Meningiomas: Overview and New Directions in Therapy

Abstract

The majority of meningiomas, the most common primary brain tumor, are considered to be benign, and characteristic magnetic resonance imaging features allow a preliminary diagnosis. Meningiomas can be classified in the World Health Organization system as grade I, II, or III, depending on various histological features. In many cases, observation is the preferred management option, although this means the absence of a histological diagnosis. If necessary, standard therapy consists of surgery with or without adjuvant radiation, depending on the tumor grade and the degree of resection. To date, systemic therapies are not included in the standard of care. The level of evidence for treatment recommendations is low, and effective treatment regimens, especially for surgery-refractory and radiation-refractory meningiomas, are still very limited. Recent studies have broadened our knowledge of the genetics and pathogenesis of meningiomas and will lead to new therapeutic options. This review summarizes the epidemiology, pathogenesis and genetics, classification, and diagnosis of meningiomas, as well as management principles, including promising new avenues of therapy.

Characterization of Progesterone Receptor Expression in Intracranial Meningiomas of Patients Treated in a High-Complexity Hospital in Bogota, Colombia

“…Since the early 1980s, the association of sex hormone receptors with meningiomas has been the subject of numerous studies [1,[15][16]. The higher incidence of these neoplasms in women than in men, the relapse and remission of symptoms during pregnancy, and the epidemiological link described between meningiomas and breast carcinomas have led to the assumption that the hormonal environment might influence the growth of these tumors [5][6]13,[17][18][19].…”

“…Several studies have focused on the presence or absence of the PR and the estrogen receptor (ER) in meningiomas; therefore, it has been documented that these types of tumors often contain steroid hormone receptors [17,[19][20]. Nonetheless, the correlation between the receptor presence and the mitotic index with the patient prognosis continues to be studied [1,[6][7]15].…”

“…Meningiomas are the single most common brain tumor, comprising approximately 36.5% of all primary brain tumors [1][2]. These tumors form and grow from the arachnoid cap cells found at the arachnoid villi and can be found anywhere in the skull vault, skull base, or spinal canal [3].…”

“…In addition to surgery, other treatments include radiotherapy, hormonal therapy, and chemotherapy, any of which can be applied to the patient depending on their particular conditions at the clinical assessment time [3]. To identify the safest and most effective treatment options for each patient, an analysis of possible pre-, intra-, and postoperative complications that can arise is performed [1,3,12].…”

Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib

“…Patients with a recurrence will likely face further surgical resections, however this option is limited to those with tumors which can be surgically removed. For patients in whom surgery and radiotherapy are no longer a viable option, the current recommendation is to initiate systemic therapy, however systemic therapy is still lacking robust evidence in order to support the use of specific agents, as well as questions involving lines of treatment, treatment sequencing, targeted agents and assessment of clinical and radiological outcomes [8].…”