Materiały źródłowe

• #1 An Overview of Managements in Meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7473392/

  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. […] 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. […] The aim of this study is to review the current advancement of meningioma treatment. […] For small and asymptomatic meningiomas, an strategy of wait and see is recommended, clinical and MRI evaluation was performed every 6 months after an initial observation.

• #1 An Overview of Managements in Meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7473392/

  Surgical resection is the primary treatment choice for symptomatic meningiomas. […] The purpose of the operation is to relieve symptoms caused by the tumor, change the natural course of the tumor, and improve quality of life. […] The factors that affect the surgical strategy are as follows: (1) surgical benefits; (2) surgical risks; (3) biological characteristics of tumor; (4) tumor mass effect or clinical symptoms; (5) subjective wishes of patients. […] The location of the tumor is very important for the assessment of surgical risk. […] At present, it is generally recommended to resect the tumor outside the superior sagittal sinus. […] Traditional experience has shown that the risk of complete removal of the invaded sinus is not high and there is no need to reconstruct the venous circulation.

• #1 An Overview of Managements in Meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7473392/

  Surgery microscope, neuronavigation technology, intraoperative neurophysiological monitoring, intraoperative imaging, adaptive hybrid surgery, and cavitational ultrasonic aspirators have greatly improved the success rate of surgery. […] Endoscopic endonasal approach should be the primary choice for tuberculum sellae meningiomas with suspected involvement of the optic canal. […] The efficacy of endonasal approach depends on many factors, including the size, growth pattern, invasion degree, and transfer status of meningioma. […] Preoperative embolization can improve the safety of the operation and fully expose the tumor during the operation. […] The postoperative complications of meningioma include cerebral hemorrhage, infection, neurological deficit, brain edema, epilepsy, etc. […] Radiation therapy (RT) is suitable for the following patients: patients diagnosed with WHO grade II or grade III meningioma; patients after STR; patients who have lost the opportunity of surgery for various reasons or have a recurrence and are not suitable for resection.

• #1 An Overview of Managements in Meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7473392/

  The purpose of radiotherapy is to reduce its proliferation ability and control its progress. […] Drug therapy can only be carried out when surgery and radiotherapy strategies are no longer available, such as recurrent or progressive meningiomas. […] There are a variety of chemotherapy drugs and molecular targeted drugs for the treatment of non-benign meningiomas, such as alkylating agents, tyrosine kinase inhibitors, endocrine drugs, interferon, targeted molecular pathway inhibitors, etc. […] The most reliable prognostic factors for meningiomas are histological grade (WHO grade) and resection degree (Simpson grade).

• #2 Meningioma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17858-meningioma

  Meningiomas are treatable. […] Treatment for meningiomas is highly individualized and will likely involve a combination of the following therapies: Observation (wait and see), Surgery, Radiation therapy, Palliative care, Chemotherapy (rarely). […] Surgical resection, which is the surgical removal of a tumor, is the primary choice for symptomatic meningiomas or large tumors that are anticipated to cause symptoms soon. […] Radiation therapy is a form of cancer treatment that uses radiation (strong beams of energy) to kill cancer cells or keep them from growing and dividing. […] Radiation therapy is the first-line treatment for meningiomas that can’t be fully removed or when the risk of surgery outweighs the potential benefit. […] Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting you and your family.

• #2 Meningioma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17858-meningioma

  Chemotherapy is one of several cancer treatments that use drugs against various types of cancer. Although the use of chemotherapy is rare in treating meningiomas, healthcare providers generally recommend chemotherapy for people who develop recurrent or progressive meningiomas that no longer respond to surgery or radiation therapy. […] The treatment options for meningiomas come with certain risks and possible complications and side effects. Be sure to ask your healthcare team questions about the risks involved with your treatment plan. […] The five-year survival rates for meningioma are as follows: Grade I tumor: 95.7%, Grade II tumor: 81.8%, Grade III tumor: 46.7%. […] The 10-year survival rates for meningioma are as follows: Grade I tumor: 90%, Grade II tumor: 69%.

• #3 Meningioma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/meningioma/diagnosis-treatment/drc-20355648

  Treatment for a meningioma depends on many factors, including: […] Not everyone with a meningioma needs treatment right away. A small, slow-growing meningioma that isn’t causing symptoms may not need treatment. […] If your healthcare provider finds that the meningioma is growing and needs to be treated, you have several treatment choices. […] If the meningioma causes symptoms or shows signs that it’s growing, your healthcare professional may suggest surgery. […] Surgeons work to remove the entire meningioma. But because a meningioma may be near fragile structures in the brain or spinal cord, it isn’t always possible to remove the entire tumor. Then, surgeons remove as much of the meningioma as they can. […] If no visible tumor remains, then no further treatment may be needed. But you will have follow-up scans from time to time.

