A neuro-oncologic challenge: the case of a large, aggressive, malignant meningioma of the skull base with paranasal sinus involvement.
BACKGROUND
Malignant meningiomas, rare tumors that account for approximately 1%-3% of all meningioma, have high recurrence, morbidity, and mortality rate and a particularly poor outcome. Surgical excision followed by adjuvant radiotherapy is the current approach for the treatment of these tumors.


METHODS
In the case reported, the disease, characterized by a high proliferative index (Ki67 60%-70%), was treated with endoscopic surgery limited to the extracranial portion; then the patient underwent radiotherapy, on the residual tumor volume, to a total dose of 66 Gy delivered in 33 fractions (2 Gy/fraction) by helical intensity-modulated radiation therapy with image-guided radiotherapy daily checks (tomotherapy).


RESULTS
Two and a half years after the treatment, the patient is alive and a partial response is maintained. The patient is healthy overall with grade I fatigue and grade II hearing loss as late toxicity (Common Terminology Criteria for Adverse Events 4.1).


CONCLUSIONS
Within a multidisciplinary approach, new radiotherapy techniques confirm their effectiveness and reliability for the treatment of malignant meningioma.
Radiation Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Paolo
P
Ghirardelli
Radiation Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Luca
L
Triggiani
Radiation Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Sara
S
Pedretti
Pathology Department, University and Spedali Civili Hospital, Brescia - Italy.
Fausta
F
Bonetti
Neuro-radiology Department, University and Spedali Civili Hospital, Brescia - Italy.
Roberto
R
Liserre
Neurology Department, University and Spedali Civili Hospital, Brescia - Italy.
Stefano
S
Gipponi
Neurosurgery Department, University and Spedali Civili Hospital, Brescia - Italy.
Pierpaolo
P
Panciani
Neurosurgery Department, University and Spedali Civili Hospital, Brescia - Italy.
Luciano
L
Buttolo
Medical Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Salvatore
S
Grisanti
Radiation Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Mauro
M
Urpis
Medical Physics, Spedali Civili Hospital, Brescia - Italy.
Luigi
L
Spiazzi
Radiation Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Stefano Maria
SM
Magrini
Radiation Oncology Department, University and Spedali Civili Hospital, Brescia - Italy.
Michela
M
Buglione
D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D009361:Neoplasm Invasiveness; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D019292:Skull Base Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden