Advances in multidisciplinary therapy for meningiomas

Abstract

Surgery has long been established as the first-line treatment for the majority of symptomatic and enlarging meningiomas, and evidence for its success is derived from retrospective case series. Despite surgical resection, a subset of meningiomas display aggressive behavior with early recurrences that are difficult to treat. The decision to radically resect meningiomas and involved structures is balanced against the risk for neurological injury in patients. Radiation therapy has largely been used as a complementary and safe therapeutic strategy in meningiomas with evidence primarily stemming from retrospective, single-institution reports. Two of the first cooperative group studies (RTOG 0539 and EORTC 22042) evaluating the outcomes of adjuvant radiation therapy in higher-risk meningiomas have shown promising preliminary results. Historically, systemic therapy has resulted in disappointing results in meningiomas. However, several clinical trials are under way evaluating the efficacy of chemotherapies, such as trabectedin, and novel molecular agents targeting Smoothened, AKT1, and focal adhesion kinase in patients with recurrent meningiomas.

Meningioma: A Review of Clinicopathological and Molecular Aspects

“…Simple decompression with or without biopsy 0-5 mm (115,116). For more advanced, WHO grade II-III meningiomas, treatment is typically 59.4-60 Gy with a wider 10-20 mm gross tumor volume (GTC) to CTV anisotropic expansion while respecting anatomic barriers to tumor growth (116). For smaller tumors with a diameter of less than 3-4 cm and at least 2-mm separation from critical normal structures (such as optic nerves), single fraction SRS is a feasible option.…”

“…For smaller tumors with a diameter of less than 3-4 cm and at least 2-mm separation from critical normal structures (such as optic nerves), single fraction SRS is a feasible option. EBRT has been utilized for some tumor locations in which a GTR may cause significant morbidity to the patient (116). For example, one series of patients with optic nerve sheath meningiomas had~25% of patients treated with EBRT alone and they showed no failures and improved or stable vision in 86% at a median of 8.3 years of follow-up (117).…”

“…Studies of particle therapy are limited, although there are phase I and phase II trials underway to look at the role of proton radiation in a variety of settings with meningiomas [UPCC 24309 (NCT01117844)] (119). As well as a combined phase I/II study (NCT02693990) is investigating proton therapy with dose escalation for atypical meningiomas that underwent STR and anaplastic meningiomas following surgical resection (116). Brachytherapy is infrequently used, with the largest cohort being 42 patients receiving I-125 permanent seed implant during resection of atypical or malignant meningiomas.…”

A Rapid Robust Method for Subgrouping Non-NF2 Meningiomas According to Genotype and Detection of Lower Levels of M2 Macrophages in AKT1 E17K Mutated Tumours

“…Combining recent genetic findings, including DNA methylation data [3], could lead to a potential molecular classification that will be better at predicting patient outcomes [4,5]. Surgical resection with adjuvant radiotherapy in grade II and III tumours (higher-grade meningiomas) remains the primary treatment option, with no clinically efficacious drug treatment for the management of meningiomas currently known [6].…”

Features of tumor texture influence surgery and outcome in intracranial meningioma

“… 1 However, in many cases this is not feasible and while radiation therapy is of limited value, there are currently no meaningful chemotherapeutic options. 2 …”