Management of Recurrent Meningiomas: State of the Art and Perspectives

Abstract

Background: While meningiomas often recur over time, the natural history of repeated recurrences and their management are not well described. Should recurrence occur, repeat surgery and/or use of adjuvant therapeutic options may be necessary. Here, we summarize current practice when it comes to meningioma recurrence after initial surgical management. Methods: A total of N = 89 articles were screened. N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review. Results: The articles were distributed as follows: studies on chemotherapy (N = 14), radiotherapy, protontherapy, and stereotaxic radiosurgery (N = 6), boron-neutron capture therapy (N = 2) and surgery (N = 3). No study seems to provide serious alternatives to surgery in terms of progression-free and overall survival. Recurrence can occur long after the initial surgery and also affects WHO grade 1 meningiomas, even after initial gross total resection at first surgery, emphasizing the need for a long-term and comprehensive follow-up. Conclusions: Surgery still seems to be the state-of-the-art management when it comes to meningioma recurrence, since none of the non-surgical alternatives show promising results in terms of progression-free and overall survival.

Topographic Patterns of Intracranial Meningioma Recurrences—Systematic Review with Clinical Implication

“…Meningiomas may recur not only within or close to the surgical bed, but also distant from it; therefore, the opportunity to theoretically predict at first diagnosis the possible site of recurrence is of paramount importance to guide treatment strategies, from both the surgical and the radiation therapy points of view, to decrease/prevent the recurrence risk and the complications related to repeated reoperations [ 10 , 11 , 12 ].…”

“…Intracranial meningiomas account for more than one third of primary intracranial tumors [ 1 , 2 ] and pose a significant challenge for multidisciplinary management teams due to their propensity for recurrence [ 3 ]. In fact, despite their predominantly benign histology (80%), and although most patients recover following initial treatment [ 4 ], a not-insignificant percentage (about 20%) tends to have one or more recurrences over the patient’s lifetime [ 5 , 6 , 7 , 8 ], requiring additional treatments [ 4 , 9 , 10 , 11 , 12 , 13 ].…”

Recurrent meningioma: When to intervene

“…Meningiomas recur over time, especially when patients receive less than GTR resections (13,23). Management of recurrent meningioma is similar to primary treatment, mainly involving repeat surgery, but can involve adjuvant therapeutics, though the alternatives are less promising than surgical intervention (23).…”

Recurrent meningioma: When to intervene

“…However, although gross total resection (GTR) is an admirable goal, achieving GTR is very challenging, and surgeons often employ safer margins to avoid surgery-related comorbidity and adverse outcomes (e.g., skull base meningiomas) (20)(21)(22). Meningiomas recur over time, especially when patients receive less than GTR resections (13,23). Management of recurrent meningioma is similar to primary treatment, mainly involving repeat surgery, but can involve adjuvant therapeutics, though the alternatives are less promising than surgical intervention (23).…”