Meningioma

Question 1

Grades of Meningioma

Answer 1

Grade I : Benign meningioma
Grade II: Atypical meningioma
Grade III: Malignant meningioma

Question 2

Grade I

Meningioma

Answer 2

<4 mitoses per 10 high power fields without high risk features
.
.
RT Dose 54Gy
90% local control with def RT
90% local control with adjuvant RT

Question 3

Grade II

Meningioma

Answer 3

Atypical Meningioma
>4 but <20 mitoses per 10 high power field
brain invasion
clear cell/choroid histology
3 or more of following path features
1) increased cellularity
2) prominent nucleoli
3) Sheet like patternless growth
4) foci of spontaneous necrosis
5) small cells with high nuclear/cytoplasm ratio

Question 4

Grade III

Meningioma

Answer 4

Malignant Meningioma
>20 mitoses per 10 high power fields
homozygous deletion of CDKN2A/B, TERT promoter mutation.
.
RT Dose 60Gy

Question 5

Image findings

for LGG

Answer 5

MRI Brain:
T1 isointense (like normal brain)
T2 hyperintense (brighter than normal brain)

Question 6

Risk factors for meningioma

Answer 6

1) Prior radiation
2)

Question 7

Slow growth Meningioma predicting factors

Answer 7

1) Old age
2) Calcifications on imaging
3) No growth in serial scans
4) Hypo intense on T1 MRI

Question 8

SRS Dose

Meningioma

Answer 8

12-16Gy

Question 9

SRS treatment prone for

Meningioma

Answer 9

Margin failure

Question 10

RTOG 05-39

Remember a May 1939

Answer 10

Volumes:
Grade II
CTV: 1.0 cm
PTV: 0.5cm
.
.
Grade III/recurrent/STR
CTV: 1.0 cm for 60Gy ; SIB with 2.0 cm for 54Gy
PTV: 0.5cm

Question 11

F/U

Meningioma

Answer 11

Grade I/II
MRI Brain Q6-12 months
.
.
Grade III
MRI Brain Q 3 months

Question 12

Optic nerve sheath meningioma

Answer 12

Def RT is the best option for vision preservation (90% preserved)
Dose: 5040Gy