Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy
Meningiomas account for approximately one third of all primary intracranial tumors. Arising from the cells of the arachnoid mater, these neoplasms are found along meningeal surfaces within the calvarium and spinal canal. Many are discovered incidentally, and most are idiopathic, although risk factor...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1137849/full |
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| author | Varun Yarabarla Amrutha Mylarapu Tatiana J. Han Susan L. McGovern Shaan M. Raza Thomas H. Beckham |
| author_facet | Varun Yarabarla Amrutha Mylarapu Tatiana J. Han Susan L. McGovern Shaan M. Raza Thomas H. Beckham |
| author_sort | Varun Yarabarla |
| collection | DOAJ |
| description | Meningiomas account for approximately one third of all primary intracranial tumors. Arising from the cells of the arachnoid mater, these neoplasms are found along meningeal surfaces within the calvarium and spinal canal. Many are discovered incidentally, and most are idiopathic, although risk factors associated with meningioma development include age, sex, prior radiation exposure, and familial genetic diseases. The World Health Organization grading system is based on histologic criteria, and are as follows: grade 1 meningiomas, a benign subtype; grade 2 meningiomas, which are of intermediately aggressive behavior and usually manifest histologic atypia; and grade 3, which demonstrate aggressive malignant behavior. Management is heavily dependent on tumor location, grade, and symptomatology. While many imaging-defined low grade appearing meningiomas are suitable for observation with serial imaging, others require aggressive management with surgery and adjuvant radiotherapy. For patients needing intervention, surgery is the optimal definitive approach with adjuvant radiation therapy guided by extent of resection, tumor grade, and location in addition to patient specific factors such as life expectancy. For grade 1 lesions, radiation can also be used as a monotherapy in the form of stereotactic radiosurgery or standard fractionated radiation therapy depending on tumor size, anatomic location, and proximity to dose-limiting organs at risk. Optimal management is paramount because of the generally long life-expectancy of patients with meningioma and the morbidity that can arise from tumor growth and recurrence as well as therapy itself. |
| first_indexed | 2024-03-12T13:56:51Z |
| format | Article |
| id | doaj.art-63a938112b4c44c1b7698b97daa52a65 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-12T13:56:51Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-63a938112b4c44c1b7698b97daa52a652023-08-22T12:41:11ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-08-011310.3389/fonc.2023.11378491137849Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapyVarun Yarabarla0Amrutha Mylarapu1Tatiana J. Han2Susan L. McGovern3Shaan M. Raza4Thomas H. Beckham5Philadelphia College of Osteopathic Medicine, Suwanee, GA, United StatesDepartment of Internal Medicine, Advent Health Redmond, Rome, GA, United StatesDepartment of Internal Medicine, WellSpan Health, York, PA, United StatesDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesMeningiomas account for approximately one third of all primary intracranial tumors. Arising from the cells of the arachnoid mater, these neoplasms are found along meningeal surfaces within the calvarium and spinal canal. Many are discovered incidentally, and most are idiopathic, although risk factors associated with meningioma development include age, sex, prior radiation exposure, and familial genetic diseases. The World Health Organization grading system is based on histologic criteria, and are as follows: grade 1 meningiomas, a benign subtype; grade 2 meningiomas, which are of intermediately aggressive behavior and usually manifest histologic atypia; and grade 3, which demonstrate aggressive malignant behavior. Management is heavily dependent on tumor location, grade, and symptomatology. While many imaging-defined low grade appearing meningiomas are suitable for observation with serial imaging, others require aggressive management with surgery and adjuvant radiotherapy. For patients needing intervention, surgery is the optimal definitive approach with adjuvant radiation therapy guided by extent of resection, tumor grade, and location in addition to patient specific factors such as life expectancy. For grade 1 lesions, radiation can also be used as a monotherapy in the form of stereotactic radiosurgery or standard fractionated radiation therapy depending on tumor size, anatomic location, and proximity to dose-limiting organs at risk. Optimal management is paramount because of the generally long life-expectancy of patients with meningioma and the morbidity that can arise from tumor growth and recurrence as well as therapy itself.https://www.frontiersin.org/articles/10.3389/fonc.2023.1137849/fullintracranial meningiomabrain tumorneurosurgeryradiosurgeryradiotherapy |
| spellingShingle | Varun Yarabarla Amrutha Mylarapu Tatiana J. Han Susan L. McGovern Shaan M. Raza Thomas H. Beckham Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy Frontiers in Oncology intracranial meningioma brain tumor neurosurgery radiosurgery radiotherapy |
| title | Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy |
| title_full | Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy |
| title_fullStr | Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy |
| title_full_unstemmed | Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy |
| title_short | Intracranial meningiomas: an update of the 2021 World Health Organization classifications and review of management with a focus on radiation therapy |
| title_sort | intracranial meningiomas an update of the 2021 world health organization classifications and review of management with a focus on radiation therapy |
| topic | intracranial meningioma brain tumor neurosurgery radiosurgery radiotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1137849/full |
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