• #3 Meningioma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/meningioma/diagnosis-treatment/drc-20355648

  If the tumor is benign and only a small piece remains, then your healthcare professional may suggest follow-up scans only. Some small leftover tumors may be treated with a form of radiation treatment called stereotactic radiosurgery. […] If the tumor is irregular or cancer, you’ll likely need radiation. […] If the entire meningioma can’t be removed surgically, your healthcare professional may suggest radiation therapy after or instead of surgery. […] The goal of radiation therapy is to destroy any meningioma cells that are left and reduce the chance that the meningioma may come back. […] Medicine therapy, also called chemotherapy, rarely is used to treat meningiomas. But it may be used when the meningioma doesn’t respond to surgery and radiation.

• #4 EANO guideline on the diagnosis and management of meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8563316/

  Meningiomas are the most common intracranial tumors. […] However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic approach to meningioma. […] A surgical intervention with tissue, commonly with the goal of gross total resection, is required for the definitive diagnosis according to the WHO classification. […] A gross total surgical resection including the involved dura is often curative. […] Inoperable or recurrent tumors requiring treatment can be treated with radiosurgery, if the size or the vicinity of critical structures allows that, or with fractionated radiotherapy (RT). […] Treatment concepts combining surgery and radiosurgery or fractionated RT are increasingly used, although there remain controversies regard timing, type, and dosing of the various RT approaches.

• #4 EANO guideline on the diagnosis and management of meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8563316/

  The best albeit modest results with pharmacotherapy have been obtained with bevacizumab or multikinase inhibitors targeting vascular endothelial growth factor receptor, but no standard of care systemic treatment has been yet defined. […] Observation is the first option in incidental, asymptomatic, suspected meningiomas. […] Surgical resection is the first option for growing or symptomatic tumors. […] Radiosurgery or fractionated radiotherapy may be complementary therapies or even alternative approaches to surgery in certain situations. […] Molecular diagnostics are developing rapidly. Tissue asservation for molecular diagnostics and future targeted therapies is highly recommended. […] The primary treatment for the majority of symptomatic or enlarging meningiomas is surgery. […] The fundamental principles of meningioma surgery are maximum safe resection with low morbidity and preservation of neurological function.

• #4 EANO guideline on the diagnosis and management of meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8563316/

  When gross total resection is not possible, a planned subtotal resection should be undertaken to preserve neurological function. […] Successful surgery achieves 2 goalsrelief of neurological symptoms and mass effect and provision of tissue for diagnosis. […] SRS has been established as an alternative therapy to surgery in well-defined cases with small tumors in elderly or critically sick patients. […] Fractionated external beam RT remains an important component in the therapeutic armamentarium for the management of meningiomas. […] The role of pharmacotherapy in meningioma remains ill-defined and there are no positive controlled clinical trials to base sound recommendations on. […] A variety of drugs including hydroxyurea, cyclophosphamide/adriamycin/vincristine chemotherapy, interferon-alpha, megestrol acetate, medroxyprogesterone acetate, octreotide, Sandostatin LAR, pasireotide LAR, imatinib, erlotinib, gefitinib, vatalanib, sunitinib, and bevacizumab have been evaluated in retrospective studies and small prospective studies in patients with WHO grade 2 and 3 meningiomas.

• #4 EANO guideline on the diagnosis and management of meningiomas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8563316/

  The most promising results have been reported for anti-angiogenic compounds including bevacizumab, vatalanib, and sunitinib. […] Treatment of WHO grade 1 meningiomas should be stratified by the major prognostic factors and clinical constellations summarized above. […] Therapy is indicated in symptomatic or growing meningiomas with surgery being the first option for the following reasons: the patient can often be cured by Simpson grade I resection, neurological and cognitive symptoms and signs may be reversed, tissue-based diagnosis can be made, tissue is gained for molecular pathologic testing. […] Conversely, possible short- and long-term effects of surgery on cognition and HRQoL should be considered. […] In WHO grade 1 tumors, there are only data for recurrent, high-risk meningiomas to support this recommendation. […] For follow-up, annual MRI in suspected meningiomas or after treatment is recommended for 5 years.

• #5 Meningioma | Brain Tumor Center | Stanford Medicine

  https://med.stanford.edu/brain-tumor/conditions/meningioma.html

  Surgery, with or without subsequent radiation therapy, is the preferred treatment. […] At Stanford Brain Tumor Center, our team of doctors and specialists create an individualized treatment plan, which may include active surveillance, minimally invasive surgery, radiation therapy, or a combination of surgery and radiation therapy. […] Because meningiomas are generally benign tumors, the goal of treatment is to allow for patients to maintain their quality of life in addition to resection or radiation in situations where the tumors need to be treated. Physicians consider the patients symptoms, age, and overall health together with the tumor location, size, and appearance on imaging when recommending the preferred treatment option. […] If the meningioma appears benign and is small, slow growing, and not causing symptoms, observation with periodic physical examinations and brain imaging may be sufficient.

