Can “stereotactic” radiotherapy cure meningioma in the elderly?

In my 88-year-old mother, doctors found a one-centimeter meningioma in the posterior cranial fossa. It is not known what type it is (a biopsy with histological examination is problematic in such an elderly person). Monitoring will be used to see if it is getting bigger and how quickly, given that neurosurgery has age-related risks. Is this a correct approach? Could stereotactic radiotherapy be useful?

He replies Vittorio DonatoScientific Director INI Group, Rome (GO TO THE FORUM)

In the case of a meningioma in the elderly, the problem often arises biopsy of the lesion. In fact, the procedure is not easy to perform and an increase in possible complications is noted in these patients, as well as their difficult therapeutic management. There Radiotherapy can be a valid alternative to surgery, that remains Anyway the main therapeutic procedure. In the absence of a histological examination, radiotherapy treatment could only be carried out in the presence of an accurate diagnostic examination, such as magnetic resonance imaging, which precisely indicates the possible meningiomatous nature of the lesion, or in the presence of symptoms which invalidate the patient's quality of life. patient or, finally, if the lesion shows growth and enlargement over the years.

New radiotherapy techniques

I assume that your mother does not present neurological symptoms and therefore I am in agreement with colleagues who would like to monitor the lesion over time, in order to highlight any growth. This data could indicate her potential aggression and the possible urgency of an intervention. For what concern radiotherapy treatmentit will be possible to do it and with the most advanced techniques with modulated intensity in a high number of fractions, i.e. more than 25 applicationsor with stereotactic technique (which can deliver very high doses with great precision, ed). In your case, given the small size, it will be possible to perform a stereotactic treatment in a few fractions, or with radiosurgery in a single fraction.

Radiosurgery

clear that the stereotactic techniques, and especially radiosurgerywill have to be carried out in a highly specialized environment who has the specific skills for this type of intervention because the very high radiotherapy dose is delivered in a single administration. It is then clear that the choice of technique and fractionation will have to be set by the radiation oncologist based on the patient's condition, the morphological characteristics of the lesion, any proximity to organs at risk and finally on the basis of its biological aggressiveness.

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