Management of Meningiomatosis
Diagnostic Evaluation
- MRI without and with IV contrast remains the gold standard for evaluating meningioma recurrence, with recommended follow-up intervals based on tumor grade 1
- Somatostatin receptor (SSTR) PET imaging should be obtained to accurately assess tumor extension and differentiate recurrence from treatment-related changes 2, 3
- SSTR PET has high sensitivity and specificity for meningioma detection and should be performed if tumor extension or recurrence diagnosis is unclear 3
- Brain MRI should be performed within 2 weeks prior to any treatment as baseline for disease monitoring and response assessment 2
Treatment Algorithm
Radiation Therapy Options
- For residual or recurrent tumor after surgery, SRS is preferred for smaller residual tumors (typically <3-4 cm) 1
- Fractionated stereotactic radiotherapy (SRT) should be considered for larger tumors or those near critical structures 1
- SRS offers higher rates of tumor shrinkage compared to SRT (53% vs 29%) 1
Advanced Treatment Options
- For treatment-refractory cases with positive SSTR expression on PET imaging, peptide receptor radionuclide therapy (PRRT) may be considered 2, 3
- PRRT eligibility criteria include positive somatostatin receptor expression on SSTR PET imaging within the last 2 months 2
- PRRT eligibility criteria include Karnofsky performance status above 60% or ECOG 0-2 2
- PRRT eligibility criteria include no contraindications such as compromised renal function (GFR <40 ml/min/1.73 m²) or bone marrow function 3
Follow-up Protocol
- For WHO grade 1 meningiomas, MRI surveillance should be performed every 6-12 months 1
- For higher-grade or recurrent meningiomas, more frequent imaging (every 3-6 months) is recommended 1
- SSTR PET imaging should be repeated to assess treatment response, particularly after PRRT 2
- After SRS or radiotherapy, imaging follow-up at 1 month and then every 2-3 months for the first year is recommended 4