Key Points in the Management of Meningioma
- Not all meningiomas require treatment, and a subset may be managed by active surveillance.
- Three World Health Organization (WHO) grades have been defined, and treatment is in part dependent on the pathologic grade.
- Treatment, when indicated, entails maximal safe surgical resection, which, if completed in WHO grade I (benign meningioma) and grade II (atypical meningioma) tumors, is sufficient upfront treatment. By contrast, in WHO grade III tumors (anaplastic meningioma), fractionated radiotherapy is administered regardless of the degree of resection. Surgically inaccessible meningiomas are most commonly treated with stereotactic radiotherapy as initial therapy.
- Recurrent meningioma may be treated with repeat surgery if this is possible and is likely to be of clinical benefit; post-surgery radiotherapy may be administered if residual disease remains. Stereotactic radiotherapy as a single-modality therapy remains the most common salvage therapy for recurrent meningioma.
- In patients with no further surgery or radiotherapy treatment options, systemic therapy may be used, although data regarding benefit from such therapy are meager. Three agents are commonly employed, most often sequentially, including Î±-interferon, somatostatin receptor agonists (octreotide long-acting release depot), and vascular endothelial growth factor (VEGF) signaling pathway inhibitors (bevacizumab and sunitinib). There remains a significant unmet need for new systemic therapies for the treatment of meningioma.