• #5 Meningioma | Brain Tumor Center | Stanford Medicine

  https://med.stanford.edu/brain-tumor/conditions/meningioma.html

  Surgical resection is the complete or partial removal of the meningioma. The goal is maximal safe resection: to remove as much of the tumor as possible while minimizing injury to nearby structures. […] Surgical resection is typically planned if the patient has symptoms. […] Radiation therapy directs high doses of radiation at the meningioma and damages the DNA of the tumor cells. […] Surgical resection is the preferred treatment for meningioma, but surgery is not always safe. […] Sometimes radiation therapy is administered after surgery, called adjuvant radiation therapy. […] When radiation therapy is planned, the neurosurgeon and radiation oncologist, together with other specialists, carefully select the radiation field, the total radiation dose, the timing of treatment, and the delivery method. […] Innovative Treatments and Clinical Trials […] Current research is actively looking at some new ways to treat cancer, including: Immunotherapy, Targeted therapy, Peptide receptor radionuclide therapy.

• #5

• #6 Meningioma | Brain and spinal cord tumours | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/brain-tumours/types/meningioma

  Your treatment depends on whether the meningioma is low grade (slow growing) or high grade (fast growing). It also depends on where the tumour is. […] For a low grade meningioma, your doctor might monitor you with regular MRI scans. This is called active monitoring. You then have treatment if there are signs that the tumour is growing. […] A highly specialised doctor (neurosurgeon) removes as much of the tumour as possible. Sometimes this is the only treatment you need. The exact type of surgery you have depends on where the tumour is. […] It isnt always possible to completely remove the tumour during the operation. Especially if the tumour is growing around important nerves or blood vessels. You might have more surgery if doctors couldn’t remove all of the tumour. Or your doctor might suggest that you have radiotherapy.

• #6 Meningioma | Brain and spinal cord tumours | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/brain-tumours/types/meningioma

  For a grade 1 meningioma, you might have an MRI scan every year, for up to 5 years. You then have an MRI scan every 2 years. […] For a grade 2 meningioma, you might have an MRI scan every 6 to 12 months. After 5 years, you have an MRI scan every 2 years. […] For a grade 3 meningioma, you might have an MRI scan every 3 to 6 months. After 2 years, you have an MRI scan every 6 to 12 months. […] As part of your treatment, your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or look at different combinations of existing treatments.

• #6 Meningioma | Brain and spinal cord tumours | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/brain-tumours/types/meningioma

  Radiotherapy uses high energy x-rays to kill tumour cells. You might have radiotherapy: to reduce the risk of the meningioma coming back, especially if the tumour is fast growing; if the tumour is in an area that is too difficult to operate (for example, the base of the skull); if you can’t have surgery for any reason; if the meningioma comes back. […] You may have a type of radiotherapy called stereotactic radiotherapy. It targets high doses of radiotherapy to the tumour. Doctors sometimes call this stereotactic radiosurgery, although it isn’t a type of surgery. […] You have regular appointments with your doctor or nurse after treatment finishes. Your doctor examines you at each appointment. They ask how you are feeling, whether you have had any symptoms or side effects, and if you are worried about anything. You also have MRI scans on some visits.

• #7 Patient education: Meningioma (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/meningioma-beyond-the-basics

  Radiation therapy is often recommended after surgery if there is a high risk of tumor recurrence or if surgery is not possible. […] For some small tumors, radiation therapy alone can be given, instead of surgery. […] Active surveillance may also be recommended for people who are older (who have a higher risk of treatment-related side effects) or those who have other serious medical problems. […] If a meningioma grows back after treatment, it may be possible to have more surgery or radiation treatment.

• #8 Get Meningioma Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/meningioma-treatment

  Most people with meningiomas will have surgery to remove the tumor (surgical resection). This is particularly true if your meningioma causes symptoms or is expected to start causing them. Our goal is to remove as much of the tumor as possible, if not all of it, as safely as possible. […] We may recommend radiation therapy for meningiomas that are too deep or large to safely remove with surgery. We offer external beam radiation therapy and stereotactic radiosurgery (SRS), including Gamma Knife surgery. […] Gamma Knife radiosurgery is a painless, minimally invasive procedure that doesn’t require any incisions or even a hospital stay. During a one- to two-hour treatment, we deliver powerful doses of radiation to the tumor from multiple angles. This radiation targets your tumors exact shape, reducing damage to nearby tissues. After treatment, you can return to your normal activities quickly, with minimal downtime.

• #9 Meningioma: Diagnosis and Treatment – NCI

  https://www.cancer.gov/rare-brain-spine-tumor/tumors/meningioma

  The first treatment for a malignant meningioma is surgery, if possible. The goal of surgery is to obtain tissue to determine the tumor type and remove as much tumor as possible without causing more symptoms. […] Most people with atypical and anaplastic meningiomas receive additional treatments after surgery. These treatments may include radiation, chemotherapy, or clinical trials. Clinical trials test new chemotherapy, targeted therapy, or immunotherapy drugs. Treatments are decided by the patients health care team based on the patients age, remaining tumor after surgery, tumor type, and tumor location.

