{"product_id":"new-technology-in-radiation-treatment-for-brain-meningiomas-what-patients-should-know","title":"New Technology in Radiation Treatment for Brain Meningiomas: What Patients Should Know","description":"\u003cp\u003eMeningiomas are the most common tumors that start in the brain and spinal cord in the United States, making up more than 35% of primary central nervous system tumors. This review summarizes recent technological advances in radiotherapy for meningiomas, including external beam radiation therapy, proton therapy, and brachytherapy. The authors describe how artificial intelligence, a better understanding of meningioma biology, and molecular imaging are likely to change how these tumors are managed, affecting treatment effectiveness, efficiency, and safety.\u003c\/p\u003e\n\n\u003ch1\u003eNew Technology in Radiation Treatment for Brain Meningiomas: What Patients Should Know\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: What Are Meningiomas and Why Does Radiation Matter?\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#external-beam\"\u003eExternal Beam Radiotherapy: The Mainstay of Treatment\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#cyberknife\"\u003eCyberKnife: Robotic Precision Radiation\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#gammaknife\"\u003eGammaKnife: Focused Gamma-Ray Treatment\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#proton\"\u003eProton Therapy: A Different Kind of Radiation\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#brachytherapy\"\u003eBrachytherapy: Placing Radiation Directly in the Tumor\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#comparison\"\u003eComparing the Different Radiation Modalities\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#emerging\"\u003eEmerging Technologies: Artificial Intelligence and Molecular Imaging\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications: What This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations: What the Research Could Not Prove\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eMeningiomas are the most common primary brain and spinal cord tumors in the US, making up over 35% of primary CNS tumors.\u003c\/li\u003e\n\u003cli\u003eRadiotherapy is used when surgery is impossible or incomplete, for high-grade tumors, or when tumors recur after treatment.\u003c\/li\u003e\n\u003cli\u003eCyberKnife and GammaKnife are precise radiosurgery platforms; GammaKnife has sharper dose fall-off, CyberKnife generally allows quicker treatment.\u003c\/li\u003e\n\u003cli\u003eProton therapy spares normal tissue by depositing energy at a specific depth, but it is costly and less widely available.\u003c\/li\u003e\n\u003cli\u003eBrachytherapy places radioactive sources directly in or near the tumor; it is invasive and carries a risk of radiation necrosis.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: What Are Meningiomas and Why Does Radiation Matter?\u003c\/h2\u003e\n\n\u003cp\u003eMeningiomas are the most common tumors of the central nervous system (CNS, which includes the brain and spinal cord). They make up more than 35% of primary CNS tumors in the United States. These tumors start from arachnoid cells, which form the middle protective layer covering the brain. Meningiomas usually grow slowly.\u003c\/p\u003e\n\n\u003cp\u003eSince 1993, the World Health Organization (WHO) has classified meningiomas into three grades based on how the tumor cells look under a microscope:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eWHO Grade I (benign):\u003c\/strong\u003e About 80% of cases. These tumors are slow-growing and non-cancerous.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eWHO Grade II (atypical):\u003c\/strong\u003e About 18% of cases. These tumors grow somewhat faster and are more likely to return.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eWHO Grade III (malignant):\u003c\/strong\u003e About 2% of cases. These tumors grow quickly and are the most aggressive.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe WHO grading system was updated in 2000, 2007, 2016, and 2021. The percentages above reflect the 2021 revision.