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Progress in Brain Research 2022Meningiomas arise in various locations. Convexity tumors are relatively simple to remove. Skull base tumors and tumors adjacent to the major cerebral veins and venous...
Meningiomas arise in various locations. Convexity tumors are relatively simple to remove. Skull base tumors and tumors adjacent to the major cerebral veins and venous sinuses can be very difficult to extirpate. Attempts at radical resection can lead to serious morbidity. The combination of bulk reduction using microsurgery followed by GKNS gives greatly improved survival and very low morbidity. With smaller tumors, GKNS may be used as the primary treatment. Increasing numbers of asymptomatic meningiomas are demonstrated either as an unexpected finding or as a residual or recurrent tumor after surgery. In all of these situations, GKNS gives a better result than observation or reoperation.
Topics: Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Skull Base Neoplasms; Treatment Outcome
PubMed: 35074079
DOI: 10.1016/bs.pbr.2021.10.031 -
Advances in Experimental Medicine and... 2023Meningiomas are the most common primary intracranial brain tumor, and have a heterogeneous biology and an unmet need for targeted treatment options. Existing treatments... (Review)
Review
Meningiomas are the most common primary intracranial brain tumor, and have a heterogeneous biology and an unmet need for targeted treatment options. Existing treatments for meningiomas are limited to surgery, radiotherapy, or a combination of these depending on clinical and histopathological features. Treatment recommendations for meningioma patients take into consideration radiologic features, tumor size and location, and medical comorbidities, all of which may influence the ability to undergo complete resection. Ultimately, outcomes for meningioma patients are dictated by extent of resection and histopathologic factors, such as World Health Organization (WHO) grade and proliferation index. Radiotherapy is a critical component of meningioma treatment as either a definitive intervention using stereotactic radiosurgery or external beam radiotherapy, or in the adjuvant setting for residual disease or for adverse pathologic factors, such as high WHO grade. In this chapter, we provide a comprehensive review of radiotherapy treatment modalities, therapeutic considerations, radiation planning, and clinical outcomes for meningioma patients.
Topics: Humans; Meningioma; Radiosurgery; Adjuvants, Immunologic; Neoplasm, Residual; Meningeal Neoplasms
PubMed: 37432622
DOI: 10.1007/978-3-031-29750-2_8 -
Handbook of Clinical Neurology 2020Radiation-induced meningiomas (RIMs) became more common as the use of ionizing radiation was adopted in the treatment of medical conditions, both benign and malignant....
Radiation-induced meningiomas (RIMs) became more common as the use of ionizing radiation was adopted in the treatment of medical conditions, both benign and malignant. Currently, RIMs represent the most common radiation-induced tumors. They are heterogeneous in terms of patient characteristics, radiographic appearance, genetics, pathology, symptoms, and management strategies. They tend to occur in a younger population and are generally more aggressive in nature than their spontaneous counterparts. Their characteristics also vary based on the dose of radiation received, which is most commonly separated into low dose (<10Gy) and high dose (>10Gy). The importance of the dosing classification is that it can provide insight into the nature and biologic behavior of the tumor. Given their heterogeneity, RIMs pose significant challenges in management. While surgical resection remains the preferred treatment when feasible, recent data supports stereotactic radiosurgery (SRS) as a comparable alternative. Although there is more knowledge about the molecular pathways leading to RIMs, targeted drug therapy is still limited and is the focus of current research.
Topics: Adult; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasms, Radiation-Induced; Radiosurgery; Treatment Outcome
PubMed: 32553295
DOI: 10.1016/B978-0-12-804280-9.00018-4 -
Neurosurgery Clinics of North America Jul 2023Meningiomas are the most common intracranial brain tumor. Spheno-orbital meningiomas are a rare subtype that originate at the sphenoid wing and characteristically extend... (Review)
Review
Meningiomas are the most common intracranial brain tumor. Spheno-orbital meningiomas are a rare subtype that originate at the sphenoid wing and characteristically extend to the orbit and surrounding neurovascular structures via bony hyperostosis and soft tissue invasion. This review summarizes early characterizations of spheno-orbital meningiomas, presently understood tumor characteristics, and current management strategies.
