From the Guidelines
Treatment for meningioma should prioritize surgical resection as the primary approach, with the goal of complete tumor removal, and consideration of stereotactic radiosurgery or fractionated radiation therapy for tumors in difficult locations or when complete resection isn't possible, as supported by the most recent guidelines 1. When considering treatment options for a patient diagnosed with a meningioma, several factors come into play, including tumor size, location, growth rate, and patient symptoms.
- For small, asymptomatic meningiomas, observation with regular MRI monitoring may be recommended, as many meningiomas grow slowly or not at all.
- Surgical resection is the primary approach for symptomatic or growing meningiomas, with the goal of complete tumor removal (Simpson Grade I or II resection) to minimize recurrence risk, as emphasized in 1.
- For tumors in difficult locations or when complete resection isn't possible, stereotactic radiosurgery (such as Gamma Knife) or fractionated radiation therapy may be used either as primary treatment or as adjuvant therapy after subtotal resection, with conventional radiation therapy typically delivering 50-54 Gy in 1.8-2.0 Gy fractions.
- Recent guidelines also suggest the potential use of peptide receptor radionuclide therapy (PRRT) for recurrent or aggressive meningiomas, particularly those with positive expression of SSTR type 2 receptors on SSTR-directed PET imaging, as noted in 1 and 1.
- Systemic therapies, including sunitinib or bevacizumab, may be considered for recurrent or aggressive meningiomas, although their efficacy may vary.
- Long-term monitoring is crucial, as recurrence can occur years after treatment, with follow-up MRIs typically scheduled at 3 months post-treatment, then every 6-12 months for several years, and annually thereafter.
From the Research
Treatment Options for Meningioma
The treatment options for a patient diagnosed with a meningioma include:
- Surgery: Complete resection is often curative, especially for benign meningiomas 2, 3
- Radiotherapy: This can be administered as either conventional external-beam radiation therapy or stereotactically by linear accelerator, Leksell Gamma Knife, or Cyberknife radiosurgery 2, 4, 5
- Hormonal therapy: This may be considered when the meningioma is unresectable or all other treatments have failed 2, 3
- Chemotherapy: This may be considered for recurrent or malignant meningiomas, although its role is less clear 6
Factors Influencing Treatment
The treatment recommendations for meningioma patients take into consideration:
- Radiologic features
- Tumor size and location
- Medical comorbidities
- Histopathologic factors, such as World Health Organization (WHO) grade and proliferation index 4, 3
Outcomes and Prognosis
The outcomes for meningioma patients are dictated by: