title: Treatment of unresectable skull base meningiomas with somatostatin analogs.
abstract: OBJECTIVE
  The standard surgical treatment for meningiomas is total resection, but the complete removal of skull base meningiomas can be difficult for several reasons. Thus, the management of certain meningiomas of the skull base--for example, those involving basal vessels and cranial nerves--remains a challenge. In recent reports it has been suggested that somatostatin (SST) administration can cause growth inhibition of unresectable and recurrent meningiomas. The application of SST and its analogs is not routinely integrated into standard treatment strategies for meningiomas, and clinical studies proving growth-inhibiting effects do not exist. The authors report on their experience using octreotide in patients with recurrent or unresectable meningiomas of the skull base.
  
  
  METHODS
  Between January 1996 and December 2010, 13 patients harboring a progressive residual meningioma (as indicated by MR imaging criteria) following operative therapy were treated with a monthly injection of the SST analog octreotide (Sandostatin LAR [long-acting repeatable] 30 mg, Novartis). Eight of 13 patients had a meningioma of the skull base and were analyzed in the present study. Postoperative tumor enlargement was documented in all patients on MR images obtained before the initiation of SST therapy. All tumors were benign. No patient received radiation or chemotherapy before treatment with SST. The growth of residual tumor was monitored by MR imaging every 12 months.
  
  
  RESULTS
  Three of the 8 patients had undergone surgical treatment once; 3, 2 times; and 2, 3 times. The mean time after the last meningioma operation (before starting SST treatment) and tumor enlargement as indicated by MR imaging criteria was 24 months. A total of 643 monthly cycles of Sandostatin LAR were administered. Five of the 8 patients were on SST continuously and stabilized disease was documented on MR images obtained in these patients during treatment (median 115 months, range 48-180 months). Three of the 8 patients interrupted treatment: after 60 months in 1 case because of tumor progression, after 36 months in 1 case because of side effects, and after 36 months in 1 case because the health insurance company denied cost absorption.
  
  
  CONCLUSIONS
  Although no case of tumor regression was detected on MR imaging, the study results indicated that SST analogs can arrest the progression of unresectable or recurrent benign meningiomas of the skull base in some patients. It remains to be determined whether a controlled prospective clinical trial would be useful.
authors.affiliation: Neurosurgical Clinic, German Armed Forces Military Hospital Ulm, Oberer Eselsberg 40, Ulm, Germany. chr74@gmx.de
authors.forename: Chris
authors.initials: C
authors.lastname: Schulz
authors.forename: René
authors.initials: R
authors.lastname: Mathieu
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kunz
authors.forename: Uwe Max
authors.initials: UM
authors.lastname: Mauer
mesh_terms: D000328:Adult; D005260:Female; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007456:Iodine Isotopes; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008579:Meningioma / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D004369:Pentetic Acid; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000188:drug therapy* / Q000601:surgery; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D006728:Hormones; D007456:Iodine Isotopes; D013004:Somatostatin; D004369:Pentetic Acid