Meningioma interventions: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Meningioma}} | {{Meningioma}} | ||
{{CMG}}; | {{CMG}}; {{AE}} {{IO}} | ||
==Overview== | ==Overview== | ||
Asymptomatic meningiomas found incidentally are usually treated expectantly. In cases with [[Tissue (biology)|tissue]] [[edema]] and [[vascular]] compromise, another approach can be taken. [[Radiation therapy|Radiotherapy]] is pursued depending on the patient factor and location of the [[tumor]]. It can be done after [[surgery]] with little advantage over [[Radiation therapy|radiotherapy]] alone. | |||
==Indications== | |||
===Observation/Expectant Management=== | |||
*In some cases, a meningioma can be found incidentally when doing a work-up for another condition. [[Expectant management]] can be pursued in incidental meningiomas without [[Tissue (biology)|tissue]] [[edema]], [[vascular]] compromise, or those only presenting with [[epileptic seizures]] that are easily controlled with [[Anticonvulsant|anti-epileptic]] medications.<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161 }} </ref> | |||
== | |||
===Radiotherapy=== | ===Radiotherapy=== | ||
*The decision to treat with either surgery or radiotherapy depends on patient factors and the anatomical location of the tumor.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | *The decision to treat with either [[surgery]] or radiotherapy depends on patient factors and the anatomical location of the [[tumor]].<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | ||
* For the treatment of smaller meningiomas, single fraction stereotactic radiosurgery may be used. Fractionated radiotherapy is used for larger volume tumors and/or those in contact with the optic chiasm/nerve.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | * For the treatment of smaller meningiomas, single fraction [[stereotactic radiosurgery]] may be used. Fractionated radiotherapy is used for larger volume [[Tumor|tumors]] and/or those in contact with the [[optic chiasm]]/nerve.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | ||
* It can lead to symptom improvement with about less than 5% of patients presenting with worsened neurological deficit.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | * It can lead to symptom improvement with about less than 5% of patients presenting with worsened neurological deficit.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | ||
* In some cases, subtotal resection (a form of surgery) followed by radiotherapy is done. This provides only little advantage over treatment with radiotherapy alone.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | * In some cases, subtotal resection (a form of surgery) followed by radiotherapy is done. This provides only little advantage over treatment with radiotherapy alone.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | ||
* In situations where complete resection (with low morbidity) can be achieved, and/or to decompress tumors associated with pressure symptoms, surgery is highly appropriate.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | * In situations where complete resection (with low morbidity) can be achieved, and/or to decompress [[Tumor|tumors]] associated with pressure symptoms, surgery is highly appropriate.<ref name="pmid30782319">{{cite journal| author=Smee R, Williams J, Kotevski D, Schneider M| title=Radiotherapy as a means of treating meningiomas. | journal=J Clin Neurosci | year= 2019 | volume= 61 | issue= | pages= 210-218 | pmid=30782319 | doi=10.1016/j.jocn.2018.10.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30782319 }} </ref> | ||
* There could be a 20.5% risk for stroke associated with fractionated radiotherapy, with the average stroke developing about 5.6 years after the treatment.<ref name="pmid30775077">{{cite journal| author=McClelland Iii S, Mitin T, Kubicky CD, Jaboin JJ| title=Long-term stroke risk in meningioma patients treated with conventionally fractionated photon-based radiation therapy. | journal=J Radiosurg SBRT | year= 2019 | volume= 6 | issue= 1 | pages= 77-79 | pmid=30775077 | doi= | pmc=6355449 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30775077 }} </ref> | * There could be a 20.5% risk for [[stroke]] associated with conventionally fractionated radiotherapy (radiation-based), with the average [[stroke]] developing about 5.6 years after the treatment.<ref name="pmid30775077">{{cite journal| author=McClelland Iii S, Mitin T, Kubicky CD, Jaboin JJ| title=Long-term stroke risk in meningioma patients treated with conventionally fractionated photon-based radiation therapy. | journal=J Radiosurg SBRT | year= 2019 | volume= 6 | issue= 1 | pages= 77-79 | pmid=30775077 | doi= | pmc=6355449 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30775077 }} </ref> | ||
* Adjuvant radiotherapy can improve survival in patients that present with atypical meningioma with [[brain]] invasion.<ref name="pmid17766430">{{cite journal| author=Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW| title=Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. | journal=J Neurol Neurosurg Psychiatry | year= 2008 | volume= 79 | issue= 5 | pages= 574-80 | pmid=17766430 | doi=10.1136/jnnp.2007.121582 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17766430 }} </ref> | |||
==References== | ==References== | ||
Latest revision as of 20:03, 29 September 2019
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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]
Overview
Asymptomatic meningiomas found incidentally are usually treated expectantly. In cases with tissue edema and vascular compromise, another approach can be taken. Radiotherapy is pursued depending on the patient factor and location of the tumor. It can be done after surgery with little advantage over radiotherapy alone.
Indications
Observation/Expectant Management
- In some cases, a meningioma can be found incidentally when doing a work-up for another condition. Expectant management can be pursued in incidental meningiomas without tissue edema, vascular compromise, or those only presenting with epileptic seizures that are easily controlled with anti-epileptic medications.[1]
Radiotherapy
- The decision to treat with either surgery or radiotherapy depends on patient factors and the anatomical location of the tumor.[2]
- For the treatment of smaller meningiomas, single fraction stereotactic radiosurgery may be used. Fractionated radiotherapy is used for larger volume tumors and/or those in contact with the optic chiasm/nerve.[2]
- It can lead to symptom improvement with about less than 5% of patients presenting with worsened neurological deficit.[2]
- In some cases, subtotal resection (a form of surgery) followed by radiotherapy is done. This provides only little advantage over treatment with radiotherapy alone.[2]
- In situations where complete resection (with low morbidity) can be achieved, and/or to decompress tumors associated with pressure symptoms, surgery is highly appropriate.[2]
- There could be a 20.5% risk for stroke associated with conventionally fractionated radiotherapy (radiation-based), with the average stroke developing about 5.6 years after the treatment.[3]
- Adjuvant radiotherapy can improve survival in patients that present with atypical meningioma with brain invasion.[4]
References
- ↑ Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I (2019). "Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count". Open Access Maced J Med Sci. 7 (1): 56–64. doi:10.3889/oamjms.2018.503. PMC 6352459. PMID 30740161.
- ↑ 2.0 2.1 2.2 2.3 2.4 Smee R, Williams J, Kotevski D, Schneider M (2019). "Radiotherapy as a means of treating meningiomas". J Clin Neurosci. 61: 210–218. doi:10.1016/j.jocn.2018.10.006. PMID 30782319.
- ↑ McClelland Iii S, Mitin T, Kubicky CD, Jaboin JJ (2019). "Long-term stroke risk in meningioma patients treated with conventionally fractionated photon-based radiation therapy". J Radiosurg SBRT. 6 (1): 77–79. PMC 6355449. PMID 30775077.
- ↑ Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008). "Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features". J Neurol Neurosurg Psychiatry. 79 (5): 574–80. doi:10.1136/jnnp.2007.121582. PMID 17766430.