From the Guidelines
Meningioma management should prioritize a multidisciplinary approach, considering tumor size, location, growth rate, and symptoms, with treatment options including observation, surgical resection, stereotactic radiosurgery, fractionated radiotherapy, and medical therapy, as supported by the most recent evidence from 2024 1.
Key Considerations
- Tumor size and location play a crucial role in determining the management approach, with small, asymptomatic meningiomas often being observed with regular MRI monitoring.
- Surgical resection is the primary treatment for symptomatic meningiomas or those showing significant growth, aiming for complete tumor removal (Simpson Grade I or II resection) when possible.
- 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, with typical SRS doses ranging from 12-16 Gy in a single fraction, and fractionated radiotherapy delivering 50-54 Gy in 1.8-2.0 Gy fractions, as noted in earlier guidelines 1.
Medical Therapy and Emerging Treatments
- Medical therapy has limited efficacy but may include hormonal agents like mifepristone for progesterone receptor-positive tumors, or somatostatin analogs like octreotide for somatostatin receptor-positive tumors.
- For recurrent or aggressive meningiomas, chemotherapy agents such as hydroxyurea or bevacizumab may be considered, with emerging evidence supporting the potential benefit of peptide receptor radionuclide therapy (PRRT) in patients with somatostatin receptor-positive meningiomas, as indicated by recent practice guidelines 1.
Individualized Treatment Decisions
- Treatment decisions should be individualized based on tumor characteristics, patient age, comorbidities, and preferences, ideally through a multidisciplinary approach, considering the latest evidence and guidelines to optimize outcomes in terms of morbidity, mortality, and quality of life.
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.