• #10 Meningioma Treatment – Treatment of Meningiomas | Mount Sinai – New York

  https://www.mountsinai.org/care/neurosurgery/services/meningiomas/treatments-procedures

  „The vast majority of meningiomas are permanently cured by simple and safe surgical removal,” says Joshua Bederson, MD, Professor and Chair of Neurosurgery at The Mount Sinai Health System in New York City. „In certain cases, when the tumor involves critical structures, we’ll remove 95 to 99 percent of it and observe the rest. If the tumor begins to grow back, radiation can stop its growth.” […] The key to preventing disability from meningioma is early diagnosis and development of a treatment plan. At Mount Sinai, the two primary approaches we use to treat meningiomas are surgery and radiation. […] We may choose to do a surgical removal (resection) of the tumor. If we do so, we use the Simpson Grading system to indicate the level of cure we were able to achieve. The grades are: […] Most of the time, surgery cures the tumor. If you need further treatment, we will use our neuropathologist’s assessment of your tumor to develop a treatment plan. […] We treat some Grade IV menigiomas with surgery, radiation, and occasionally chemotherapy as well.

• #11 Meningioma Brain Tumor – Neurosurgery | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/conditions-treated/meningioma-brain-tumor

  Meningioma Treatment, therapy […] The decision of whether to, and how best to, treat a meningioma is based on multiple factors, including size and location of the tumor, symptoms, growth rate, and age of the patient (among others). In general, there are three basic options: observation, surgical removal, and radiation. […] Meningioma surgery varies from relatively straightforward to highly complex, sometimes requiring multiple surgeons from different specialties. […] The goals of surgery are to: obtain tissue to confirm the diagnosis […] remove sufficient tumor in order relieve pressure or distortion of the normal brain tissue […] preserve and/or improve neurological function […] if possible and safe, remove all the tumor so that it will not grow back. […] For those ineligible for surgery or with incomplete surgical removal, either conventional radiation or fractionated stereotactic radiosurgery (radiotherapy) can slow or stop the growth of meningiomas. […] Stereotactic radiosurgery stops the growth of meningiomas in up to 80 percent of cases.

• #12 Meningioma Treatment Options | Seattle, WA | UW MedicineCalendar

  https://www.uwmedicine.org/specialties/neurosciences-institute/meningioma-treatment

  For patients who are not candidates for radiosurgery, we offer proton beam radiation, an advanced radiation treatment that precisely targets tumors. […] We can also perform brachytherapy, where we place tiny radioactive seeds next to your tumor. […] Our neurosurgeons utilize minimally invasive and endoscopic procedures to remove a tumor from the most difficult locations. […] If we can’t remove the entire tumor, radiation therapy can help destroy what’s left after. […] If your meningioma is cancerous, we also offer personalized targeted therapies and access to clinical trials for novel treatment of aggressive meningiomas. This may include a type of chemotherapy called Avastin® (bevacizumab). […] At UW Medicine, you get a team of specialists — led by one of our neurosurgeons — dedicated to your treatment and recovery. Whether you need radiation therapy, physical therapy or pain management services, several experts will work together to help you get better. […] Because our doctors are also researchers, they can provide access to the latest, evidence-based meningioma treatments.

• #13 Meningioma: Diagnosis, Treatment & Surgery | Pacific Brain Tumor Center

  https://www.pacificneuroscienceinstitute.org/brain-tumor/conditions/meningioma/

  Symptomatic tuberculum sellae or planum sphenoidale meningiomas are typically treated by surgical removal through either a supraorbital eyebrow or an endoscopic endonasal approach. […] The advantage of the endonasal approach over a transcranial approach is that brain retraction is not necessary and manipulation of the optic nerves and chiasm is minimized. […] However, for larger tumors (over 3 cms) or those that extend far off the midline, the supraorbital eyebrow approach is an excellent minimally invasive alternative. […] For invasive parasellar meningiomas that involve the cavernous sinus, Meckels cave, sella and/or petroclival region, endoscopic endonasal tumor debulking and bony decompression is a reasonable treatment option that we often use and often follow with focused stereotactic radiotherapy.

• #14 Radiation therapy for WHO grade I meningioma – Day – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/15325/html

  Maximal safe resection has long been the cornerstone of treatment for WHO grade I benign meningioma. […] However, as technology for both imaging and radiation delivery has advanced, radiation therapy has played an increasingly important role in the management of patients with WHO grade I meningioma. Radiation therapy, whether delivered as standard fractionated treatment over several weeks, stereotactic radiosurgery over 1 session, or multisession stereotactic radiation therapy, has been shown to provide excellent local control when used as an adjunct to surgery or as primary treatment. […] Thus, radiation therapy has long had a role as adjunct therapy after subtotal resection (STR) for recurrence. In addition, radiation therapy has a role in the primary treatment of image defined meningioma especially in surgically inaccessible areas or for candidates who are medically inoperable or do not wish to undergo surgery.

• #14 Radiation therapy for WHO grade I meningioma – Day – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/15325/html

  Multiple treatment techniques including stereotactic radiosurgery (SRS), fractionated external beam radiation therapy, and particle therapy using protons have been used successfully for the treatment of these tumors. […] When possible, a gross total resection (GTR) remains the cornerstone of definitive management of WHO Grade 1 meningioma. […] However, others argue that especially in young patients with tumor locations that are likely to become symptomatic, adjuvant radiation therapy is indicated. […] Multiple observational studies have demonstrated the benefit of fractionated EBRT in the adjuvant setting following STR of benign meningioma. […] Furthermore, certain series suggest that there may be a survival benefit to adjuvant radiation therapy after STR. […] Though most of the early series utilized standard external beam radiation therapy with margins added, more recent series have used improved imaging and targeting capabilities with stereotactic localization to successfully treat skull base tumors with higher precision.

