Abstract
Meningiomas are tumors that originate from arachnoidal cells of the leptomeninges. With an incidence of approximately 7 per 100,000, they are the most common tumors of the central nervous system. Meningiomas are classified into three groups. The vast majority are benign grade I tumors. More aggressive grade II and III tumors are rare and characterized by higher recurrence rates and an infiltrating growth pattern. Since meningiomas are typically slow growing tumors, they can remain asymptomatic for long periods of time. Possible symptoms include headaches, seizures, nausea, personality changes, and paresis. Contrast-enhanced MRI is the gold standard in meningioma imaging. CT scans and DOTATOC-PET can provide additional information. The treatment options for patients with meningioma include surgery, radiotherapy, or observation depending on symptoms, size of the tumor, the patient’s comorbidities, and preferences. An interdisciplinary approach for treatment planning is recommended. Small, asymptomatic tumors can be managed by observation. Resection is usually the preferred treatment in symptomatic and large meningioma. Even though gross total resection (GTR) is aimed for, the tumor location may impede aggressive surgery. Radiotherapy is an alternative to surgery if preferred by the patient or in patients with contraindications against surgery. Adjuvant or additive radiotherapy should be performed depending on the tumor grading and the resection status.
While grade I meningioma has a favorable prognosis, grade II and, even more so, grade III meningioma experience high recurrence rates. Therefore, adjuvant radiotherapy is indicated in grade III meningioma, in subtotally resected grade II tumors, and in recurrent grade I tumors.
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Scharl, S., Combs, S.E. (2019). Radiation Therapy in Meningiomas. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_1-1
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DOI: https://doi.org/10.1007/978-3-319-52619-5_1-1
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