54-60 Gy for WHO grade 3 meningiomas may be recommended 1. Key considerations in the treatment of brain meningiomas include:
- The WHO grade of the tumor
- The size and location of the tumor
- The presence of symptoms
- The growth rate of the tumor Treatment approaches may vary depending on these factors, and the goal of treatment is to achieve the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Treatment Options for Brain Meningiomas
- Surgery is a primary treatment option for meningiomas, with the goal of complete resection 2, 3
- Radiotherapy is also a critical component of meningioma treatment, either as a definitive intervention or in the adjuvant setting for residual disease or adverse pathologic factors 2
- Stereotactic radiosurgery (SRS) is an effective treatment for patients with meningiomas eligible for complete resection, providing reliable long-term local tumor control with low rates of mild morbidity 4
- Fractionated stereotactic radiotherapy (SRT) is useful for larger meningiomas or those closely approximating critical structures, with excellent 5-year tumor control rates of greater than 90% for benign meningiomas 5
Considerations for Treatment
- Treatment recommendations for meningioma patients take into consideration radiologic features, tumor size and location, and medical comorbidities 2
- The presence of symptoms or neurological deficits prior to SRS and the treatment volume can affect the risk of adverse events 4
- Observation is a preferred management option for some meningiomas, especially if they are asymptomatic and have characteristic magnetic resonance imaging features 3
Emerging Trends in Meningioma Treatment
- Recent studies have broadened our knowledge of the genetics and pathogenesis of meningiomas, leading to new therapeutic options 3
- Advances in genomics and molecular characteristics of meningiomas have uncovered potential uses for more accurate grading and prediction of prognosis and recurrence 6
- Specific biologic targets are being trialed for possible management of meningiomas that are not responsive to standard surgery and radiotherapy treatment 6