Spinal Cord Meningioma After Radiotherapy or Radiosurgery Failure in a Patient with Good Clinical Condition

Clinical scenario

A patient with symptomatic or growing spinal cord meningioma who is in good clinical condition and whose tumour has not achieved adequate size reduction following prior radiotherapy or radiosurgery. The primary treatment for the majority of symptomatic or enlarging meningiomas is surgery, considered as the first therapeutic option across all WHO grades when treatment is indicated. This protocol addresses the situation where subsequent radiation-based approaches have also been exhausted.

Previous line — goal not achieved

Prior postoperative conformal fractionated radiotherapy or stereotactic radiosurgery — including single-dose radiosurgery or hypofractionated approaches for spinal meningiomas, and fractionated radiotherapy for WHO grade 3 tumours — failed to meet its primary target: reduction of tumour size on imaging. This failure is the trigger for escalation to the current protocol.

Next-line approach (partial)

When no further local treatment option remains, systemic salvage pharmacotherapy targeting vascular growth pathways is considered. The full protocol specifies the eligible agents, selection criteria, and the conditions under which this approach applies.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/neuonc/noab150

The primary treatment for the majority of symptomatic or enlarging meningiomas is surgery. Surgery should be considered as the first therapeutic option in tumors of all WHO grades if therapy is indicated.

Pharmacotherapy using bevacizumab or multikinase inhibitors targeting VEGF receptors should only be considered if no further local treatment option exists.

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