\u003c\/p\u003e\n\n\u003cp\u003eHow a meningioma is treated depends on several factors. These factors include the patient's age, the tumor's size, the tumor's histological grade (how the cells look under a microscope), and molecular data (genetic and protein markers).\u003c\/p\u003e\n\n\u003cp\u003eSurgery is the main treatment for symptomatic Grade I meningiomas that can be safely removed. Small, asymptomatic Grade I tumors can often simply be watched over time. Complete surgical removal is the goal when possible. However, about one-third of meningiomas cannot be removed by surgery. This is usually because of where the tumor is located or other medical considerations.\u003c\/p\u003e\n\n\u003cp\u003eRadiotherapy (radiation treatment) plays a critical role in meningioma care. It is especially important when surgery is impossible or incomplete, when the tumor is high-grade, or when tumors come back after treatment. Extensive evidence supports using radiotherapy for Grade I disease. Current National Comprehensive Cancer Network (NCCN) guidelines recommend radiotherapy as a primary treatment for selected Grade I meningiomas. The guidelines also recommend radiotherapy after surgery for incompletely removed Grade II tumors and for all Grade III tumors.\u003c\/p\u003e\n\n\u003cp\u003eA range of radiotherapy techniques are used to treat meningiomas. These include three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (SRT), brachytherapy, and proton therapy. This review summarizes recent technological advances that may influence how radiotherapy is used for meningiomas.\u003c\/p\u003e\n\n\u003ch2 id=\"external-beam\"\u003eExternal Beam Radiotherapy: The Mainstay of Treatment\u003c\/h2\u003e\n\n\u003cp\u003eConventional linear accelerator (LINAC)-based radiotherapy has become increasingly important for meningioma management. This is particularly true when complete surgical removal is not possible. A linear accelerator produces high-energy photon beams (X-ray beams) that can be precisely shaped and directed using advanced image guidance and multi-leaf collimators (devices that shape the beam).\u003c\/p\u003e\n\n\u003cp\u003eThe LINAC's isocentric setup aligns the gantry, couch, and collimator around a single point. This allows non-coplanar beam angles that minimize radiation exposure to surrounding normal tissues. Using flattening filter-free (FFF) beams can further increase dose rates, which shortens treatment durations.\u003c\/p\u003e\n\n\u003cp\u003eSRS and SRT using conventional LINAC systems offer versatility for a wide spectrum of tumor sizes and locations. A notable development is Varian HyperArc, an automated non-coplanar planning and delivery system. HyperArc combines multiple optimized arcs with automated planning algorithms. This refines dose conformity for complex or multiple lesions while limiting normal tissue exposure.\u003c\/p\u003e\n\n\u003cp\u003eIn a dosimetric study by Snyder and colleagues, 12 patients with skull base meningiomas were retrospectively planned using HyperArc. The resulting treatment plans achieved high target coverage with decreased normal brain dose and superior treatment efficiency.\u003c\/p\u003e\n\n\u003cp\u003eNumerous retrospective analyses confirm the efficacy and safety of LINAC-based SRS for WHO Grade I meningiomas. Key findings include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003ePou and colleagues found 100%, 98.4%, and 92.6% local control at 1, 5, and 10 years, respectively, in 60 patients.\u003c\/li\u003e\n\u003cli\u003eAnother study of 241 patients with skull base meningiomas revealed a 91.2% tumor control rate over a median follow-up of 102 months. The 5-, 10-, and 14-year progression-free survival (PFS) rates exceeded 85%.\u003c\/li\u003e\n\u003cli\u003eGawish and colleagues, in a cohort of 36 patients, observed 95% local control at 2 years and 70% at 5 years.\u003c\/li\u003e\n\u003cli\u003eAlatriste-Martínez and colleagues reported a 93% local control rate over 68 months.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese results confirm that LINAC-based SRS or SRT can yield durable outcomes with minimal morbidity (side effects).