Multimodal management of metastatic malignant meningiomas: the role of radiosurgery in long-term local control.

Abstract

Metastatic meningiomas (MMs) is rare (0.1/100 cases). Treatment requires a multimodal approach, with surgery, radiotherapy, chemotherapy and radiosurgery, which allows a long-term local control (LC) and an extension of free survival (PFS). In this study, the authors performed a review of the literature and reported two cases of patients affected by extracranial MMs, with long-term follow-up. CASE 1: a 48 yo woman was admitted for resection of an extra-axial falx lesion (meningioma G1). After two years, the lesion got a local recurrence, resected with a histological diagnosis of meningioma G3. During the following 9 years, the patient underwent 5 times GKRS for local recurrence. At 56 yo, she was readmitted for a surgical local recurrence (histological definition: anaplastic meningioma G3). At age 62 yo, the patient underwent to right lobectomy for a lung mass (histological diagnosis: anaplastic meningioma G3). After that, multiple lesions at soma L5 and adrenal gland were discovered and then monitored. CASE 2: a 48 yo woman was operated for a lesion involving torcular Erophilii (meningioma G2). After three years, a local recurrence requires GKRS combined with Tamoxifene. In the next seven years, she underwent 5 GKRS for local recurrence. The patient also carried out chemotherapy with Octeotride. At age 61 yo, she discovered multiple lesions in both lungs, liver, kidney. An hepatic biopsy showed anaplastic meningioma G3. Also this patient does not suffers from any neurological neither clinical deficits. LC in malignant meningioma is achievable through a multimodal approach; GKRS make possible LC but a novel aspect of these lesions is opened to discussion: the metastases. Those reports shows that multimodal treatment for MMs is an effective approach with good LC and improvement of overall survival. However a long survival may allow systemic diffusion of the disease in particular when sagittal sinus are involved.