EANO guidelines for the diagnosis and treatment of meningiomas

Abstract

Although meningiomas are the most common intracranial tumours, the level of evidence to provide recommendations for the diagnosis and treatment of meningiomas is low compared with other tumours such as high-grade gliomas. The meningioma task force of the European Association of NeuroOncology (EANO) assessed the scientific literature and composed a framework of the best possible evidence-based recommendations for health professionals. The provisional diagnosis of meningioma is mainly made by MRI. Definitive diagnosis, including histological classification, grading, and molecular profiling, requires a surgical procedure to obtain tumour tissue. Therefore, in many elderly patients, observation is the best therapeutic option. If therapy is deemed necessary, the standard treatment is gross total surgical resection including the involved dura. As an alternative, radiosurgery can be done for small tumours, or fractionated radiotherapy in large or previously treated tumours. Treatment concepts combining surgery and radiosurgery or fractionated radiotherapy, which enable treatment of the complete tumour volume with low morbidity, are being developed. Pharmacotherapy for meningiomas has remained largely experimental. However, antiangiogenic drugs, peptide receptor radionuclide therapy, and targeted agents are promising candidates for future pharmacological approaches to treat refractory meningiomas across all WHO grades.

DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis

“…As a result, deciding on radiotherapy based on the current grading is heavily debated 5 . Thus, we correlated meningioma MCs with progression-free survival (PFS) to evaluate their potential for predicting outcome compared to WHO grading ( Fig.…”

“…subtypes and three grades of malignancy 4 , but some of the diagnostic criteria are vaguely defined and subject to a high inter-observer bias, indicating thea need for more reliable biomarkers 5,7 .…”

DNA methylation analysis for the treatment of meningiomas

“…More aggressive anaplastic WHO grade III tumors are likely have mutations in NF2 (10), and meningiomas with mutations in NF2 are found to have significantly lower recurrence-free survival rates (3). Sizes of tumors with NF2 mutations were found to be significantly larger than tumors that do not have mutations in NF2.…”

“…Initial studies have found that NF2 is one of the most commonly found mutated genes in meningiomas (10). More aggressive anaplastic WHO grade III tumors are likely have mutations in NF2 (10), and meningiomas with mutations in NF2 are found to have significantly lower recurrence-free survival rates (3).…”

“…Most of the WHO grade II tumors were found inwith WHO grade II tumors assigned to MC ben-1 had a 75.7% probability of being progression-free at 72 months compared to a 28.3% and 23.1% chance of progressionfree at 72 months in both the MC int-A and MC int-B respectively. In WHO grade II meningiomas, fractionated radiotherapy should be used for postoperative treatment in tumors that progress or recur after surgery (10). Methylation classification will assist physicians in making decisions on radiotherapy in WHO grade II tumors, as meningiomas with the MC int-A and MC int-B should be strongly considered for fractionated radiotherapy after the initial surgery.…”