\u003c\/p\u003e\n\n\u003cp\u003eLINAC-based therapy also benefits atypical meningiomas and tumors in surgically challenging locations. Ortiz García and colleagues demonstrated 95% local tumor control in cerebellopontine angle meningiomas, with an average volume reduction of 32.8% over nearly 87 months.\u003c\/p\u003e\n\n\u003cp\u003eA European Phase II study called EORTC 22042-26042 is examining high-dose postoperative radiotherapy for atypical and malignant meningiomas. Preliminary findings suggest that dose escalation can improve tumor control with manageable toxicity.\u003c\/p\u003e\n\n\u003cp\u003eZeng and colleagues retrospectively evaluated 118 patients with WHO Grade II or III disease. They compared standard-dose (less than 66 Gy) and escalated-dose (66 Gy or higher) radiotherapy. The escalated-dose group showed higher progression-free survival rates: 78.9%, 72.2%, and 64.6% at 3, 4, and 5 years, respectively. The escalated-dose group also had reduced local failure.\u003c\/p\u003e\n\n\u003cp\u003eSeveral prospective trials are further investigating the role of postoperative radiotherapy in meningioma management:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003e\n\u003cstrong\u003eRTOG 0539\u003c\/strong\u003e (ClinicalTrials.gov Identifier: NCT00895622) is a phase II, risk-stratified study assessing fractionated external beam radiotherapy for diverse meningioma subgroups after resection.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eNRG-BN-003\u003c\/strong\u003e (ClinicalTrials.gov Identifier: NCT03180268) is a phase III trial examining whether adjuvant radiotherapy can improve outcomes in newly diagnosed atypical meningiomas.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eResults from these and other investigations will likely refine standard-of-care guidelines. They will also help optimize local tumor control strategies across different meningioma grades.\u003c\/p\u003e\n\n\u003ch2 id=\"cyberknife\"\u003eCyberKnife: Robotic Precision Radiation\u003c\/h2\u003e\n\n\u003cp\u003eCyberKnife (CK) is a specialized robotic stereotactic treatment system. It is designed to deliver high-precision, image-guided radiation treatment. CyberKnife features a compact linear accelerator mounted on a multi-axis robotic arm. This enables radiation delivery from numerous non-coplanar angles.\u003c\/p\u003e\n\n\u003cp\u003eUnlike conventional C-Arm LINAC systems, CyberKnife near-continuously tracks the tumor using orthogonal X-ray imaging. This detects and corrects any motion during treatment. This near real-time tracking, combined with submillimeter accuracy, allows clinicians to deliver prescription doses while sparing nearby critical structures. These structures include the optic apparatus (vision pathways), cranial nerves, and sensitive brain regions. CyberKnife also supports hypofractionated regimens (fewer, larger doses), making it suitable for tumors considered too large or complex for traditional radiosurgery.\u003c\/p\u003e\n\n\u003cp\u003eNumerous clinical studies report favorable local control and low toxicity. These findings support CyberKnife's role as a minimally invasive alternative or complement to surgery.\u003c\/p\u003e\n\n\u003cp\u003eSeveral retrospective investigations highlight CyberKnife's effectiveness for small, benign WHO Grade I meningiomas:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eNguyen and colleagues evaluated 62 patients (67 meningiomas) treated with SRT. They found 94.4% local control over a median follow-up of 64.7 months. The 5-year PFS and overall survival (OS) rates were 85.2% and 91.0%, respectively.\u003c\/li\u003e\n\u003cli\u003eRuge and colleagues reported 97.7% local control among 188 patients (218 meningiomas) treated with single-fraction SRS.\u003c\/li\u003e\n\u003cli\u003eManabe and colleagues studied 41 patients with WHO Grade I intracranial meningiomas treated with CyberKnife-based SRS or SRT. They achieved local tumor control in 86% of cases over a median follow-up of 49 months.