From the Guidelines
Meningioma management should prioritize a multidisciplinary approach, considering tumor size, location, growth rate, and patient symptoms, with treatment options including observation, surgical resection, stereotactic radiosurgery, fractionated radiotherapy, and systemic therapies, guided by the World Health Organization (WHO) grade of the tumor. When considering treatment options, it's essential to weigh the potential benefits and risks of each approach. For small, asymptomatic meningiomas, observation with regular MRI monitoring (typically every 6-12 months initially) is often recommended 1. Surgical resection is the primary treatment for symptomatic meningiomas or those showing significant growth, with the goal of complete tumor removal (Simpson Grade I or II resection) when possible. Some key points to consider in meningioma management include:
- Stereotactic radiosurgery (SRS) or fractionated radiotherapy may be used for tumors in surgically inaccessible locations, residual tumor after surgery, or in patients who are poor surgical candidates, typically delivering 12-14 Gy in a single session for SRS or 50-54 Gy in fractionated doses 1.
- Medication options are limited but may include anticonvulsants for seizure control if present, and corticosteroids (such as dexamethasone 4-16 mg/day) to reduce peritumoral edema.
- For recurrent or aggressive meningiomas, systemic therapies like sunitinib (50 mg daily for 4 weeks followed by 2 weeks off) or bevacizumab (10 mg/kg every 2 weeks) may be considered, though with limited efficacy 1.
- Hormone therapy with somatostatin analogs or progesterone receptor antagonists has shown minimal benefit.
- Peptide receptor radionuclide therapy (PRRT) regimens in patients with meningiomas are usually based on 4 treatment cycles spaced 8 ± 2 weeks apart, with prospective trials needed to explore safety and efficacy of alternative dosing regimens 1. Given the most recent evidence, the management approach should be guided by the World Health Organization (WHO) grade of the tumor, with higher-grade meningiomas typically requiring more aggressive treatment and closer follow-up 1.
From the Research
Management Options for Meningioma
The management of meningioma can be categorized into several options, including:
- Surgical resection: This is the preferred treatment for most intracranial meningiomas, especially for easily accessible tumors that can be safely removed 2, 3, 4.
- Radiation therapy: This includes conventional external beam radiation and stereotactic radiosurgery, which are used as second-line options for patients unwilling or unable to undergo surgery, or for recurrent or residual tumors after surgical resection 2, 3, 4.
- Chemotherapy: The role of chemotherapy in the treatment of meningiomas is limited, and it is often reserved for inoperable tumors or those refractory to radiation treatment 2, 5.
- Observation: This is a preferred management option for some cases, especially for benign meningiomas with characteristic magnetic resonance imaging features 6.
Specific Considerations
- For benign meningiomas, stereotactic radiosurgery and fractionated stereotactic radiotherapy are highly effective alternatives to surgical resection, with excellent 5-year tumor control rates of greater than 90% 3, 4.
- For atypical and anaplastic meningiomas, standard initial therapy includes maximal safe surgical resection followed by focal radiation in certain cases, with chemotherapy playing a less clear role during recurrence 5.
- The choice of treatment modality depends on various factors, including tumor location, size, grade, and the patient's overall health status 2, 3, 4, 6, 5.
Treatment Outcomes
- Surgical resection can provide excellent outcomes for patients with benign meningiomas, with low recurrence rates and minimal morbidity 2, 3, 4.
- Radiation therapy can provide durable local tumor control in 90 to 95% of cases, with stereotactic radiosurgery and fractionated stereotactic radiotherapy being highly effective alternatives to surgical resection 3, 4.
- Chemotherapy has limited efficacy in the treatment of meningiomas, with hydroxyurea and somatostatin analogues being moderately effective in controlling tumor growth 2.