• #15 Meningioma Treatment | Targeting Cancer AU & NZ

  https://www.targetingcancer.com.au/treatment-by-cancer-type/meningioma/

  The best person to talk to about radiation therapy for meningioma is a radiation oncologist. A radiation oncologist is a specialist doctor who is part of the team that takes care of people having radiation therapy. […] The type of treatment a person gets is worked out by a team of doctors and health professionals often called a Multidisciplinary Team. Doctors weigh up the possible benefits with the possible side effects when making a treatment plan. […] Treatments for meningioma include observation, surgery and radiation therapy. […] The aim of surgery is to remove as much of the meningioma as possible. […] In this case, the doctor may suggest radiation therapy after surgery to stop the meningioma from growing back. […] A doctor may recommend radiation therapy instead of surgery if the meningioma is in a high-risk area which makes an operation difficult.

• #16 Meningioma treatment | The Brain Tumour Charity

  https://www.thebraintumourcharity.org/brain-tumour-diagnosis-treatment/types-of-brain-tumour-adult/meningioma/treating-meningioma/

  With multiple meningiomas, there’s also the possibility of stereotactic radiosurgery. […] Active monitoring (also known as watch and wait) is frequently the treatment approach used for grade 1 meningiomas. […] Neurosurgery may be offered after a period of active monitoring or it can be offered straight away after diagnosis. It’s generally offered if the tumour is causing, or likely to cause, problems or symptoms that affect your day-to-day living. This will partly depend on its size and location within the brain. […] Radiotherapy may be used in the following circumstances: if all of your tumour can’t be removed, then radiotherapy may be used after surgery; if the tumour is in part of the brain which means it’s not possible to operate on (known as a non-operable tumour); if your tumour has come back (also known as a recurrent tumour).

• #16 Meningioma treatment | The Brain Tumour Charity

  https://www.thebraintumourcharity.org/brain-tumour-diagnosis-treatment/types-of-brain-tumour-adult/meningioma/treating-meningioma/

  Meningioma treatment can include active monitoring, surgery, radiotherapy, chemotherapy, or a combination of these. But, the type of treatment depends on the grade of tumour, its size, where it is in the brain, and the symptoms of the person affected. […] Your medical team will consider a range of factors about your meningioma when deciding the most appropriate treatment. […] Meningiomas are normally treated according to their grade. But their size, location and the symptoms you’re experiencing will also affect the treatment you’re offered. […] However, treatment for more than one meningioma may be different as the tumours may be of different grades and have different growth rates. If this is the case, some treatments, such as active monitoring may not be suitable. […] Surgeons prefer not to perform repeat surgery, as any surgery carries some risk. But if your tumour comes back or you have more than one tumour, surgery may be considered depending on your general health and the growth rate of your tumours.

• #17 Meningioma | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-primary/types/meningioma

  People with grade I (benign) meningiomas usually have surgery and/or radiotherapy. […] The main goal of treatment is to remove the tumor. If that is not possible or if the tumor is aggressive, our doctors use a combination of radiation and other treatments to slow down or stop the tumors growth. […] Our treatment approaches include: MRI-guided microneurosurgery, stereotactic radiosurgery, image-guided radiation or re-irradiation, proton radiotherapy, brachytherapy, targeted drug therapy and chemotherapy, immunotherapy. […] Sometimes the treatment of recurrent meningiomas includes brachytherapy. This involves placing radioactive sources directly in a tumor. […] Radiation therapy can be used in several ways for meningioma. It may be recommended as additional therapy after surgery to prevent a tumor from growing back, depending on its location and grade.

• #18 Meningioma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1156552-treatment

