Anaplastic meningioma: octreotide therapy for a case of recurrent and progressive intracranial disease

Abstract

11 The majority of Grade I meningiomas behave in an indolent manner and can be completely removed by resective surgery, or their growth can be controlled by radiation therapy. A small percentage of meningiomas are Grades II and III, which have variable growth patterns and are likely to recur after initial treatment. Grade III meningiomas are considered to be anaplastic (malignant) and warrant aggressive management. Unfortunately, there are limited treatment options beyond surgery and radiation for patients with Grades II and III meningiomas. In many patients the Grade II meningioma will gradually convert to Grade III. Initial treatment(s) will fail in most patients with Grade III meningiomas, and they will ultimately succumb to recurrent and progressive tumor. In this report, we present an encouraging case of a patient who-after 5 intracranial surgeries and 3 stereotactic radiation treatments for malignant meningioma-has had stable disease for 3.5 years following the initiation of octreotide therapy. We also review the current treatment options for recurrent malignant meningioma. case report History and ExaminationIn 1994, a 35-year-old woman presented with worsening seizures and was found to have a right frontal mass, which was embolized and subsequently resected. Histological examination demonstrated a proliferation of relatively uniform, bland meningothelial cells that were frequently arranged as the characteristic whorls ( Fig. 1). At most, we identified 2 mitoses per 10 hpf (magnification ×400). A thin rim of brain tissue was present and did not show invasion by the meningioma. Per the 2007 WHO Classification of Tumours of the Central Nervous System guidelines, 11 this tumor was consistent with the diagnosis of a Grade I meningioma. In 1998, the patient experienced a small recurrence that was treated by Gamma Knife radiosurgery with 16 Gy to the 90% isodose line. Subsequent progression at the treated site led to additional radiosurgery in 2002 (16 Gy to the 15% isodense line) and 2004 (15 Gy to the 40% isodense line).In 2008, the tumor continued to progress and was noted primarily on the right side of the falx and extending slightly across the midline, occluding the sagittal sinus ( Fig. 2A). The next intervention was embolization followed by resection leading to minimal residual tumor at the posterior aspect of the involved sagittal sinus (Fig. 2B). Histological examination revealed an atypical meningioma (WHO Grade II; Fig. 2C) with marked cytological atypia, up to 6 mitoses per 10 hpf, and a Ki 67 labeling index of approximately 30% in the most active areas. Repeat MRI 2 months postoperatively demonstrated an increased size of the residual tumor. Stereotactic radiation was recomabbreviatioNs PBS = phosphate-buffered saline; SST = somatostatin receptor. submitted October 1, 2014. accepted January 28, 2015. iNclude wheN citiNg Published online August 14, 2015; DOI: 10.3171/2015.1.JNS142260. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the ...

Octreotide therapy in meningiomas: in vitro study, clinical correlation, and literature review

“…Although the antitumoral effect of octreotide has been described in isolated cases of meningiomas, 18,21,38,40 only 4 clinical studies have aimed to assess this question (Table 2). 10,23,42,45 Three trials were performed on patients with aggressive and recurrent meningiomas, while 1 trial was conducted on patients with WHO Grade I skull base meningiomas who had not received prior radiotherapy or chemotherapy.…”

“…Some clinical studies have analyzed octreotide efficacy in patients with meningioma, yet their conclusions remain disputed and are sometimes undefined. 10,17,18,21,23,38,40,42,45 Moreover, the results of octreotide treatment in meningioma cells in vitro have been contradictory. 4,26 Therefore, should we reject octreotide for meningioma therapy?…”

MR‐guided laser interstitial thermal therapy in the treatment of recurrent intracranial meningiomas

“…Resection may not be possible in a small subset of patients—those with significant comorbidities or meningiomas located in the skull base and/or abutting venous sinuses . For these, radiation therapy in the form of stereotactic radiosurgery (SRS) is preferred.…”

Emerging Medical Treatments for Meningioma in the Molecular Era

“…Nevertheless, larger randomized studies should be performed to make solid conclusion [ 144 , 145 ]. A recent study reported an antitumor effect of octreotide on a progressive meningioma grade II from grade I after surgery and radiotherapy which stayed in remission for over three years while being treated with octreotide [ 153 ].…”