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Guidelines to the treatment of meningioma
C Marosi1, M Hassler, K R Ssler
1Clinical Division of Oncology, Department of Medicine I, University Hospital Vienna, Währinger Gürtel, Vienna, Austria.
Epidemiology:
Meningiomas constitute the largest subgroup of all intracranial tumours. Their incidence is about 2-3/100,000/yr, with a 3:2 to 2:1 female:male ratio, with a peak incidence in the sixth and the seventh decade of life. Meningiomas are usually slow growing, benign neoplasms, causing symptoms by compression of adjacent structures or by increased cranial pressure, the specific symptoms depending on the location of the tumour.
Risk Factors:
Meningiomas can be induced by radiation to the head, even by low dose radiation as used for dental radiographic examination after up to 35 yrs interval. The female preponderance in meningioma patients as well as the expression of progesterone receptor on the cell membranes of more than 50% of meningiomas is argument for an influence of gestagene in meningioma proliferation. The most frequent genetic predisposition of meningiomas is associated with neurofibromatosis 2 (NF-2); at least 40% of meningiomas show a deletion in the NF-2 gene.
Treatment:
To date, surgical resection is the mainstay of meningioma therapy. The completeness of the resection is the single most important prognostic factor for recurrence. In case of incomplete resection or recurrence, radiation therapy with 54 Gy (1.8 to 2 Gy/fraction) yields comparable results to total resection. Radiosurgery is a valuable alternative to radiotherapy (RT), maybe in the future also for surgery, as recently demonstrated. In the rare meningioma patients, that have exhausted the possibilities of surgery and RT, there have been some successful small series using hydroxyurea or interferon alpha. Future therapeutic options might consist in octreotide isotopic therapy or targeted therapy directed against tumour neo-angiogenesis or other proliferation associated markers in meningiomas.
Insights
Meningiomas are common brain tumors, often benign and slow-growing. Treatment focuses on surgical removal, with radiation therapy as a key option for recurrence, and new targeted therapies emerging.
Area of Science:
- Neurosurgery
- Oncology
- Radiotherapy
Background:
- Meningiomas are the most common intracranial tumors, affecting women more than men, typically in their sixth and seventh decades.
- These benign neoplasms cause symptoms through compression or increased intracranial pressure, depending on tumor location.
- Risk factors include radiation exposure and genetic predisposition, such as neurofibromatosis type 2 (NF-2).
Purpose of the Study:
- To review the current understanding of meningioma epidemiology, risk factors, and treatment modalities.
- To highlight the prognostic significance of complete surgical resection.
- To discuss established and potential future therapeutic strategies for meningiomas.
Main Methods:
- Review of existing literature on meningioma incidence, etiology, and treatment outcomes.
- Analysis of prognostic factors, particularly the completeness of surgical resection.
- Evaluation of the efficacy of radiation therapy, radiosurgery, and emerging systemic treatments.
Main Results:
- Complete surgical resection is the primary determinant of recurrence-free survival.
- Radiation therapy and radiosurgery offer effective alternatives for incompletely resected or recurrent meningiomas.
- Novel therapeutic avenues, including targeted therapies and isotopic treatments, are under investigation for advanced cases.
Conclusions:
- Meningioma management relies on a multidisciplinary approach, prioritizing complete resection.
- Radiation-based therapies are crucial for managing residual or recurrent disease.
- Ongoing research into targeted therapies holds promise for improving outcomes in challenging meningioma cases.
