Complete surgical resection is the standard treatment for menin-gioma and is compatible with long-term progression-free survival (PFS). However, about one third of the meningiomas are not amenable to complete resection secondary to the location, large size, and proximity to critical structures. Complete resection of skull base meningiomas can only be achieved in approximately half of the patients. Subtotal resection without any adjuvant treatment is regarded as inadequate therapy and is associated with inferior PFS. Postoperative radiation therapy is frequently employed after subtotal resection of meningiomas and can significantly improve the PFS with relatively low toxic-ity. In patients with unresectable meningiomas or patients with poor pretreatment factors for surgery, radiation therapy alone has been demonstrated to be effective in terms of long-term PFS. Radiation therapy is also given to patients who have unirradi-ated recurrent meningiomas. The management of optic nerve sheath meningiomas has been controversial. Surgical resection is indicated for aggressive tumors with intracranial extension. However, this can result in blindness. Observation alone will eventually lead to blindness as a result of tumor progression. Radiation therapy is often given to enhance local control and is regarded as a potentially vision-sparing procedure. For patients with atypical (grade 2) and anaplastic (grade 3) meningiomas, there is an increased risk of tumor recurrence even after complete surgical resection, and postoperative radiation therapy is frequently given to reduce the risk of recurrence. This chapter summarizes the data concerning conventional radiation therapy for meningiomas in different settings. Advanced radiation techniques for meningiomas is discussed in the preceding chapter.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Jaaskelainen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 1986;26(5):461–9.
Mirimanoff RO, Dosoretz DE, Linggood RM, et al. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985;62(1):18–24.
Condra KS, Buatti JM, Mendenhall WM, et al. Benign menin-giomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 1997;39(2):427–36.
Levine ZT, Buchanan RI, Sekhar LN, Rosen CL, Wright DC. Proposed grading system to predict the extent of resection and outcomes for cranial base meningiomas. Neurosurgery 1999;45(2):221–30.
Barbaro NM, Gutin PH, Wilson CB, et al. Radiation therapy in the treatment of partially resected meningiomas. Neurosurgery 1987;20(4):525–8.
Taylor BW, Jr., Marcus RB, Jr., Friedman WA, et al. The menin-gioma controversy: postoperative radiation therapy. Int J Radiat Oncol Biol Phys 1988;15(2):299–304.
Miralbell R, Linggood RM, de la Monte S, et al. The role of radiotherapy in the treatment of subtotally resected benign meningiomas. J Neurooncol 1992;13(2):157–64.
Stafford SL, Perry A, Suman VJ, et al. Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc 1998;73(10):936–42.
Glaholm J, Bloom HJ, Crow JH. The role of radiotherapy in the management of intracranial meningiomas: the Royal Marsden Hospital experience with 186 patients. Int J Radiat Oncol Biol Phys 1990;18(4):755–61.
Maire JP, Caudry M, Guerin J, et al. Fractionated radiation therapy in the treatment of intracranial meningiomas: local control, functional efficacy, and tolerance in 91 patients. Int J Radiat Oncol Biol Phys 1995;33(2):315–21.
Carella RJ, Ransohoff J, Newall J. Role of radiation therapy in the management of meningioma. Neurosurgery 1982;10(3):332–9.
Forbes AR, Goldberg ID. Radiation therapy in the treatment of meningioma: the Joint Center for Radiation Therapy experience 1970 to 1982. J Clin Oncol 1984;2(10):1139–43.
Melian E, Jay WM. Primary radiotherapy for optic nerve sheath meningioma. Semin Ophthalmol 2004;19(3–4):130–40.
Maier H, Ofner D, Hittmair A, et al. Classic, atypical, and ana-plastic meningioma: three histopathological subtypes of clinical relevance. J Neurosurg 1992;77(4):616–23.
Jaaskelainen J, Haltia M, Servo A. Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 1986;25(3):233–42.
Nutting C, Brada M, Brazil L, et al. Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 1999;90(5):823–7.
Goldsmith BJ, Wara WM, Wilson CB, et al. Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990. J Neurosurg 1994;80(2):195–201.
Soyuer S, Chang EL, Selek U, et al. Radiotherapy after surgery for benign cerebral meningioma. Radiother Oncol 2004;71(1):85–90.
Pourel N, Auque J, Bracard S, et al. Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience. Radiother Oncol 2001;61(1):65–70.
Wara WM, Sheline GE, Newman H, et al. Radiation therapy of meningiomas. Am J Roentgenol Radium Ther Nucl Med 1975;123(3):453–8.
Kokubo M, Shibamoto Y, Takahashi JA, et al. Efficacy of conventional radiotherapy for recurrent meningioma. J Neurooncol 2000;48(1):51–5.
Dutton JJ. Optic nerve sheath meningiomas. Surv Ophthalmol 1992;37(3):167–83.
Smith JL, Vuksanovic MM, Yates BM, et al. Radiation therapy for primary optic nerve meningiomas. J Clin Neuroophthalmol 1981;1(2):85–99.
Kennerdell JS, Maroon JC, Malton M, et al. The management of optic nerve sheath meningiomas. Am J Ophthalmol 1988;106(4):450–7.
Turbin RE, Thompson CR, Kennerdell JS, et al. A long-term visual outcome comparison in patients with optic nerve sheath meningioma managed with observation, surgery, radiotherapy, or surgery and radiotherapy. Ophthalmology 2002;109(5):890–9; discussion 899–900.
Narayan S, Cornblath WT, Sandler HM, et al. Preliminary visual outcomes after three-dimensional conformal radiation therapy for optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys 2003;56(2):537–43.
Milosevic MF, Frost PJ, Laperriere NJ, et al. Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys 1996;34(4):817–22.
Dziuk TW, Woo S, Butler EB, et al. Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 1998;37(2):177–88.
Goyal LK, Suh JH, Mohan DS, et al. Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 2000;46(1):57–61.
Modha A, Gutin PH. Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 2005;57(3): 538–50.
Lopes V V, Chan A, Loeffler J, et al. A randomized radiation dose escalation trial in patients with recurrent or incompletely resected benign meningiomas treated with proton-photon irradiation. Int J Radiat Oncol Biol Phys 2003;57(suppl): S323–324.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag London Limited
About this chapter
Cite this chapter
Lo, S.S., Tinnel, B.A., Suh, J.H. (2009). Conventional Radiation for Meningiomas. In: Lee, J.H. (eds) Meningiomas. Springer, London. https://doi.org/10.1007/978-1-84628-784-8_26
Download citation
DOI: https://doi.org/10.1007/978-1-84628-784-8_26
Publisher Name: Springer, London
Print ISBN: 978-1-84882-910-7
Online ISBN: 978-1-84628-784-8
eBook Packages: MedicineMedicine (R0)