Advances in meningioma therapy.

Meningiomas are the most common primary brain tumors in adults. Most of them are benign (World Health Organization grade I), slow-growing lesions, but some are classified as atypical (WHO grade II) or malignant (WHO grade III). Surgical resection is curative when complete removal of a benign meningioma is possible. Incompletely resected tumors and high-grade lesions are frequently treated with fractionated radiotherapy or stereotactic radiosurgery. Radiotherapy effectively reduces recurrence rates with limited toxicity. High-grade meningiomas tend to recur following maximal treatment with surgery and radiation. Chemotherapeutic agents, including hydroxyurea, have been used for recurrent disease with marginal efficacy. As the molecular pathogenesis of meningiomas is elucidated, targeted drug therapies may prove useful. Angiogenesis inhibitors, agents that target fundamental cell signaling pathways, somatostatin analogues, and a variety of other molecular treatments appear promising.