Once discovered, a patient will meet with a doctor, most commonly a neurosurgeon, to discuss symptoms, findings of the imaging studies and formulate a management plan. In patients with symptoms, treatment (usually surgery) is needed within days or weeks, rarely within hours. In asymptomatic patients, one or more scans separated by time intervals suggested by the doctor is obtained to learn about the speed of growth of the tumour. A decision to treat (surgery or radiotherapy) is then taken based on a number of factors, including the size of the tumour, its speed of growth, proximity to blood vessels and nerves, patient age, general fitness. Last but not least the probability and timing of the side effects the treatment and risks associated with no treatment or delayed treatment are discussed.
Surgery is the main treatment of meningiomas and when removed completely, many such tumours can be controlled by surgery alone. Complete removal of tumour (complete resection) is not always possible or ‘the best thing to do’. In this case, the residual tumour can be observed (with serial scans) or treated ‘up front’ with radiotherapy. As described above, a number of factors need to be taken into account when deciding on further management.
Essentially, two types of radiotherapy are used: fractionated radiotherapy (the total intended dose is delivered in multiple sittings when a small fraction of the total dose is delivered each time) and radiosurgery (a large, focused dose is delivered in one or only a few sittings). Radiosurgery comes as Gamma Knife, CyberKnife, Linac etc. Radiotherapy is given routinely after WHO grade 3 meningioma surgery. Radiotherapy is rarely given after surgery for WHO grade 1. The role of radiotherapy in the management of WHO grade 2 meningiomas is complex and a number of studies, including the ROAM trial (www.roam-trial.org.uk) are under way to help to clarify it and refine recommendations regarding the indications and timing. Sometimes radiotherapy, in its fractionated or a single dose form, can be used as a primary treatment, i.e. the first treatment.
Written by Alireza Shoakazemi for BIMS