Top Line: Radiotherapy remains a cornerstone treatment for many meningiomas.
The Study: Here is an in-depth review on where we stand with radiotherapy for common meningiomas in 2024. First up, imaging. Given that somatostatin receptors are highly expressed by meningiomas, somatostatin receptor-based PET is incrementally informative in addition to MRI, particularly for tricky scenarios such as delineating tumor from post-op changes and base of skull anatomy as well as the notorious dural tail. Recognizing a lack of prospective data, most evidence points to dose escalation significantly moving the needle for local control of high-grade disease (think standard radiosurgery doses used for brain mets or up to 70 Gy fractionated). Particle therapy with protons or carbon may offer an enhanced therapeutic ratio in some circumstances, such as reirradiation near critical structures, but for now that relies more on physician judgment than robust data. On the horizon is tumor genomics. Already, homozygous deletion of CDKN2A/B or a TERT promoter mutation classifies a tumor as WHO grade 3. Further molecular characterization of tumor behavior could better inform the intensity of therapy. Finally, the authors note a paucity of recent or ongoing clinical trials in this space that is not reflective on incidence in the population.
TBL: “Recent advances in imaging, neuropathology, and radiation techniques and modalities hold the promise to significantly refine the efficacy and safety of radiotherapy for patients treated for newly diagnosed and recurring meningiomas.” | Ehret, Int J Radiat Oncol BIol Phys 2024
The Study: Here is an in-depth review on where we stand with radiotherapy for common meningiomas in 2024. First up, imaging. Given that somatostatin receptors are highly expressed by meningiomas, somatostatin receptor-based PET is incrementally informative in addition to MRI, particularly for tricky scenarios such as delineating tumor from post-op changes and base of skull anatomy as well as the notorious dural tail. Recognizing a lack of prospective data, most evidence points to dose escalation significantly moving the needle for local control of high-grade disease (think standard radiosurgery doses used for brain mets or up to 70 Gy fractionated). Particle therapy with protons or carbon may offer an enhanced therapeutic ratio in some circumstances, such as reirradiation near critical structures, but for now that relies more on physician judgment than robust data. On the horizon is tumor genomics. Already, homozygous deletion of CDKN2A/B or a TERT promoter mutation classifies a tumor as WHO grade 3. Further molecular characterization of tumor behavior could better inform the intensity of therapy. Finally, the authors note a paucity of recent or ongoing clinical trials in this space that is not reflective on incidence in the population.
TBL: “Recent advances in imaging, neuropathology, and radiation techniques and modalities hold the promise to significantly refine the efficacy and safety of radiotherapy for patients treated for newly diagnosed and recurring meningiomas.” | Ehret, Int J Radiat Oncol BIol Phys 2024