EANO guideline on the diagnosis and management of meningiomas
- Study type
- Clinical guideline
- Study name
- EANO Meningioma 2021
- Design
- Updated clinical guideline of the European Association of Neuro-Oncology (EANO); evidence classes 1 to 4 and levels of recommendation A to C or GPP (good practice point)
- Source
- Neuro Oncol · 2021
In plain words
Meningioma is the most common tumour inside the skull and is usually benign and slow-growing. Many meningiomas are found by chance on MRI and, if they cause no symptoms, are usually just followed with regular MRI scans. If treatment is needed, surgery to remove the whole tumour is often the definitive treatment. For small tumours or those in difficult locations, radiosurgery (such as Gamma Knife) is a good alternative. For atypical or malignant types, radiotherapy after surgery is recommended. There is still no standard drug for meningioma.
Key guideline recommendations
- Evidence class 3; level C
Observation (follow-up with imaging) should be the first treatment option in asymptomatic patients with a newly diagnosed or slowly growing meningioma.
- Evidence class 3 (conclusive); level B
If treatment is needed, surgery should be considered the first treatment option for tumours of all WHO grades; the aim of surgery, whenever safely feasible, is complete resection (Simpson grade I).
- Evidence class 3; level C
Radiosurgery should be considered as an alternative to surgery for small tumours, in particular locations and in particular clinical situations, when tissue sampling does not seem necessary.
- Evidence class 2; level B
WHO grade 1 meningiomas, if surgery is not possible and treatment is needed, should be treated with radiosurgery or fractionated radiosurgery.
- Evidence class 2; level B
Patients with recurrent or atypical meningioma should receive fractionated radiotherapy.
- Evidence class 3 (conclusive); level B
In WHO grade 3 meningiomas, radical surgery and fractionated radiotherapy should be performed.
- Evidence class 3; level C
Pharmacotherapy with bevacizumab or multikinase inhibitors targeting the VEGF receptor should be considered only when no other local treatment option exists.
- Evidence class 4; GPP
Follow-up of grade 1 meningioma with MRI every 12 months and after 5 years every 2 years; grade 2 every 6 months and after 5 years every 12 months; grade 3 depending on the clinical course and at least every 3 to 6 months.
Study population
Patients with intracranial meningioma (WHO grades 1 to 3), including asymptomatic incidental, symptomatic, recurrent and atypical/anaplastic meningiomas.
Clinical significance and place in guidelines
This guideline is the European reference for managing meningioma and emphasises a "watch and scan" approach for asymptomatic cases, surgery aiming at complete resection as first treatment, and radiosurgery/radiotherapy for inoperable, recurrent or higher-grade cases. All systemic therapies (including somatostatin receptor-targeted radionuclide therapy) are considered experimental.
Limitations
Randomised trials in meningioma are very limited, and most recommendations rest on class 3 and 4 evidence or expert opinion. The role of molecular profiling (gene panel sequencing, methylation profiling) is still evolving; the guideline lists TERT promoter mutation and/or homozygous CDKN2A/B deletion as criteria for WHO grade 3. There is still disagreement on the timing, type and dose of radiotherapy.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.