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Radiation therapy for atypical and anaplastic meningiomas: an overview of current results and controversial issues.

Abstract
Meningiomas are the most common intracranial tumors. Most meningiomas are WHO grade 1 tumors whereas less than one-quarter of all meningiomas are classified as atypical (WHO grade 2) and anaplastic (WHO grade 3) tumors, based on local invasiveness and cellular features of atypia. Surgical resection remains the cornerstone of meningioma therapy and represents the definitive treatment for the majority of patients; however, grade 2 and grade 3 meningiomas display more aggressive behavior and are difficult to treat. Several retrospective series have shown the efficacy and safety of postoperative adjuvant external beam radiation therapy (RT) for patients with atypical and anaplastic meningiomas. More recently, two phase II prospective trials by the Radiation Therapy Oncology Group (RTOG 0539) and the European Organisation for Research and Treatment of Cancer (EORTC 2042) have confirmed the potential benefits of fractionated RT for patients with intermediate and high-risk meningiomas; however, several issues remain a matter of debate. Controversial topics include the timing of radiation treatment in patients with totally resected atypical meningiomas, the optimal radiation technique, dose and fractionation, and treatment planning/target delineation. Ongoing randomized trials are evaluating the efficacy of early adjuvant RT over observation in patients undergoing gross total resection.
AuthorsLorenzo Vagnoni, Sami Aburas, Martina Giraffa, Ivana Russo, Vito Chiarella, Sergio Paolini, Paolo Tini, Giuseppe Minniti
JournalNeurosurgical review (Neurosurg Rev) Vol. 45 Issue 5 Pg. 3019-3033 (Oct 2022) ISSN: 1437-2320 [Electronic] Germany
PMID35665867 (Publication Type: Journal Article, Review)
Copyright© 2022. The Author(s).
Topics
  • Brain Neoplasms
  • Child
  • Humans
  • Meningeal Neoplasms (pathology, radiotherapy, surgery)
  • Meningioma (pathology, radiotherapy, surgery)
  • Prospective Studies
  • Retrospective Studies

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