  Medical care for meningiomas has been disappointing. It is restricted either to perioperative drugs or to medications that are used after all other means of treatment have failed. The use of corticosteroids preoperatively and postoperatively has significantly decreased the mortality and morbidity rates associated with surgical resection. Antiepileptic drugs should be started preoperatively in supratentorial surgery and continued postoperatively for no less than 3 months. The current experience with chemotherapy is disappointing. This modality of treatment is reserved for malignant cases after failure of surgery and radiotherapy to control the disease. The main drugs studied include temozolomide, which had no effect against recurrent meningiomas in a phase 2 study, and hydroxyurea (ribonucleotide reductase inhibitor); RU-486 (synthetic antiprogestin); and interferon-alpha. The last 3 drugs also showed disappointing results. A recently published prospective phase 2 study of irinotecan (CPT-11) also failed to demonstrate any efficacy. The combination of interferon alpha and 5-fluorouracil synergistically reduces meningioma cell proliferation in culture and warrants further investigation. Some studies have shown a possible role of COX-2 inhibitors in the treatment of recurrent meningiomas. The role of targeted chemotherapy to block the tumorogenic pathways of meningiomas at specific sites is being extensively investigated. Molecules to block specific growth factors or enzymes are being developed. Atypical meningioma (WHO grade II) and anaplastic meningioma (WHO grade III) showed increased fatty acid synthase (FAS) expression. FAS inhibitor (cerulein) decreased meningioma cell survival in vitro. Thus, increased FAS expression in human meningiomas represents a novel therapeutic target for the treatment of unresectable or malignant meningiomas. Although most meningiomas grow slowly and have a low mitotic rate, clinical benefit has been reported in many case series with either tumor regression or stasis after radiotherapy; however, these results have not been confirmed in randomized trials. Radiotherapy is mainly used as adjuvant therapy for incompletely resected, high-grade and/or recurrent tumors. It can also be used as primary treatment in some cases (optic nerve meningiomas and some unresectable tumors). In general, the ideal treatment of a benign meningioma is surgical resection if possible. Stereotactic radiosurgery has been shown to provide excellent local tumor control with minimal toxicity. It is mainly used for small (3 cm in diameter) residual or recurrent lesions when surgery is considered to carry a significantly high risk of morbidity. It has been advocated as an effective management strategy for small meningiomas and for meningiomas involving the skull base or the cavernous sinus. It is used primarily to prevent tumor progression. In a recently published series, the long-term follow up after radiosurgery was reported; a tumor control rate of 94% was found after an average of 103 months. Patients who undergo operation for meningiomas should receive regular follow-up with enhanced MRI to check for possible recurrences. Patients who are discharged home with antiepileptic agents should be monitored by a neurologist. Before or after surgery, patients with skull-base meningiomas may have numerous disabilities, such as diplopia, dysphasia, dysphagia, or motor weakness. These problems should be managed with a multidisciplinary approach (eg, occupational therapy, physiotherapy, speech therapy). The constant principles in meningioma resection are the following: If possible, all involved or hyperostotic bone should be removed. The dura involved by the tumor as well as a dural rim that is free from tumor should be resected (duraplasty is performed). Dural tails that are apparent on MRI are best removed, even though some may not be involved with the tumor. Make a provision for harvesting a suitable dural substitute (pericranium or fascia lata). The surgeon also can use commercially available dural substitutes. If feasible, always start by coagulating the arterial feeders to the meningioma. Surgical strategies for managing meningiomas in specific locations are discussed in the sections that follow. It should be noted that there is a significant amount of experience reported regarding surgical resection of meningiomas in their various locations and the goal of avoiding complications during and after these procedures.

• #19 Meningioma Treatment | CyberKnife Center of Miami

  https://www.cyberknifemiami.com/meningioma/

  The success rate for treating brain or spine meningiomas with CyberKnife stereotactic radiosurgery is very high. In fact, about 95 percent of meningiomas stop growing after one treatment or a small series of treatments. […] Treatment options are microsurgery to remove it or radiation therapy like CyberKnife. […] A major advantage to CyberKnife is that its non-invasive and doesn’t require a metal frame be screwed into the patient’s skull to perform treatment like with the Gamma Knife. […] Another advantage of CyberKnife treatment is the ability to deliver treatment in one to five sessions, which makes it possible to more safely treat some meningiomas that are larger or located next to critical structures like the optic nerve. […] The CyberKnife uses highly focused and precisely aimed radiation beams that destroy the tumor while sparing surrounding healthy tissue.

• #20 Systemic treatment of recurrent meningioma – UpToDate

  https://www.uptodate.com/contents/systemic-treatment-of-recurrent-meningioma

  Systemic treatment of recurrent meningioma […] Surgery and/or radiation therapy (RT) constitutes the initial therapeutic approach. Furthermore, surgery and/or RT are able to control disease in some patients with recurrence. […] Despite the appropriate use of surgery and RT for initial management and management of recurrent disease, there is a subset of patients in whom disease cannot be controlled with these approaches. Experience with systemic therapy is limited, and most data are from observational studies. Although a number of agents have been studied, none have an established role in prolonging progression-free or overall survival. […] The available data for systemic therapy are reviewed here.

• #21 Medication for Meningioma | NYU Langone Health

  https://nyulangone.org/conditions/meningioma/treatments/medication-for-meningioma

  Medication is not often used to treat meningioma, but it is an option for people who have atypical or malignant tumors that dont respond well to surgery or radiation therapy. It may also be recommended for people who cant have surgery or radiation therapy due to poor health. […] NYU Langone doctors may encourage people who need medication to enroll in a clinical trial, in which new and experimental therapies are evaluated. You and your doctor can discuss whether a clinical trial is right for you. […] One medication that has shown some promise in people with meningioma is interferon, which is composed of naturally occurring proteins that stimulate the immune system to fight malignant meningioma. Interferon may help reduce blood flow to meningiomas, preventing them from growing. […] Bevacizumab, also known as Avastin, is a monoclonal antibody medication composed of immune system proteins that attack malignant cells. It may also decrease blood flow to meningiomas. […] Hydroxyurea, a medication that slows or stops the growth of cancer cells, may also be effective for some people with meningioma. […] Medications that prevent the hormone progesterone from attaching to meningioma cells may also be promising. Some tumors grow when they are exposed to progesterone.

