Grade I Meningioma

World Health Organization (WHO) grade I meningiomas are usually curable when resectable. (Refer to the Meningeal tumors section in the Classification section of this summary for more information.)

STANDARD TREATMENT OPTIONS:

1. Surgery.[1]
2. Surgery plus radiation therapy is used in selected cases, such as for patients with known or suspected residual disease or with recurrence after previous surgery.[2,3,4]
3. Radiation therapy for patients with unresectable tumors.[5]

Grade II and III Meningioma and Hemangiopericytoma

The prognoses for patients with WHO grade II meningiomas (i.e., atypical, clear cell, and chordoid), WHO grade III meningiomas (i.e., anaplastic/malignant, rhabdoid, and papillary), and hemangiopericytomas are worse than for patients with low-grade meningiomas because complete resections are less common and the proliferative capacity is greater.[6,7] (Refer to the Meningeal tumors section in the Classification section of this summary for more information.)

STANDARD TREATMENT OPTIONS:

• Surgery plus radiation therapy.

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Patients with brain tumors that are either infrequently curable or unresectable should be considered candidates for clinical trials that evaluate interstitial brachytherapy, radiosensitizers, hyperthermia, or intraoperative radiation therapy in conjunction with external-beam radiation therapy to improve local control of the tumor. Such patients are also candidates for studies that evaluate new drugs and biological response modifiers following radiation therapy.

Information about ongoing clinical trials is available from the NCI Web site.

References:

1. Black PM: Meningiomas. Neurosurgery 32 (4): 643-57, 1993.
2. Wara WM, Sheline GE, Newman H, et al.: Radiation therapy of meningiomas. Am J Roentgenol Radium Ther Nucl Med 123 (3): 453-8, 1975.
3. Barbaro NM, Gutin PH, Wilson CB, et al.: Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 20 (4): 525-8, 1987.
4. Taylor BW Jr, Marcus RB Jr, Friedman WA, et al.: The meningioma controversy: postoperative radiation therapy. Int J Radiat Oncol Biol Phys 15 (2): 299-304, 1988.
5. Debus J, Wuendrich M, Pirzkall A, et al.: High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 19 (15): 3547-53, 2001.
6. Alvarez F, Roda JM, Pérez Romero M, et al.: Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features. Neurosurgery 20 (5): 688-94, 1987.
7. Perry A, Scheithauer BW, Stafford SL, et al.: "Malignancy" in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 85 (9): 2046-56, 1999.