What is the management of benign meningioma?

From the Guidelines

Benign meningiomas should be managed with observation or surgical resection depending on their size, location, and associated symptoms, with a preference for observation for small asymptomatic tumors and surgery for symptomatic or large tumors. When considering the management of benign meningioma, several factors come into play, including tumor size, symptoms, and potential neurologic consequences.

• For small benign meningiomas (< 30 mm) that are asymptomatic, observation is the preferred approach, as indicated by the guidelines 1.
• For large benign meningiomas (≥ 30 mm) or those that are symptomatic, surgery is recommended if accessible, followed by radiation therapy (RT) if the tumor is WHO grade 3c or if there is incomplete resection and the tumor is WHO grade 1/2 1.
• The goal of treatment is to balance tumor control with preservation of neurological function, recognizing that while benign, meningiomas can cause significant morbidity through mass effect on adjacent neural structures.
• It's also important to consider the role of radiation therapy, which can be either external-beam or stereotactic radiosurgery (SRS), in the management of benign meningiomas, particularly for incompletely resected tumors or those in critical locations where surgery carries high risk 1.
• Multidisciplinary input for treatment planning is also recommended, if feasible, to ensure the best possible outcome for the patient 1.

From the Research

Management Options for Benign Meningioma

• Benign meningiomas can be observed if not symptomatic or growing 2
• Treatment options include surgery, radiosurgery, fractionated radiation therapy, or a combination of these modalities 2, 3, 4
• Surgery is the preferred treatment if achievable with minimal morbidity, with an expected durable local control of 80% to 90% when a gross total resection is obtained 2, 3
• Radiosurgery and fractionated radiation therapy are useful for incompletely resected or inoperable benign meningiomas, with durable local tumor control in 90 to 95% of cases 3, 4
• Stereotactic radiosurgery is an alternative or adjuvant therapy to surgery for meningiomas in locations where operative manipulation may be difficult, with excellent 5-year tumor control rates of greater than 90% 3, 5

Considerations for Treatment

• The decision for choosing a treatment modality must be made on a case-by-case basis, including an analysis of risks vs. benefits to the individual patient 5
• Patients with smaller benign asymptomatic meningiomas are often followed with sequential MR studies, and may require stereotactic radiosurgery or open surgery if they become symptomatic 5
• Surgery may be warranted in the presence of certain mitigating factors, such as young age or lesions located adjacent to critical structures 5
• Fractionated radiation therapy is an interesting alternative for large inoperable tumors, with encouraging results regarding local control and morbidity 4

Outcomes and Survival Rates

• The 5-year survival rates for stereotactic radiosurgery range from 95.2% to 97%, while the 10-year survival rates vary from 88.6% to 94% 5
• Local control and morbidity rates are excellent for both stereotactic radiosurgery and fractionated radiation therapy, with durable local tumor control in 90 to 95% of cases 3, 4