Meningioma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]
Overview
Patients presenting with asymptomatic meningiomas are usually managed conservatively with the decision to undergo surgery being based on the patient's age, clinical presentation, and location of the tumor. In symptomatic patients, surgery is the definite management method. Though chemotherapy is not necessarily used in the treatment of meningioma, hydroxyurea can be used as an adjuvant therapy after incomplete resection of an atypical meningioma in cases where adjuvant radiotherapy cannot be done. There is no difference in the mean progression-free survival between both therapies.
Medical Therapy
Conservative Management
- In asymptomatic meningiomas, the decision of surgical resection must be weighed against the possibility of conservative management according to the patient's age, clinical presentation, and the anatomical location of the tumor.[1]
- Conservative management with observation and close imaging follow-up is recommended among certain patients with small sized asymptomatic meningioma.
- Meningiomas are more likely to grow in size on repeated imaging studies among patients younger than 60 years of age; thus conservative management is not recommended in these patients.
- Conservative management is not recommended among symptomatic meningioma patients.
Chemotherapy
- Hydroxyurea chemotherapy may be used as an adjuvant therapy after incomplete resection of an atypical meningioma in cases where adjuvant radiotherapy cannot be applicable. Both have equal mean progression-free survival (PFS) after surgery, and it has been studied that both are associated with longer mean progression-free survival (PFS) than conservative therapy after surgery.[2]
- The therapy may be given every 28 days for 4 weeks at 1,000 mg/m2/day divided twice per day.[2]
- Some of the side effects associated with the use of hydroxyurea are anemia, thrombocytopenia, neutropenia, nausea/vomiting, mucositis, diarrhea/constipation, and renal toxicity.[2]
References
- ↑ Herscovici Z, Rappaport Z, Sulkes J, Danaila L, Rubin G (2004). "Natural history of conservatively treated meningiomas". Neurology. 63 (6): 1133–4. PMID 15452322.
- ↑ 2.0 2.1 2.2 Kim J, Kim KH, Kim YZ (2017). "The Clinical Outcome of Hydroxyurea Chemotherapy after Incomplete Resection of Atypical Meningiomas". Brain Tumor Res Treat. 5 (2): 77–86. doi:10.14791/btrt.2017.5.2.77. PMC 5700031. PMID 29188208.