\u003c\/li\u003e\n\u003cli\u003eAnother investigation involving 156 skull base meningiomas treated with multisession SRS attained 95% local tumor control at 36.6 months. The 2-, 5-, and 10-year PFS rates were 95%, 90%, and 80.8%.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCollectively, these findings confirm robust tumor control and minimal morbidity in Grade I disease.\u003c\/p\u003e\n\n\u003cp\u003eCyberKnife also shows promise for complex, inoperable meningiomas. In 13 patients with olfactory groove meningiomas (OGMs, tumors near the sense of smell), Liu and colleagues found 100% local control over 48 months. The median tumor volume reduction was 31.7%.\u003c\/p\u003e\n\n\u003cp\u003eAmong 167 patients with perioptic meningiomas (tumors near the optic nerve), local control reached 95.2% at a median follow-up of 51 months. These patients also had high PFS rates at 3, 5, and 8 years.\u003c\/p\u003e\n\n\u003cp\u003eMalone and colleagues reported on a single case of an unresectable foramen magnum meningioma treated with 30 Gy in 5 fractions. This achieved 8-year local control and a 30% reduction in tumor volume without adverse effects.\u003c\/p\u003e\n\n\u003cp\u003eHong and colleagues, in a study of 113 patients with central skull base meningiomas, observed 98% local control at 49 months. This highlights CyberKnife's capacity to deliver therapeutic doses while preserving neurological function.\u003c\/p\u003e\n\n\u003cp\u003eAlthough high-grade meningiomas are more challenging, CyberKnife can still provide meaningful tumor control with acceptable toxicity. Acker and colleagues demonstrated local control rates of 97%, 77%, and 67% at 12, 36, and 60 months, respectively, for WHO Grade II lesions. For Grade III lesions, the local control rate was 66% at 12 and 24 months.\u003c\/p\u003e\n\n\u003cp\u003eIn another study of 102 WHO Grade II and 4 WHO Grade III meningiomas, 45% of lesions remained stable over time. Patients experienced mild toxicities, and there were no reported cases of radionecrosis (tissue death caused by radiation). These data underscore CyberKnife's viability for a wide range of meningioma grades, particularly when surgical resection is not possible or is incomplete.\u003c\/p\u003e\n\n\u003ch2 id=\"gammaknife\"\u003eGammaKnife: Focused Gamma-Ray Treatment\u003c\/h2\u003e\n\n\u003cp\u003eGammaKnife (GK) is a dedicated stereotactic radiosurgery platform. It uses multiple cobalt-60 sources to deliver highly focused gamma-ray beams for intracranial lesions, including meningiomas. Advances in imaging, planning software, and delivery techniques facilitate both single-fraction and hypofractionated treatment protocols.\u003c\/p\u003e\n\n\u003cp\u003eThe introduction of newer GammaKnife platforms, such as GammaKnife Icon, has further broadened therapeutic capabilities. GammaKnife Icon features on-board imaging and frameless immobilization. This enables fractionated stereotactic treatment on this platform.\u003c\/p\u003e\n\n\u003cp\u003eA large body of data supports GammaKnife's efficacy for benign WHO Grade I meningiomas:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eIn a 10-year retrospective study, Lippitz and colleagues reported 87.8% local tumor control among 86 patients (130 tumors).\u003c\/li\u003e\n\u003cli\u003eGe and colleagues, analyzing 130 patients treated with GammaKnife SRS, noted a 94.6% tumor control rate over a median follow-up of 36.5 months. Neurological symptoms improved in almost one-third of patients.\u003c\/li\u003e\n\u003cli\u003eNaik and colleagues documented 96.3% control in Grade I lesions. This dropped to 62.5% in Grade II, illustrating the impact of histology (tissue type) on outcomes.\u003c\/li\u003e\n\u003cli\u003eA dose-staged approach achieved 97.2% local control over 36 months, with no significant long-term neurological deficits.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCollectively, these studies validate GammaKnife as a safe and effective modality for benign meningiomas. This is especially true when resection is incomplete or poses excessive risks.