EANO guidelines for the diagnosis and treatment of meningiomas.
Although meningiomas are the most common intracranial tumours, the level of evidence to provide recommendations for the diagnosis and treatment of meningiomas is low compared with other tumours such as high-grade gliomas. The meningioma task force of the European Association of Neuro-Oncology (EANO) assessed the scientific literature and composed a framework of the best possible evidence-based recommendations for health professionals. The provisional diagnosis of meningioma is mainly made by MRI. Definitive diagnosis, including histological classification, grading, and molecular profiling, requires a surgical procedure to obtain tumour tissue. Therefore, in many elderly patients, observation is the best therapeutic option. If therapy is deemed necessary, the standard treatment is gross total surgical resection including the involved dura. As an alternative, radiosurgery can be done for small tumours, or fractionated radiotherapy in large or previously treated tumours. Treatment concepts combining surgery and radiosurgery or fractionated radiotherapy, which enable treatment of the complete tumour volume with low morbidity, are being developed. Pharmacotherapy for meningiomas has remained largely experimental. However, antiangiogenic drugs, peptide receptor radionuclide therapy, and targeted agents are promising candidates for future pharmacological approaches to treat refractory meningiomas across all WHO grades.
Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany. Electronic address: roland.goldbrunner@uk-koeln.de.
Roland
R
Goldbrunner
Radiation Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
Giuseppe
G
Minniti
Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
Matthias
M
Preusser
Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
Michael D
MD
Jenkinson
Department of Neurosurgery, University Hospital San Carlos, Universidad Cumplutense de Madrid, Madrid, Spain; Department of Oncologia Radioterapia Robotizada-CyberKnife, IMOncology Madrid Arturo Soria, Madrid, Spain.
Kita
K
Sallabanda
Service de Neuroradiologie, Hôpital Lariboisière, Paris, France.
Emmanuel
E
Houdart
Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; CCU Neuropathology German Cancer Center (DKFZ), Heidelberg, Germany.
Andreas
A
von Deimling
Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany.
Pantelis
P
Stavrinou
Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Florence
F
Lefranc
Department of Neurosurgery, Bergen University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Morten
M
Lund-Johansen
Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.
Elizabeth Cohen-Jonathan
EC
Moyal
Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands.
Dieta
D
Brandsma
Regional Cancer Centre Stockholm, Stockholm, Sweden; Department of Radiation Science and Oncology, University of Umeå, Umeå, Sweden.
Roger
R
Henriksson
Department of Neuro-Oncology, City of Health and Science University Hospital, Turin, Italy.
Riccardo
R
Soffietti
Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Michael
M
Weller
D005060:Europe; D006801:Humans; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008579:Meningioma / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*