Topics: Humans; Meningioma; Treatment Outcome; Sphenoid Bone; Neoplasm Recurrence, Local; Brain Neoplasms; Meningeal Neoplasms
PubMed: 37210130
DOI: 10.1016/j.nec.2023.02.006 -
Journal of Neuro-oncology Nov 2022Meningiomas are the most common primary central nervous system neoplasm. Despite promising recent progress in elucidating the genomic landscape and underlying biology of... (Review)
Review
Meningiomas are the most common primary central nervous system neoplasm. Despite promising recent progress in elucidating the genomic landscape and underlying biology of these histologically, molecularly, and clinically diverse tumors, the mainstays of meningioma treatment remain maximal safe resection and radiation therapy. The aim of this review of meningioma radiotherapy is to provide a concise summary of the history, current evidence, and future for application of radiotherapy in meningioma treatment.
Topics: Humans; Meningioma; Meningeal Neoplasms; Radiotherapy, Adjuvant
PubMed: 36315366
DOI: 10.1007/s11060-022-04171-9 -
Nature Medicine Dec 2023Surgery is the mainstay of treatment for meningioma, the most common primary intracranial tumor, but improvements in meningioma risk stratification are needed and...
Surgery is the mainstay of treatment for meningioma, the most common primary intracranial tumor, but improvements in meningioma risk stratification are needed and indications for postoperative radiotherapy are controversial. Here we develop a targeted gene expression biomarker that predicts meningioma outcomes and radiotherapy responses. Using a discovery cohort of 173 meningiomas, we developed a 34-gene expression risk score and performed clinical and analytical validation of this biomarker on independent meningiomas from 12 institutions across 3 continents (N = 1,856), including 103 meningiomas from a prospective clinical trial. The gene expression biomarker improved discrimination of outcomes compared with all other systems tested (N = 9) in the clinical validation cohort for local recurrence (5-year area under the curve (AUC) 0.81) and overall survival (5-year AUC 0.80). The increase in AUC compared with the standard of care, World Health Organization 2021 grade, was 0.11 for local recurrence (95% confidence interval 0.07 to 0.17, P < 0.001). The gene expression biomarker identified meningiomas benefiting from postoperative radiotherapy (hazard ratio 0.54, 95% confidence interval 0.37 to 0.78, P = 0.0001) and suggested postoperative management could be refined for 29.8% of patients. In sum, our results identify a targeted gene expression biomarker that improves discrimination of meningioma outcomes, including prediction of postoperative radiotherapy responses.
Topics: Humans; Biomarkers; Gene Expression Profiling; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Prospective Studies
PubMed: 37944590
DOI: 10.1038/s41591-023-02586-z -
Revue Neurologique Jun 2023Multi-recurrent high-grade meningiomas remain an unmet medical need in neuro-oncology when iterative surgeries and radiation therapy sessions fail to control tumor... (Review)
Review
Multi-recurrent high-grade meningiomas remain an unmet medical need in neuro-oncology when iterative surgeries and radiation therapy sessions fail to control tumor growth. Nevertheless, the last 10years have been marked by multiple advances in the comprehension of meningioma tumorigenesis via the discovery of new driver mutations, the identification of activated intracellular signaling pathways, and DNA methylation analyses, providing multiple potential therapeutic targets. Today, Anti-VEGF and mTOR inhibitors are the most used and probably the most active drugs in aggressive meningiomas. Peptide radioactive radiation therapy aims to target SSTR2A receptors, which are strongly expressed in meningiomas, but have an insufficient effect in most aggressive meningiomas, requiring the development of new techniques to increase the dose applied to the tumor. Based on the multiple potential intracellular targets, multiple targeted therapy clinical trials targeting Pi3K-Akt-mTOR and MAP kinase pathways as well as cell cycle and particularly, cyclin D4-6 are ongoing. Recently discovered driver mutations, SMO, Akt, and PI3KCA, offer new targets but are mostly observed in benign meningiomas, limiting their clinical relevance mainly to rare aggressive skull base meningiomas. Therefore, NF2 mutation remains the most frequent mutation and main challenging target in high-grade meningioma. Recently, inhibitors of focal adhesion kinase (FAK), which is involved in tumor cell adhesion, were tested in a phase 2 clinical trial with interesting but insufficient activity. The Hippo pathway was demonstrated to interact with NF2/Merlin and could be a promising target in NF2-mutated meningiomas with ongoing multiple preclinical studies and a phase 1 clinical trial. Recent advances in immune landscape comprehension led to the proposal of the use of immunotherapy in meningiomas. Except in rare cases of MSH2/6 mutation or high tumor mass burden, the activity of PD-1 inhibitors remains limited; however, its combination with various radiation therapy modalities is particularly promising. On the whole, therapeutic management of high-grade meningiomas is still challenging even with multiple promising therapeutic targets and innovations.
