Background and recommendations Flashcards
What is the median age?
50-60s
Which NF syndrome is associated with meningioma?
NF 2
What histologic features are common with meningiomas?
Psammoma bodies
Calcifications
What are negative prognostic features for meningiomas?
- High grade
- Young age
- Chromosomal alterations
- Poor performance status
- STR
What are the grades for meningiomas?
Grade I: benign
Grade II: Atypical
Grade III: Anaplastic/malignant
Median OS for patients with grade III meningiomas?
3.2 years
What are the history elements to capture at work up?
Hx: headaches, neurologic deficits
Physical: CN exam, gait, extremity exam for strength and sensation
Dose constraint for optic chiasm after SRS?
8 Gy max
LC rate of meningiomas after SRS?
5 year LC: 98%
If observes when should patients return for exam and MRI?
At 3 months, 9 months and then yearly if stable
What are the treatment options for meningiomas?
- Observation
- Surgery
- Fractionated RT
- SRS
For which sites is RT the preferred treatment modality?
Meningiomas involving the optic nerve sheath or cavernous sinus
What is the appearance of meningiomas on MRI?
Homogenously enhancing on T1, well circumscribed with a dural tail
Isointense on T1
Hyperintense on T2
DDx for tumors having a dural tail
Chloroma
Lymphoma
Sarcoidosis
Which lesions should observation be considered?
- Incidental lesions, asymmtomatic
- Not in a high risk area
- Reliable patients
- Older patients
Indications for adjuvant RT after surgery?
- Atypical or anaplastic histology
- STR
- Recurrent tumors
What are the recurrence rates after surgery?
10 year:
GTR: 10%
STR: 30-40%
What doses should be used for Grade I meningiomas?
Fractionated: 50.4 Gy at 1.8 Gy/fx
SRS: 12.5
What doses should be used for Grade II-III meningiomas?
60 Gy at 2 Gy/fx
How are patients with optic nerve sheath/cavernous sinus meningiomas followed?
Serial MRIs
Neuropthalmology exam
Endocrine labs
RT volume for Grade II-III tumors?
GTV is gross tumor seen on MRI including dural tail
CTV=GTV+1 cm
What histologic features define each grade?
- WHO Grade I (80%): Mitoses <4/10 hpf
- WHO Grade II(20%):Mitoses 4/10 or more per hpf chondroid, clear cell, brain invasion
- WHO Grade II(20%):Mitoses 20/10 or more per hpf or papillary, rhabdoid
RT volume for Grade II-III tumors?
GTV+ 3 mm = CTV
What is the treatment paradigm for Grade II-III tumors?
Maximal safe resection
Adjuvant RT
What is the LC for tumors treated with STR + fractionated RT?
UF data published by Kellie Condra
10 year LC of 87%
What RT dose to provide after STR?
54 Gy at 1.8 Gy/fx
What are the toxicities of RT for meningiomas?
Alopecia
Nausea
Headache
Seizure
What special study do you need for diagnosis of an optic nerve meningioma?
MR T1 + contrast and fat suppression