\u003c\/p\u003e\n\n\u003cp\u003eGammaKnife has also been shown effective for meningiomas in rare or difficult locations:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eDaza-Ovalle and colleagues reported a 94.7% local control rate for intraventricular meningiomas (tumors inside the brain's fluid-filled spaces). The 5- and 10-year PFS rates were 95% and 85%.\u003c\/li\u003e\n\u003cli\u003eHung and colleagues recorded 92% control for cavernous sinus meningiomas.\u003c\/li\u003e\n\u003cli\u003eAbdallah and colleagues documented 100% and 83% local control at 5 and 10 years for lesions at the confluence of the falx and tentorium (membranes that separate parts of the brain).\u003c\/li\u003e\n\u003cli\u003eAkyoldas and colleagues attained 100% control for anterior clinoid process meningiomas over 75 months.\u003c\/li\u003e\n\u003cli\u003eHa and colleagues reported a 91.1% PFS at 5 years for petroclival meningiomas, dropping to nearly 70% at 10 years.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese outcomes highlight GammaKnife's capacity to spare vital structures while delivering definitive treatment in anatomically challenging scenarios.\u003c\/p\u003e\n\n\u003cp\u003eFor higher-grade tumors (WHO Grade II and III), GammaKnife SRS can serve as an adjunct or alternative when complete resection is unfeasible. Migliorati and colleagues evaluated 47 WHO Grade II meningiomas. Among 24 treated with GammaKnife for residual or recurrent lesions, 87.5% remained controlled at 20 to 23 months.\u003c\/p\u003e\n\n\u003cp\u003eKim and colleagues reported a 50% local control rate over a median follow-up of 106.5 months in recurrent or residual Grade II and III lesions. This illustrates the difficulty posed by higher-grade disease. These rates are lower compared to those for benign disease. GammaKnife SRS can still offer meaningful tumor stabilization and palliation (symptom relief). This is when surgery is limited by anatomical constraints or patient factors.\u003c\/p\u003e\n\n\u003ch2 id=\"proton\"\u003eProton Therapy: A Different Kind of Radiation\u003c\/h2\u003e\n\n\u003cp\u003eProton therapy (PT) is an advanced form of radiotherapy that uses protons (positively charged particles) to treat tumors and other diseases. In contrast to photon-based or electron-based radiotherapy, proton beams exhibit distinct physical properties. These include a finite range and a steep dose gradient at the Bragg peak.\u003c\/p\u003e\n\n\u003cp\u003eAs protons travel through tissue, their energy deposition increases at a specific depth (the Bragg peak). This minimizes exit dose and thereby limits irradiation of normal tissues. This characteristic can be especially valuable for meningiomas located near critical structures such as the brainstem, optic apparatus, and hippocampus.\u003c\/p\u003e\n\n\u003cp\u003eA comparative planning study analyzed intensity-modulated proton therapy (IMPT), volumetric arc therapy (VMAT), and IMRT for skull-base meningiomas. The study found that IMPT significantly improved dose conformity and reduced bilateral hippocampal and mean brain dose.\u003c\/p\u003e\n\n\u003cp\u003eIn a review by Weber and colleagues, about 500 WHO Grade I meningioma patients treated with upfront proton therapy or salvage proton therapy demonstrated excellent local control and minimal toxicities. However, Grade II and III tumors required more careful evaluation.\u003c\/p\u003e\n\n\u003cp\u003eHoltzman and colleagues reported outcomes in 59 WHO Grade I patients who received a median dose of 50.4 Gy RBE (relative biological effectiveness). These patients showed an 87% 5-year actuarial overall survival rate and a 2% rate of Grade 3 or higher toxicities.\u003c\/p\u003e\n\n\u003cp\u003eIannalfi and colleagues retrospectively examined 167 meningioma patients receiving pencil-beam scanning (PBS) proton therapy. Among these, 73 were WHO Grade I, 26 were Grade II, and 3 were Grade III. The median prescribed dose was 55.8 Gy for benign or radiologically diagnosed meningiomas and 66 Gy for atypical or anaplastic lesions. Five-year local recurrence-free survival (LRFS) was 98% for benign or radiologically diagnosed tumors and 47% for higher-grade lesions. There were limited Grade 3 toxicities and no Grade 4 or 5 events.