Spinal Cord Meningioma in Poor-Condition or Inoperable Patients: What to Do When Radiosurgery or Radiotherapy Has Not Reduced Tumor Size
Clinical scenario
This protocol applies to patients with symptomatic spinal cord meningioma who are not surgical candidates — either because of poor overall clinical condition or a specific contraindication to surgery. In this population, radiosurgery or radiotherapy serves as the primary local treatment. Radiosurgery is an established alternative to surgery in well-defined cases with small tumors in elderly or critically ill patients, and is also applicable when absolute or relative surgical contraindications are present.
Previous treatment — failure condition
The preceding line consisted of stereotactic radiosurgery (for smaller tumors) or fractionated radiotherapy, chosen because surgical resection was not feasible. Escalation to this protocol is indicated when that local radiation approach fails to achieve its primary goal: reduction of tumor size on imaging.
Next-step approach (partial)
When no further local treatment option is available, a systemic pharmacotherapy approach targeting tumour vasculature may be considered. The complete eligibility criteria, sequencing, and full regimen are available in the structured protocol.
References
DOI: 10.1093/neuonc/noab150
- SRS has been established as an alternative therapy to surgery in well-defined cases with small tumors in elderly or critically sick patients.
- Radiosurgery may be an alternative in patients with relative or absolute contraindications for surgery and with small tumors without mass effect, although a higher grade meningioma or a different histology cannot be entirely ruled out.
- Pharmacotherapy using bevacizumab or multikinase inhibitors targeting VEGF receptors should only be considered if no further local treatment option exists.
View source ↗