Meningioma+(adult)

Grade II - (Atypical) – Any of the following criteria: 1. Four or more mitoses per 10 high-power fields 2. Brain invasion 3. Three or more of the following: a) Increased cellularity b) Small cells c) Necrosis d) Prominent Nuclei e) Sheeting architecture Grade III - (Anaplastic) – Either if the following criteria:  1. Twenty or more mitoses per high-power fields  2. Obviously malignant cytologic characteristics such that the tumor cell resembles carcinoma, sarcoma, or melanoma. [2] || Seizures  Short term memory deficiency  Difficulty with problem solving  Loss of balance and/or trouble walking  Otitis externa  Serous otitis media  Dermatitis  Decreased visual acuity  Decreased visual field  Retinopathy  Cataract  Blindness  Hormone insufficiency  High tone hearing loss  Vestibular damage  Nausea and vomiting  Fatigue  Secondary tumor  Death  Neurologic deterioration: Can begin 6-12 months following radiation treatment.  Radiation necrosis: Can appear after 6 months following radiation treatment  Radiosurgery Side Effects – are dependent on the treatment location and radiation dose.[2] || Brain 45 Gy 50 Gy 60 Gy  Brainstem 50 Gy 53 Gy 60 Gy  Cauda equina 60 Gy  Ear 55 Gy 55 Gy 55 Gy  Lens 10 Gy  Optic chiasm 50 Gy  Optic nerve 50 Gy  Retina 45 Gy  Spinal cord 47 Gy(20 cm) 50 Gy(10 cm) 50(5 cm) [2] || [2] Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. [3] Barnes L. //Surgical Pathology of the Head and Neck//. 2nd ed. New York, NY: Informa Healthcare; 2001. [4] Washington C, Leaver D. //Principles and Practices of Radiation Therapy//. 3rd ed. St. Louis, MO: Mosby Elsevier; 2010. [5] Lenhard RE, Osteen RT, Gansler T. //The American Cancer Society's Clinical Oncology//. Atlanta, GA: The American Cancer Society; 2001. [6] http://ars.els-cdn.com/content/image/1-s2.0-S0958394703001067-gr2.jpg Accessed June 1, 2012.
 * **Epidemiolgy:** || Meningioma accounts for thirty percent of all primary brain and most common benign brain tumors in adults. According to the Central Brain Tumor Registry, in United States alone there are over 170,000 reported cases of meningioma and approximately 18,000 new cases are diagnosed each year. Meningioma usually occurs between the ages of forty and ninety and it peaks at the age of eighty. The ratio between male and female is one to two for all meningioma. [1] ||
 * **Etiology:** || The main cause of meningioma is unknown. However, persons who have been exposed to high doses of ionizing radiation have shown to have a higher risk of developing meningioma. However, a number of studies have shown that low levels of radiation, such as dental x-rays, can also increase the risk of meningioma. Patients with neurofibromatosis type 2 (NF-2), with a loss of chromosome 22q, have more than a fifty percent chance of developing meningioma. [1] ||
 * **Signs & Symptoms:** || Generally, the early stages of the meningioma manifest no symptoms. Small sized tumors, less than two centimeters, are typically found at autopsy. The most common symptoms at the time of presentation include headaches, personality change, confusion, and paresis. For the larger tumors, the symptoms correlate with the location. Seizures and severe headaches are usually found in cases of meningioma located on the surface of cerebrum. [1,2] ||
 * **Diagnostic Procedures:** || * A complete history and general physical examination.
 * Complete blood counts.
 * Stereotactic biopsy is sufficient for tissue diagnosis.
 * Neurological examination.
 * Brain and spine MRI.
 * Easily visualized on CT and MRI with contrast and arteriography. ||
 * **Histology:** || Arise from arachonoidal cells near the venous sinuses. Are highly vascularized and are usually dome shaped. ||
 * **Lymph node drainage:** || Primary intracranial meningiomas may metastasize to the cervical lymph nodes.[3] ||
 * **Metastatic spread:** || Meningiomas are considered to be neoplastic growth that derived from the leptomeninges. Malignant meningiomas are rare. The development of metastatic spread from meningiomas is less than 1 per 1,000. In an 18 year study seven of 396 meningiomas were labeled as malignant. Out of the seven, three of them spread to extracranial tissues. Overall, the metastatic spread infiltrated the vertebral bodies, liver, pelvis, long bones, and the spinal cord. There is a 0.76% chance of metastases when including all meningiomas and 43% chance of metastasis when malignant meningiomas are considered. [2] ||
 * **Grading:** || Classification of meningiomas is based upon the WHO classification system. [2]Grade I - (Benign) - does not fulfill criteria for grades II (atypical) or III (anaplastic)
 * **Staging:** || There is no formal staging system for Meningiomas since CNS tumors cannot be staged the same way as other types of tumors. In the past the TMN system was used for staging brain tumors. [2] ||
 * **Radiation side effects:** || AlopeciaHeadaches
 * **Prognosis:** || The most important factors are location of the lesion, extent of surgical resection, and histopathologic factors. Also, age, tumor type, tumor grade, seizure symptoms, duration of symptoms, performance status, extent of resection, radiation doses. Neurologic function at diagnosis is an important prognostic factor. [2,5] ||
 * **Treatments:** || Treatment of choice is complete surgical resection if possible. This is difficult for tumors in the base of skull, cerebellopontine angle, or cavernous sinus. Post-surgical resection irradiation is recommended for subtotal resections. Radiation fields encompassing tumor volume plus a 2 cm margin are typically treated to doses of 50-54 Gy in 1.8-2.0 fractions. Larger margins (3 cm) should be used for malignant meningiomas and total dose should be 60 Gy in 1.8-2.0 Gy fractions.Wedged pairs, 3D conformal, or arc techniques are used to deliver dose and spare normal brain tissue. Smaller meningiomas can be treated with stereotactic radiosurgery. [2] ||
 * **TD 5/5:** || __ ORGAN WHOLE ⅔ ⅓ __
 * **References:** || [1] Hansen KE, Roach M. //Handbook of Evidence-Based Radiation Oncology//. 2nd ed. New York, NY: Springer; 2010.



||

Back to Week 2