Topics: Humans; Meningioma; Meningeal Neoplasms; Proto-Oncogene Proteins c-akt; Phosphatidylinositol 3-Kinases; Neoplasm Recurrence, Local; Mutation
PubMed: 36959063
DOI: 10.1016/j.neurol.2023.03.006 -
Der Radiologe Mar 2021Spinal tumors are often classified into three anatomical compartments on the basis of their relationship to the dural space and myelon. The most common primary spinal... (Review)
Review
Spinal tumors are often classified into three anatomical compartments on the basis of their relationship to the dural space and myelon. The most common primary spinal neoplasms are glial tumors (ependymoma, astrocytoma), nerve sheath tumors (schwannoma, neurofibroma) and meningioma. Metastases represent another common tumor entity and can occur in every spinal compartment. Magnetic resonance imaging (MRI) is the most important noninvasive method for spinal tumor imaging.
Topics: Ependymoma; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Spinal Neoplasms
PubMed: 33570679
DOI: 10.1007/s00117-021-00815-5 -
Advances in Experimental Medicine and... 2023Systemic treatment approaches are urgently needed for a subset of meningioma patients who do not achieve local tumor control with surgery and radiotherapy. Classical...
Systemic treatment approaches are urgently needed for a subset of meningioma patients who do not achieve local tumor control with surgery and radiotherapy. Classical chemotherapy or anti-angiogenic agents exert only very limited activity in these tumors. Long-term survival of patients with advanced metastatic cancer following treatment with immune checkpoint inhibitors, i.e., monoclonal antibodies designed to unleash suppressed anticancer immune responses, has fostered hopes for benefit from similar approaches in patients with meningiomas that recur after standard local therapy. Moreover, a plethora of immunotherapy approaches beyond these drugs have entered clinical development or clinical practice for other cancer entities, including (i) novel immune checkpoint inhibitors that may act independently of T cell activity, (ii) cancer peptide or dendritic cell vaccines to induce anticancer immunity utilizing cancer-associated antigens, (iii) cellular therapies utilizing genetically modified peripheral blood cells to directly target cancer cells, (iv) T cell engaging recombinant proteins that link tumor antigen-binding sites to effector cell activating or recognition domains, or to immunogenic cytokines, and (v) oncolytic virotherapy utilizing attenuated viral vectors designed to specifically infect cancer cells, seeking to elicit systemic anticancer immunity. This chapter provides an overview of the principles of immunotherapy, summarizes ongoing immunotherapy clinical trials in meningioma patients, and discusses the applicability of established and emerging immunotherapy concepts to meningioma patients.
Topics: Humans; Meningioma; Immune Checkpoint Inhibitors; Neoplasm Recurrence, Local; Immunotherapy; Histocompatibility Antigens Class II; Oncolytic Viruses; Meningeal Neoplasms
PubMed: 37432631
DOI: 10.1007/978-3-031-29750-2_17 -
Acta Neurochirurgica Dec 2019
Topics: Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Sphenoid Bone
PubMed: 31656983
DOI: 10.1007/s00701-019-04098-7