[Defining the Role of Radiotherapy in Meningioma Treatment]

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Molecular Diagnostics

Background:

• The clinical utility of radiotherapy for meningiomas is not well-established, lacking sufficient evidence.
• Recent WHO classification updates and molecular diagnostics have improved meningioma recurrence risk stratification.
• Uncertainty persists regarding the precise indications for radiotherapy in meningioma management.

Purpose of the Study:

• To explore the evolving role of radiotherapy in meningioma treatment.
• To discuss the impact of advanced diagnostics and novel therapies on meningioma management.
• To address the contentious issues surrounding radiotherapy for high-risk and 'brain invasion in otherwise benign' (BIOB) meningiomas.

Main Methods:

• Review of current literature on meningioma classification, risk stratification, and treatment modalities.
• Discussion of the integration of advanced imaging (PET-MRI) for radiation target definition.
• Exploration of emerging therapeutic strategies, including Boron Neutron Capture Therapy (BNCT).

Main Results:

• Refined risk stratification necessitates a re-evaluation of radiotherapy's role.
• PET-MRI integration offers advantages in defining radiation targets.
• Boron Neutron Capture Therapy (BNCT) shows potential for meningiomas with infiltrative components.

Conclusions:

• The precise role of radiotherapy in meningioma treatment requires further investigation, especially for high-risk and BIOB subtypes.
• Advanced imaging and molecular diagnostics are crucial for personalized treatment strategies.
• Emerging therapies like BNCT offer new avenues for managing invasive meningiomas.