\u003c\/p\u003e\n\n\u003cp\u003eProton therapy also has applications in re-irradiation settings (treating tumors that have returned after previous radiation). Imber and colleagues studied 16 patients (7 WHO Grade I, 8 Grade II, and 1 Grade III) who underwent proton therapy re-irradiation. The median dose was 60 Gy RBE, yielding 1-year and 2-year PFS rates of 80% and 43%, respectively.\u003c\/p\u003e\n\n\u003cp\u003eIn a larger series by Scartoni and colleagues, 32 recurrent meningioma patients re-irradiated with PBS reported similar outcomes using median doses around 54 Gy RBE.\u003c\/p\u003e\n\n\u003cp\u003eWith the emergence of advanced imaging, prognostic biomarkers may improve patient stratification. Buizza and colleagues identified diffusion-weighted MRI parameters, such as diffusion coefficient and apparent cellularity. These parameters can aid in assessing tumor grading and therapy response at a microscale. This is for patients who receive proton therapy.\u003c\/p\u003e\n\n\u003cp\u003eHowever, proton therapy remains costly. More robust evidence is awaited from ongoing trials (ClinicalTrials.gov Identifier: NCT01117844, NCT02693990, and NCT02978677) that are evaluating its efficacy for meningioma management.\u003c\/p\u003e\n\n\u003ch2 id=\"brachytherapy\"\u003eBrachytherapy: Placing Radiation Directly in the Tumor\u003c\/h2\u003e\n\n\u003cp\u003eBrachytherapy (BT) involves placing radioactive sources in or near the target tissue. In the context of recurrent high-grade meningiomas, permanent seed implants with isotopes like Iodine-125 (I-125) or Cesium-131 (Cs-131) have been used as adjuvant therapy after resection.\u003c\/p\u003e\n\n\u003cp\u003eCs-131 is a newer isotope with a shorter half-life (9.7 days versus 59.4 days for I-125) and lower mean energy of 30 keV. It rapidly delivers half its therapeutic dose within the first 10 days. Both isotopes emit low-energy photons, limiting tissue penetration to a few millimeters. This makes them suitable only when minimal residual tumor remains.\u003c\/p\u003e\n\n\u003cp\u003eBrachytherapy offers several theoretical benefits for recurrent meningioma:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eReduced radiation exposure to normal tissue by using low-energy photon-emitting isotopes.\u003c\/li\u003e\n\u003cli\u003eImmediate radiotherapy initiation after resection, when tumor burden is lowest.\u003c\/li\u003e\n\u003cli\u003eIntraoperative placement of sources for precise targeting.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eMultidisciplinary collaboration among neurosurgery, radiation oncology, and medical physics is crucial for planning and performing brachytherapy implants.\u003c\/p\u003e\n\n\u003cp\u003eMagill and colleagues documented outcomes for 42 patients (50 resections) with recurrent high-grade meningiomas treated with I-125 brachytherapy. The median time to progression after resection plus I-125 brachytherapy was 20.9 months for atypical and 11.4 months for malignant meningiomas. Median survival was 3.5 years and 2.3 years, respectively. Nineteen percent of patients experienced radiation necrosis.\u003c\/p\u003e\n\n\u003cp\u003eIn a separate series using Cs-131 seeds, Chen and colleagues treated 12 recurrent atypical (n = 7) or anaplastic (n = 5) meningiomas. The prescription dose was 80 Gy to 5 mm from the resection cavity using stranded Cs-131 seeds. One-year local control was 100%, and overall survival reached 91.7%.\u003c\/p\u003e\n\n\u003cp\u003eBander and colleagues similarly used Cs-131 with a prescription dose of 80 Gy for 15 patients (Grade I to III). They noted 73.3% 1-year survival and 83.3% local control.\u003c\/p\u003e\n\n\u003cp\u003eAnother single-center retrospective study by Mooney and colleagues employed both I-125 and Cs-131 seeds embedded in an absorbable mesh. This achieved a 100 Gy minimum peripheral dose at 5 mm from the cavity margin for 11 recurrent high-grade meningiomas. Six-month and 12-month PFS rates were 92.3% and 84.6%, respectively. These patients demonstrated improved PFS compared with controls without brachytherapy, although at the cost of a higher incidence of radiation necrosis.