Meningioma+(Child)

“Meningiomas grow slowly in a localized fashion from the dura, eventually compressing and encasing surrounding vascular or neural structures. They are often quite vascular.” “Atypical or malignant meningiomas may metastasize outside of the central nervous system, but this tends to be a feature of advanced/recurrent disease and does not occur with low-grade (WHO1) tumors. 1 || Grade I: benign Grade II: atypical Grade III: anaplastic Grade IV: sarcomatous The grading system has prognostic significance for behavior. 5 || 1. Tumor histology/Grading. 2. Labeling Undex using MIB-1 test. 3. Age of patient. 4. Extent of tumor residual. 5. Tumor location. 6. Functional neurologic status. 7. Metastatic spread. 6 ||  -Fatigue, skin irritation (on scalp) and neurologic deterioration can all occur during and shortly after the course of radiation treatment. 8  -Hormone deficiency (growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, and gonadotropins) can occur when the pituitary and hypothalamus receive a dose of 20 Gy or more. 3,8  -Hair loss (temporary or permanent) can occur with doses of 20-40 Gy and doses greater than 40 Gy, respectively. 8  -Optic neuropathy and brain necrosis can occur with doses over 60 Gy. 3  -Secondary malignancies in the bone, soft tissue or bone marrow can occur later in life. 3,8  -Late effects from high dose hyperfractionated regimens include: neurocognitive deficits, hearing loss, leukoencephalopathy, diffuse microhemorrhages, and dystrophic calcifications. 3 || <span style="color: #008000; font-family: Arial,Helvetica,sans-serif;"> The overall 5 year survival rate for children with a CNS tumor is 74%. <span style="color: #008000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">10 ||
 * Epidemiology: || <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">More common in females than males. There is no difference in incidence for race. <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">1 ||
 * Etiology: || <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif;">Head Trauma, Ionizing radiation, Gene on chromosome 22, Sex hormones, Breast Cancer . <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">8 ||
 * Signs & Symptoms: || <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif;">Focal neurologic dysfunction, increased intracranial pressure, hydrocephalus. The neurologic effects of the locally growing or infiltrating tumor may predict the tumor location. Headache ussually worse in the morning due to intracranial pressure. Optic atrophy or blindness. Seizures, back pain, bowel or bladder dysfunction. <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">3 ||
 * Diagnostic Procedures: || <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif;">CT lesion associated with dura. <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">8 ||
 * Histology: || <span style="color: #800000; font-family: Arial,Helvetica,sans-serif;">Meningiomas arise from cells of the archnoid membrane. Most of these tumors are benign . 4 ||
 * Lymph Node Drainage: || <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">According to the AJCC the reason that the N in the TNM staging doesn’t work for brain and spinal cord cancers is because the brain and spinal cord do not have lymph nodes . <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">2 ||
 * Metastatic Spread: || <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">“An M classification is not pertinent to the majority of neoplasms that affect the central nervous system, because most patients with tumors of the central nervous system do not live long enough to develop metastatic disease (except for some pediatric tumors that tend to “seed” through the cerebrospinal fluid spaces).” This phenomenon of “seeding” is rarely seen adults and is a hallmark for some childhood tumors. The M category of the TNM staging should help “differentiate between extraneural metastasis and metastasis within CNS and CSF pathways. ” <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">2
 * Grading: || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Meningiomas are benign tumors, although there are rare malignant meningiomas. The majority of meningiomas are classified as meningotheliomatous or syncitial, fibrous, transitional, or angioblastic. The World Health Organization (WHO) has developed a grading system, which scores architecture, celllularity, nuclear pleomorphism, mitotic figures, necrosis, and brain infiltration. Using the WHO scoring system, tumors are graded as:
 * Staging: || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">There is no formal staging system for meningioma because CNS tumors cannot be staged the same way as other types of tumors. For meningioma, doctors use 7 factors to establish the course of treatment and to determine prognosis:
 * Radiation Side Effects: || <span style="color: #008000; font-family: Arial,Helvetica,sans-serif;">The presence of these side effects varies due to tumor location, tumor size, and treatment technique/total dose. Late radiation side effects tend to be worse the younger a child is during treatment. <span style="color: #008000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">8
 * Prognosis: || <span style="color: #008000; font-family: Arial,Helvetica,sans-serif;">Prognosis is strongly related to tumor grade. <span style="color: #008000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">5
 * Treatments: || <span style="color: #800000; font-family: Arial,Helvetica,sans-serif;">Meningiomas are usually treated successfully by surgical removal. Surgery will establish the diagnosis, cure most meningiomas, and debulk those that cannot be excised completely. Increasing evidence shows that a number of meningiomas do not grow. If affected patients have only seizures that can be controlled easily by anticonvulsant medication, the tumor can be followed up with serial MRI. If the tumor does not grow, no further treatment in necessary.

