Therapy: Surgery, Radiotherapy, Drug Treatment

Chapter 10 - Classification and Treatment Strategies of Meningiomas

Therapy Surgery Figure 1

Courtesy J. Furtner, Medical University of Vienna, Vienna

Neurosurgical resection is the treatment of choice for newly diagnosed meningiomas and is curative in most cases. However, meningiomas in inaccessible locations (e.g. skull base) may not be completely resectable.

Incompletely resected meningiomas and meningiomas with histopathological signs of increased malignancy (WHO Grade 2 or 3 meningiomas, tumours with brain infiltration) have a tendency to progress or recur and often require salvage therapies.

If feasible, neurosurgical resection is an important treatment option for progressive or recurrent meningioma.

In the newly diagnosed setting, adjuvant radiotherapy (RT) is commonly applied after resection of WHO Grade 3 meningiomas, and after incomplete resection of WHO Grade 2 meningiomas.

In the recurrent setting, fractionated RT or radiosurgery are important treatment options, depending on meningioma size, localisation and prior therapies.

Drug therapy is commonly considered in meningiomas recurring after the exhaustion of all surgical and radiotherapeutic options. However, the lack of clinical trials with systemic agents in this patient population precludes recommendation of specific drugs. Cytotoxic therapies such as hydroxyurea seem to be of very limited value.

Antiangiogenic agents such as bevacizumab and sunitinib have shown signs of anti-meningioma activity in small and uncontrolled studies that require confirmation in further investigations.

Therapy Surgery Figure 3

Courtesy J. Furtner, Medical University of Vienna, Vienna

Some meningiomas are associated with significant and symptomatic brain oedema that may require anti-oedematous therapy, e.g. with dexamethasone.

Revision Questions

  1. What is the treatment of first choice for newly diagnosed convexity meningioma?
  2. Discuss treatment options for recurrent Grade 2 meningioma.
  3. What is the role for cytotoxic chemotherapy in recurrent meningioma?

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Last update: 18 September 2017