2021 Volume 30 Issue 5 Pages 356-364
Treatment of WHO grade Ⅱ and Ⅲ meningiomas is challenging, and the number of grade Ⅱ meningiomas has increased after the recent revision of the WHO classification. In terms of surgical treatment, the benefit of gross total resection (GTR) to subtotal resection (STR) for grade Ⅱ meningiomas is well established, but it has not been established for grade Ⅲ meningiomas. In terms of postoperative radiotherapy (PORT), PORT is effective after STR but not after GTR for grade Ⅱ meningiomas. However, PORT benefits after GTR for grade Ⅱ meningiomas have been recently reported and these techniques are currently being investigated in ongoing phase Ⅲ clinical trials. There have also been reports that high-dose irradiation and particle beam irradiation, including boron neutron capture therapy, can benefit conventional radiotherapy, and their effectiveness is also being investigated in ongoing clinical trials. Despite poor prognoses, there have been reports about the benefits of radiotherapy for grade Ⅲ meningioma. The use of systemic therapy should only be considered for refractory tumors as salvage therapy because its effectiveness has been shown to be limited in clinical trials.