• #22 Neurosurgeon’s goal: Finding a meningioma treatment that doesn’t require surgery | MUSC Hollings Cancer Center

  https://hollingscancercenter.musc.edu/news/archive/2024/03/26/neurosurgeons-goal-finding-a-meningioma-treatment-that-doesnt-require-surgery

  For that reason, Strickland seeks an immunotherapy treatment that could target meningioma, whether benign or high-grade. […] If we could live in a world where we had targeted therapy for these tumors to empower the immune system so it could recognize the tumor, and we could avoid surgery altogether, thats even better, he said. […] Immunotherapy refers to treatments that shut down or block these signals, unmasking the cancer, or that re-engineer immune cells to boost their effectiveness. […] The main idea is to figure out exactly what methods the brain tumor cells use to avoid detection by our bodys normal immune system and to hopefully develop clinical trials to reverse that, he said. […] Unlike medications for tumors within the brain, which must be engineered so that they can cross the blood-brain barrier, any medications for meningioma wouldnt need to cross this barrier and could be more easily delivered.

• #23 Treating Specific Types of Brain Tumors and Spinal Cord Tumors in Adults | American Cancer Society

  https://www.cancer.org/cancer/types/brain-spinal-cord-tumors-adults/treating/treating-specific-types.html

  Most meningiomas tend to grow slowly, so small tumors that arent causing symptoms can often be watched rather than treated, particularly in the elderly. […] If treatment is needed, these tumors can usually be cured if they can be removed completely with surgery. Radiation therapy may be used along with, or instead of, surgery for tumors that cant be removed completely. […] For meningiomas that are atypical/invasive (grade II) or anaplastic (grade III), which tend to come back after treatment, radiation therapy is typically given after surgery even if all of the visible tumor has been removed. […] For meningiomas that recur after initial treatment, further surgery (if possible) or radiation therapy may be used. If surgery and radiation arent options, drug treatments (such as chemotherapy, targeted drug therapy, immunotherapy, or hormone-like drugs) may be tried, but its not clear how much benefit they offer. […] Meningiomas of the spinal canal are often cured by surgery, as are some ependymomas. If surgery doesnt remove the tumor completely, radiation therapy is often given.

• #24 Meningiomas > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/meningiomas

  As discussed above, Grade 2 and Grade 3 meningiomas require surgery and radiation will often be given afterwards. Once removed, these tumors are evaluated by experienced neuropathologists who determine the diagnosis. The patient and his/her tumor is then discussed at a multidisciplinary tumor board, where doctors meet to determine the best possible treatment plan for each individual patient.

• #25 New insights may improve treatment for meningioma

  https://www.thebraintumourcharity.org/news/research-news/new-insights-may-improve-treatment-for-meningiomas/

  Their key findings were: 1. That the removal of the whole meningioma reduces the likelihood of the tumour growing back. […] 2. These proliferative meningiomas appeared to be resistant to radiotherapy, unlike meningiomas from other molecular groups which may benefit from the addition of radiation after surgery. […] 3. Completely removing the most aggressive proliferative meningiomas during surgery improves overall survival of those facing this diagnosis. […] 4. In addition to complete resection, removal or heat treatment of the edges of the meningioma which are in contact with the dura mater helps to prevent the tumour from growing back as quickly. […] 5. Molecular biomarkers appeared to accurately predict the tumours response to radiotherapy. […] This work builds on previous work from this research group which identified four distinct molecular groups of meningioma.

• #25 New insights may improve treatment for meningioma

  https://www.thebraintumourcharity.org/news/research-news/new-insights-may-improve-treatment-for-meningiomas/

  A tumours response to surgery and radiotherapy varies significantly between people. This is because the biology of each meningioma can be so different. […] This research is so urgently needed to find the best way to treat each person facing this diagnosis. […] The role of molecular biomarkers in being able to accurately predict treatment outcomes has not been fully explored, and this is what we tried to do with our research. […] This research focussed on understanding molecular biomarkers which act as clues about a tumour. They help predict how the tumour is likely to respond to treatment. […] In this study, we set out to analyse whether the biology of the tumour can predict how well a patient would respond to treatment. […] What we found will build on our understanding of the biological underpinnings of disease and take it a step further, to actually help improve patient outcomes.

• #25 New insights may improve treatment for meningioma

  https://www.thebraintumourcharity.org/news/research-news/new-insights-may-improve-treatment-for-meningiomas/

• #26 Novel Advances in Treatment of Meningiomas: Prognostic and Therapeutic Implications

  https://www.mdpi.com/2072-6694/15/18/4521

  The goal of RT is to reduce meningioma’s proliferation and control its progress. […] Stereotactic radiosurgery (SRS) is the precise, single-session delivery of a therapeutically effective radiation dose to a certain target. […] Although surgery remains the primary option, radiotherapy has become a first-line option for some meningiomas, particularly lesions of the cranial base that enclose vascular-nerve structures such as the optic nerve sheath or the cavernous sinus. […] At long-term follow-up, up to 60% of meningiomas can recur after 15 years and exhibit aggressive behavior. […] Due to their limited effectiveness, systemic therapies should be considered once all surgical and radiotherapy possibilities have been excluded and should be planned on an individual basis. […] Hydroxyurea has shown stabilizing activity in only a few cases, but this has not been fully confirmed.