In patients in whom only a partial resection or no resection is possible, radiotherapy either may prevent further growth of the tumor or may cause some shrinkage, but rarely, if ever, eradicates the tumor. Radiosurgery is being advocated increasingly for tumors smaller than 3 cm in surgically difficult areas, such as near a patent sagittal sinus or at the base of the brain. No established chemotherapy is used to treat these tumors. 4 ||
 * TD5/5: || <span style="color: #008000; font-family: Arial,Helvetica,sans-serif;">The following organs have the potential of being in the treatment field depending on tumor size and location.

Brain: 45Gy (whole), 50Gy (2/3), 60Gy (1/3) Brainstem (large tumors): 50Gy (whole), 53Gy (2/3), 60Gy (1/3) Cauda equina: 60 Gy Ear (acute serous otitis): 30Gy Ear (chronic serous otitis): 55Gy Lens: 10 Gy Optic Chiasm: 50 Gy Optic Nerve: 50 Gy Retina: 45 Gy Spinal Cord: 44 Gy (20cm), 50 Gy (10cm), 50 Gy (5cm) <span style="color: #008000; font-family: Arial,Helvetica,sans-serif; font-size: 80%; vertical-align: super;">9 || || <span style="font-family: Arial,Helvetica,sans-serif;">**References** 1. Gunderson and Tepper. Clinical Radiation Oncology. 2nd Edition. Philadelphia, PA: Churchill Livingstone. 2007. 2. Greene et al. Cancer Staging Handbook. 6th Edition. Chicago, Illinois: Eli Lilly and Company. 2001. 3. Chao KS, Perez CA, Brady LW. //<span style="font-family: Arial,Helvetica,sans-serif;">Radiation Oncology - Management Decisions. // <span style="font-family: Arial,Helvetica,sans-serif;"> 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 2002: 623-639. 4. Lenhard RE, Osteen RT, Gansler T. //<span style="font-family: Arial,Helvetica,sans-serif;">The American Cancer Society's Clinical Oncology //<span style="font-family: Arial,Helvetica,sans-serif;">. Atlanta: American Cancer Society. 2001:678-9. 5. Children's Hospital Boston. My Child has Meningioma. []. Accessed February 7, 2010. 6. Cancer.Net. Meningioma: Staging. []. Accessed February 11, 2010. 7. Kondziolka. //Radiosurgery//. Volume 6. Pittsburgh, Pa. Karger, 2006; 146. 8. Washington CM, Leaver D. //Principles and Practice of Radiation Therapy.// 2nd ed. Philadelphia, PA: Mosby, Inc; 2004:736-7, 880-1. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;"> 9. <span style="font-family: Arial,Helvetica,sans-serif;">RadiationOncology/Toxicity/Emami. [].Accessed February 10, 2010. 10. Cancer.Net. Central Nervous System Childhood. []. Accessed February 12, 2010.
 * Planning Photos || <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">Bilateral optic nerve meningioma treatment planning photos . 7

Ginnie is <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">bright blue <span style="font-family: Arial,Helvetica,sans-serif;">. Bridget is <span style="color: #008000; font-family: Arial,Helvetica,sans-serif;">dark green <span style="font-family: Arial,Helvetica,sans-serif;">. Sheri is <span style="color: #800000; font-family: Arial,Helvetica,sans-serif;">brown <span style="font-family: Arial,Helvetica,sans-serif;">. Zack is <span style="color: #ff00ff; font-family: Arial,Helvetica,sans-serif;">purple. <span style="font-family: Arial,Helvetica,sans-serif;"> Matthias is <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">red <span style="font-family: Arial,Helvetica,sans-serif;">.