[Frontiers in Bioscience , -0, June , 00]

Nonsurgical treatment options in the management of intracranial meningiomas

Shervin R. Dashti1, Eric Sauvageau1, Kris A. Smith1, Lynn S. Ashby2

1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, Arizona 85013, 2Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, Arizona 85013

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Radiation therapy
4. Conventional external-beam radiation therapy
5. Stereotactic radiosurgery
6. Chemotherapy
7. Hormonal therapies
8. Immunography and biological response modifiers
9. Anti-neoplastic chemotherapy and hydroxyurea
10. Conclusions
11. References

1. ABSTRACT

Surgical resection is the treatment of choice for most intracranial meningiomas. We review the current state of adjuvant therapies, including radiation and chemotherapy. Conventional external beam radiation and stereotactic radiosurgery remain second-line options for patients unwilling or unable to undergo surgery. Radiation therapy is most useful in the setting of recurrent or residual tumor after surgical resection, where it is associated with a clear increase in the length of progression-free survival. This survival advantage is most pronounced with high-grade meningiomas, which have a much higher recurrence rate than low-grade meningiomas, even after gross total resection. In contrast, the role of chemotherapy in the treatment of meningiomas is limited. This treatment modality is often reserved for inoperable tumors or those refractory to radiation treatment. Furthermore, the choice of chemotherapy agents is limited. Hydroxyurea, a ribonucleotide reductase inhibitor, has modest clinical activity in meningiomas. In recent small clinical trials, somatostatin analogues have been moderately effective in controlling tumor growth.