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Treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The treatment of meningioma is determined by the age of the patient and the accessibility of the tumour.

In some cases, for example in elderly patients and those in whom the tumour is inaccessible and relatively asymptomatic, it may decided, after consultation with the patient, for the tumour to be managed conservatively.

In all other cases, the objective is complete tumour excision. With parasagittal meningiomas, it is important to know whether the sagittal sinus is occluded. Occlusion means that it can be more safely removed since significant post-operative complications are less likely.

  • surgery is generally the mainstay of treatment of meningioma, and gross total resection can be achieved in approximately two-thirds of patients
    • complete excision including the origin may not always be possible - e.g. tumours arising from the skull base - and should be managed with radiotherapy
    • radiation therapy (RT) is typically reserved for tumors that are unresectable, incompletely resected, high-grade, or recurrent after initial resection

Following complete excision, the clinical recurrence rate is 10% at 10 years.

NICE suggest with respect to radiotherapy of meningiomas (3).

Radiotherapy

No radiotherapy

Control of tumour

There is evidence that radiotherapy is effective in the local control of a tumour

Receiving no radiotherapy means the tumour may continue to grow

Risk of developing subsequent symptoms

Controlling the tumour will reduce the risk of developing symptoms from the tumour in the future.

If the tumour grows, it can cause irreversible symptoms such as loss of vision.

Risk of re-treatment

Less risk of needing second surgery compared with no radiotherapy

Higher risk of needing second surgery compared with radiotherapy.

If the tumour has progressed, then the surgery might be more complex.

If the tumour has progressed, then not all radiotherapy techniques may be possible

If the multidisciplinary team thinks that radiotherapy may be appropriate, offer the person the opportunity to discuss the potential benefits and risks with an oncologist (3).

Reference:

  • Mirimanoff RDD, Linggood R, et al. Meningioma: analysis of recurrence and progression following neurosurgical resection. Journal of Neurosurgery. 1985;(62):18-24.
  • WAMWMCARFKF Radiotherapy alone or after subtotal resection for benign skull base meningiomas. Cancer. 2003 Oct 1;98(7):1473-82.
  • NICE (July 20180. Brain tumours (primary) and brain metastases in adults

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