• #26 Novel Advances in Treatment of Meningiomas: Prognostic and Therapeutic Implications

  https://www.mdpi.com/2072-6694/15/18/4521

  Meningiomas are considered benign lesions and are frequently linked to a lower quality of life. Total surgical resection is the gold standard treatment. […] Combination treatments that target several molecular targets are becoming available and show great potential as adjuvant treatment alternatives. […] New classifications of these malignancies and novel therapeutic strategies are now possible thanks to recent developments in genetics, epigenetics, and, specifically, in the identification of specific genetic alterations. […] Although the outcomes to this point have not been very encouraging, different molecular-focused therapies have undoubtedly attracted a great deal of attention. Recent research has shown that microRNAs may have a role in the biology of meningiomas, allowing them to be used in meningioma treatment plans in the future.

• #26 Novel Advances in Treatment of Meningiomas: Prognostic and Therapeutic Implications

  https://www.mdpi.com/2072-6694/15/18/4521

  The possibility of systemic treatment as adjuvant therapy after surgery was also evaluated in a prospective study that enrolled 14 patients with malignant meningioma. […] The recent advances in genetics and epigenetics and, in particular, the identification of specific genetic alterations have expanded our horizons to new classifications of these tumors and new therapeutic approaches. […] Currently, many clinical trials including targeted therapies and antiangiogenic agents are being investigated or under consideration, and the results of these studies could totally change the management and prognosis of these patients.

• #27 Recovery & Support for Meningioma | NYU Langone Health

  https://nyulangone.org/conditions/meningioma/support

  Recovery Support for Meningioma […] After treatment, doctors at NYU Langones Perlmutter Cancer Center develop a follow-up care plan customized to your needs. […] Our oncologists, nurses, psychologists, social workers, and physical and occupational therapists are committed to supporting you during and after treatment. […] The supportive care team at NYU Langones Perlmutter Cancer Center can manage any pain or discomfort associated with meningioma or its treatments. […] Support groups and one-on-one counseling sessions with a psycho-oncologist, a healthcare provider who is trained to address the psychological needs of people with cancer, are available at the Perlmutter Cancer Center. […] Depending on the location of a meningioma and the type of treatment prescribed, some people may have problems thinking or processing information.

• #27 Recovery & Support for Meningioma | NYU Langone Health

  https://nyulangone.org/conditions/meningioma/support

  Meningiomas can affect balance and movement. […] Occupational therapy is also prescribed for people who may need help returning to the activities of daily living, such as dressing, preparing a meal, or running errands. […] Depending on the location of the tumor and the treatments, problems with speech and swallowing may arise. […] Although rare, meningiomas can occur near the optic nerve, which runs from the eye to the brain and enables eyesight. […] Our team of doctors, which includes rehabilitation physicians, neurologists, and neuro-ophthalmologists who specialize in visual problems that occur as a result of brain trauma or a tumor can help people adapt to changes in vision or learn how to compensate for vision loss.

• #28 Physiotherapy for Meningioma

  https://www.manchesterneurophysio.co.uk/adults/conditions-we-treat/oncology/meningioma/physiotherapy-for-meningioma.php

  It is essential that individuals with meningioma receive specialist neurological physiotherapy in order to treat the symptoms and return to a normal active life. Depending on the stage of your condition, physiotherapy treatment may include: Muscle strengthening, Core stability exercises, Muscle and joint mobilizations, Balance exercises, Transfer practice ie. bed to chair or sit to stand, Mobility practice, Provision of walking aids/exercise equipment, Hydrotherapy, Pain and scar tissue management, Advice and education re: fatigue, Practice of functional activities, Reintegration into the community/ work, Carer education. […] All treatment will be focused on specific goals set by the individual during the initial assessment. […] Those who have a loved one who has declined medical treatment may benefit from physiotherapy to keep them comfortable and maintain dignity at the end of life.

• #29 Meningiomas. Causes, symptoms and treatment. Cancer Center Clínica Universidad de Navarra

  https://cancercenter.cun.es/en/all-about-cancer/cancer-types/meningiomas

  „It is recommended that treatment decisions be made within multidisciplinary units, where each specialist can contribute their experience for the benefit of the patient”. […] The initial treatment for meningiomas is surgical removal. Recurrences are possible despite removal, but are very rare when the entire tumour and its base have been removed, and more frequent if some areas cannot be removed. […] As an alternative to surgery, ionising radiation can be considered, either as a single dose (radiosurgery), as conventional fractionated radiotherapy, or as fractionated stereotactic radiotherapy. In general, the radiation treatment option has a lower immediate risk than surgery, and is a good option to stop tumour growth. The problem is that not all tumours are stopped and as the years go by, they may start to grow again. […] Apart from the indication of radiosurgery as an alternative to surgery, there is the option of using it as a combined treatment. In cases of large tumours with areas whose removal poses an additional risk of morbidity, such as skull base implantation areas or cavernous sinus invasions.

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