An Overview of Managements in Meningiomas

Abstract

Meningioma is the most frequent primary tumor of the central nervous system. Important advances have been achieved in the treatment of meningioma in recent decades. Although most meningiomas are benign and have a good prognosis after surgery, clinicians often face challenges when the morphology of the tumor is complicated or the tumor is close to vital brain structures. At present, the longstanding treatment strategies of meningioma are mainly surgery and radiotherapy. The effectiveness of systemic therapy, such as chemotherapy or targeted therapy, has not been confirmed by big data series, and some clinical trials are still in progress. In this review, we summarize current treatment strategies and future research directions for meningiomas.

Meningioma: A Review of Epidemiology, Pathology, Diagnosis, Treatment, and Future Directions

“…The “wait-and-see” observation approach is a common strategy used for patients with incidentally diagnosed meningiomas that are small (tumor diameter ≤3 cm) and asymptomatic [ 111 , 112 ]. These patients are observed and followed with MRI scans until they become symptomatic or until their tumors are considered large enough to treat [ 111 ] in order to prevent future symptoms.…”

“…Surgical resection is the primary choice for symptomatic, observation failure meningiomas, or large tumors that are anticipated to causes symptoms soon. GTR can cure the majority (70–80%) of patients [ 11 , 102 , 112 ]. The goal for surgery is GTR (Simpson I, GTR); however, the ability to achieve this may be limited by various factors, including tumor location, involvement of venous sinuses and neurovascular tissue, and other patient factors affecting safety of surgery in general [ 79 ].…”

“…Radiation therapy (RT) has become a first-line treatment for unresectable meningiomas, such as certain skull base meningiomas that have encased neurovascular structures [ 112 ]. With a lack of data from randomized controlled clinical trials comparing different RT for meningiomas, most RT data is based on retrospective studies [ 79 ].…”

“…SRS (12–16 Gy single fraction) is used in small tumors (<3 cm in diameter or 10 cm 3 in volume) and FRT (50–55 Gy given in 1.8–2.0 Gy per fraction) is used when the tumor volume cannot be treated with a single fraction [ 106 ]. Even after Simpson I resection, WHO grades II and III meningiomas have a high risk of recurrence (30–40% and 50–80% after 5 years, respectively) [ 112 ]. Therefore, adjuvant RT is often apart of initial treatment after surgery in WHO grades II and III meningiomas, with FRT being preferred over SRS [ 112 ].…”

“…Even after Simpson I resection, WHO grades II and III meningiomas have a high risk of recurrence (30–40% and 50–80% after 5 years, respectively) [ 112 ]. Therefore, adjuvant RT is often apart of initial treatment after surgery in WHO grades II and III meningiomas, with FRT being preferred over SRS [ 112 ]. Data for RT in WHO grade II meningiomas after GTR remains unclear but it is recommended that WHO grade II STR receive adjuvant FRT (54–60 Gy given in 1.8–2.0 Gy per fraction) and WHO grade III receive adjuvant FRT (at least 54 Gy given in 1.8–2.0 Gy per fraction), regardless of GTR or STR [ 106 , 112 ].…”