Meningioma+(adult)

**Metastatic spread.** Meningioma rarely metastasizes to other parts of the body. One reason for this is that a meningioma is more self-contained than a tumor that forms elsewhere in the body. Another reason metastasis does not occur often with brain tumors is due to the fact that the brain does not have a well-formed lymph system to carry cancer cells elsewhere in the body. Cerebrospinal fluid can spread cancer cells, but this is rare with meningioma.¹⁴ || A grade I tumor does not have mitosis or necrosis. A grade II tumor is hypercellular and has mitosis and may have a limited degree of necrosis, but does not invade the adjacent brain. This is usually called “atypical.” A grade III tumor has necrosis and often shows brain invasion. This is usually called “anaplastic.”¹⁴ ||
 * Epidemiology: || The average of age of patients who have Meningioma is 50 years of age. Meningioma is the most common type of nongliomatous tumors. The most common sites of occurance are parasaggital area and anterior area of the skull.⁴ ||
 * Etiology: || "Meningiomas appear to be associated with breast cancer and this association may be genetic and/or hormonally linked." There is also an association linked with 22 chromosome abnormalities. Von Recklinghausen's neurofibromatosis.⁴ ||
 * Signs & Symptoms: || Localized headaches, seizure, focal presentation related to tumor location.⁵ ||
 * Diagnostic Procedures: || Workup as detailed by Chao, et. al. includes: complete history and physical, complete neurologic evaluation, CT or MRI head scan (or both) with contrast, positron emission tomography (PET) scan, complete blood count, cerebral spinal fluid chemistry tests, cytology and microbiology studies. Neurologic exam includes mental condition, coordination, sensation, reflexes and motor + cranial nerves. Ophthalmoscopy to check for papilledema, which indicates intracranial pressure. MRI contrast scan of the complete neuraxis for staging. Cerebral spinal fluid (CSF) cytology should be performed for any tumor that typically spreads through the CSF.This is particularly true of germ call tumor, primary neuroectodermal tumors (PNET), medulloblastoma and central nervous system (CNS) lymphoma.¹ ||
 * Histology: || Accoriding to Rubin, et. al.: meningiomas can be either benign or malignant and the histology of meningiomas varies greatly. Atypical meningioma is determined histologically by the number of mitotic divisions present in the cells per 10 high power fields in microscopy. If this activity is absent, the Mayo Clinic defines atypical meningioma histologically when 3 of the 5 following characteristics are present in the cells: a sheeting pattern of growth, no whorls and fascicles, small cells, hypercellularity, macronucleoli, necrosis (many time with pseudopalisading). Malignant meningioma has mitotic activity greater than 15 per 10 high power fields. The histology of malignant meningioma resembles sarcoma, melanoma or carcinoma. Rubin also classifies hemangiopericytomas as meningial sarcomas which present histologically with dense cellularity, "staghorn vessels", mitotic activity that varies and pale zones under microscopy.² ||
 * Lymph Node Drainage: || There is no lymphatic vasculature in the CNS and tumors of the CNS do not metastsize through lymphatics.³ ||
 * Metastatic Spread: ||
 * Grading: || In general, a meningioma is classified into one of three grades:
 * Staging: || There is no formal staging system for meningioma, because CNS tumors cannot be staged the same way as other types of tumors.¹⁴ ||
 * Radiation Side Effects: || General side effects include nausea and vomiting, radiation dermatitis, alopecia, fatigue, and decreased blood counts. If the ear is included, otitis externis, and high tone hearing loss can result. If the eye is treated then cataract formation can result as well as changes in visual acuity, visual field, or blindness in doses above 54 Gy.

Cranial treatment can result in decreased learning ability, deficits in short term memory, and difficulties with problem solving.¹² || If it is benign meningioma, complete surgical resection is desired. If the tumor is in the base of skull, then sub-total resection plus radiation is recommended.
 * Prognosis: || Prognostic indicators are location of the lesion, extent of surgical resection, and whether or not the tumor is benign or malignant. Also important are age, performance status, and tumor grade.¹³ ||
 * Treatments: || Treatment for meningioma consists of surgery and radiation.

For radiation of partially resected benign meningioma, a dose of 50 - 54 Gy is given in 1.8 or 2.0 Gy fractions. The margin is generally 2 cm beyond the gross tumor volume.

For radiation of partially resected malignant meningioma, a dose of 60 Gy in 1.8 or 2.0 Gy fractions. The margin is 3 cm beyond the gross tumor volume.

Radiation techniques can include, multiple wedged fields, arcs, or IMRT. For patients with smaller meningiomas, stereotactic radiosurgery can be the only treatment modality.¹² || Table 1. TD5/5, TD50/5 11 || __** 2. References**__ 1. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:132-133. 2. Nelson DF, Jenkins RB, Scheithauer BW, et. al. Central nervous system tumors. In: Rubin P, ed. //Clinical Oncology: A Multidisciplinary Approach// //for Physicians and Students//. 8th ed.Philadelphia, PA: W.B. Saunders Company; 2001:798. 3. Adams RD, Langlin L, Leaver D. Central nervous system. In: Washington CM, Leaver D, eds. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby; 2004:726-727.
 * TD5/5: || [[image:Cranio_and_Meningio.jpg width="710" height="408"]]

4. Philip Rubin, //Clinical Oncology - A Multidisciplinary Approach for Physicians and Students//. 7th edition. Philadelphia, PA: W.B. Saunders Company. 1993. 5. Washington CM, Leaver D, eds. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby; 2004. 6. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002 7. Gamma Knife Center at Beaumont [|http://www.beaumontgammaknife.com] Accessed January 13, 2010 8. UCL Cancer Institute [|www.ucl.ac.uk] Accessed January 13, 2010: Figure 2 9. Elekta [|http://blog.electa.com] Accessed January 13, 2010: Figure 3 and 4 10. Novalis Shaped Beam Surgery Center [|www.novalisaz.org] Accessed January 13, 2010: Figure 5 11. Wikibooks en.wikibooks.org TD5/5 adapted from Emami 1991 12. Chao KS, Perez CA. Brady LW. // Radiation Oncology - Management Decisions //. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins. 2002 13. Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby. 2004 14. [|www.cancer.net/meningioma]. Accessed January 11, 2010 none //Optional:// comment for page history

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