From the Guidelines
The most effective treatment for a meningioma of the brain is surgical removal, with the goal of complete resection when possible, followed by radiation therapy if necessary, as recommended by the most recent and highest quality study 1.
Diagnosis and Treatment
A meningioma is a type of brain tumor that develops from the meninges, the protective membranes covering the brain and spinal cord. These tumors are typically slow-growing and benign (non-cancerous), accounting for about 30% of all primary brain tumors.
Key Factors in Treatment
Treatment depends on several factors including:
- Size
- Location
- Symptoms
Treatment Options
Small, asymptomatic meningiomas may simply be monitored with regular MRI scans (watchful waiting approach). For symptomatic or growing meningiomas, surgical removal is the primary treatment, with the goal of complete resection when possible. Radiation therapy may be used for tumors that cannot be completely removed surgically, for recurrent tumors, or for patients who cannot undergo surgery. Stereotactic radiosurgery (focused radiation) is sometimes used for smaller tumors in difficult locations.
Diagnostic Tools
SSTR PET is particularly valuable in cases of ambiguous MRI as well as for the delineation of meningiomas located in regions where morphologic tumor borders are difficult to assess by MRI, such as at the skull base 1.
Theranostics
Theranostics with SSTR as target structure are potentially applicable to meningiomas, with initial PRRT studies presenting encouraging results with favorable outcome in patients with treatment-refractory meningioma 1.
Symptoms and Prognosis
Symptoms vary based on tumor location but may include headaches, seizures, vision problems, weakness in limbs, or personality changes. The cause of meningiomas is largely unknown, though radiation exposure and certain genetic conditions like neurofibromatosis type 2 increase risk. Most patients have good outcomes, especially with complete surgical removal, though regular follow-up imaging is recommended as recurrence is possible even years later.
Treatment Planning
Areas with meningioma-suspicious uptake may be used to support delineation of the SSTR-positive tumor tissue, as recommended by the joint eanm/eano/rano/snmmi practice guideline/procedure standards for diagnostics and therapy (theranostics) of meningiomas using radiolabeled somatostatin receptor ligands: version 1.0 1. Multidisciplinary input for treatment planning is recommended if feasible, as stated in the guidelines for central nervous system cancers 1.
From the Research
Diagnosis of Meningioma
- Meningiomas are the most common primary intracranial brain tumor, with a heterogeneous biology and an unmet need for targeted treatment options 2
- Diagnosis is based on radiologic features, tumor size and location, and medical comorbidities, which may influence the ability to undergo complete resection 2
- Histopathologic factors, such as World Health Organization (WHO) grade and proliferation index, also play a crucial role in diagnosis and treatment planning 2
Treatment Options for Meningioma
- Existing treatments for meningiomas are limited to surgery, radiotherapy, or a combination of these depending on clinical and histopathological features 2
- Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are highly conformal techniques, using steep dose gradients and stereotactic patient immobilization, and are useful for treating meningiomas, especially in locations where operative manipulation may be difficult 3
- SRS has been used as an alternative or adjuvant therapy to surgery for meningiomas, and has excellent 5-year tumor control rates of greater than 90% for benign meningiomas 3, 4
- Radiotherapy is a critical component of meningioma treatment, and can be used as a definitive intervention or in the adjuvant setting for residual disease or adverse pathologic factors 2
Prognostic and Predictive Factors
- A higher grade is a known risk of meningioma recurrence, and it is often difficult to identify subgroups that show advantage of a combination of neurosurgery and radiosurgery 5
- The analysis of hormonal, cytogenetics, and epigenetics tumor equipment seems to be the most promising for the development of personalized treatment 5
- Key factors that affect tumor control and adverse event rates include World Health Organization grade, lesion size, and lesion location 6