From the Guidelines
Treatment for meningioma should be individualized based on tumor size, location, growth rate, and symptoms, with a focus on preserving neurological function and quality of life. When considering treatment options, it's essential to weigh the benefits and risks of each approach. For small, asymptomatic meningiomas, observation with regular MRI scans may be recommended, known as "watchful waiting" 1.
Key Considerations
- Tumor size and location
- Growth rate and symptoms
- Preservation of neurological function
- Quality of life When treatment is necessary, surgical removal (resection) is the primary approach, with the goal of complete tumor removal while preserving neurological function.
Treatment Options
- Surgical resection
- Radiation therapy, including stereotactic radiosurgery (like Gamma Knife) for smaller tumors or fractionated radiotherapy for larger ones, typically delivered in doses of 50-54 Gy over several weeks 1
- Medications, such as anticonvulsants, for managing symptoms like seizures
- Hormonal therapies for hormone-sensitive meningiomas
- Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin receptor ligands, which has shown promising results in initial studies 1 After treatment, follow-up imaging is essential to monitor for recurrence, typically every 6-12 months initially. Meningiomas are typically slow-growing tumors arising from the meninges (protective coverings of the brain and spinal cord), and about 80-90% are benign, which influences treatment decisions and long-term prognosis.
Recent Advances
- The use of radiolabeled somatostatin receptor ligands for diagnostics and therapy (theranostics) of meningiomas has shown significant promise 1
- SSTR PET has been found to be particularly valuable in cases of ambiguous MRI and for the delineation of meningiomas located in regions where morphologic tumor borders are difficult to assess by MRI 1
From the Research
Treatment Options for Meningioma
- Surgical resection is the mainstay of treatment for WHO grade 2 meningioma 2
- Fractionated radiation therapy (RT) is frequently used after surgery, though many centers utilize stereotactic radiosurgery (SRS) for recurrence or progression 2
- Stereotactic radiosurgery consists of delivering a high-dose of radiation with high precision, to the tumor in a single-fraction with a minimal exposure of surrounding healthy tissue 3
- Fractionated radiation therapy is an interesting alternative for large inoperable tumors, with results seeming encouraging as regards both local control and morbidity 3
Efficacy of Treatment Options
- Five-year gross tumor control (GTC) was higher with fractionated RT versus SRS (82% vs. 38%, P = 0.03) 2
- Five-year intracranial control (IC) was also better with fractionated RT versus SRS (82% vs. 11%, P < 0.001) 2
- Actuarial local control at one year was 95,71, and 0% for WHO grade 1, WHO grade 2, and WHO grade 3 meningiomas, respectively, after stereotactic radiosurgery 4
- Eighteen-month progression-free survival was 92.3%, while 18-month overall survival was 100% for patients treated with fractionated RT and SRS boost 5
Future Directions
- Advances in genomics and molecular characteristics of meningiomas have uncovered potential use for more accurate grading and prediction of prognosis and recurrence 6
- Specific biologic targets are now being trialed for possible management of meningiomas that are not responsive to standard surgery and radiotherapy treatment 6