\u003c\/p\u003e\n\n\u003cp\u003eGammaTile is an emerging brachytherapy platform. It uses a modular resorbable collagen-based seed carrier with radioisotope Cs-131. GammaTile has attracted interest for treating recurrent meningioma, glioblastoma, and brain metastasis. Each tile measures 2 cm x 2 cm x 4 mm and contains four Cs-131 titanium-encased sources. The center of each Cs-131 seed is spaced 1 cm apart from one another, and the seeds are spaced 3 mm from the surface of the tile that faces the brain parenchyma.\u003c\/p\u003e\n\n\u003cp\u003eUnlike traditional loose seeds or stranded seeds, GammaTile consists of a layer of collagen. This collagen serves as a spacer to avoid direct contact of Cs-131 seeds with the brain parenchyma. This potentially reduces the risk of high-dose-induced necrosis. The design and adherence of the collagen matrix can minimize seed migration after implantation and maintain source spacing after placement.\u003c\/p\u003e\n\n\u003cp\u003eBrachman and colleagues studied the combination of maximum safe resection and adjuvant radiotherapy using permanent intracranial brachytherapy GammaTile. This study included patients with recurrent, previously irradiated aggressive meningiomas. The median brachytherapy radiation dose was 63 Gy (range 54 to 80 Gy). The study included 19 patients with 20 recurrent tumors, including 4 WHO Grade I, 14 WHO Grade II, and 2 WHO Grade III. At a median radiographic follow-up of 15.4 months (range 0.03 to 47.5 months), local failure occurred in 2 cases within 1.5 cm of the implant bed. This study demonstrated surgery and brachytherapy with GammaTile to be a safe and effective treatment option for recurrent aggressive meningiomas.\u003c\/p\u003e\n\n\u003cp\u003eThere is an ongoing registry study (ClinicalTrials.gov Identifier: NCT04427384) to evaluate real-world clinical outcomes and patient-reported outcomes. This study measures the effectiveness and safety of using GammaTiles on brain tumors, including meningiomas.\u003c\/p\u003e\n\n\u003ch2 id=\"comparison\"\u003eComparing the Different Radiation Modalities\u003c\/h2\u003e\n\n\u003cp\u003eEach modality for treating meningiomas demonstrated its own distinct advantages and limitations. Understanding these differences can help patients and their care teams make informed decisions.\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eProton therapy\u003c\/strong\u003e shows beneficial dosimetry in treatment planning. However, this treatment modality is not as easily accessible as other photon-based treatment methods, and the cost for proton therapy is higher.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eBrachytherapy\u003c\/strong\u003e accessibility for meningioma management is also inferior to other modalities, and it is an invasive procedure.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eGammaKnife\u003c\/strong\u003e has a unique machine geometry that produces a sharper penumbra (dose fall-off). This results in quicker dose fall-off in plan dosimetry to spare healthy brain tissue.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eCyberKnife\u003c\/strong\u003e allows quicker treatment compared with GammaKnife, due to a higher dose rate in general.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"emerging\"\u003eEmerging Technologies: Artificial Intelligence and Molecular Imaging\u003c\/h2\u003e\n\n\u003cp\u003eIn the past few years, there have been rapid advancements in artificial intelligence (AI), understanding of meningioma biology, and molecular imaging. These advances will likely impact the clinical management of meningiomas, including treatment efficacy, efficiency, and safety.\u003c\/p\u003e\n\n\u003cp\u003eMachine learning (ML) and deep learning (DL) approaches have been applied to predict meningioma grading using MRI images before surgery. A few studies on radiomics (extracting quantitative data from medical images) have concentrated on this application.\u003c\/p\u003e\n\n\u003cp\u003eMorin and colleagues developed prognostic models for tumor grade, local failure (LF), and overall survival (OS) in meningioma patients. They used radiologic and radiomic features, including apparent diffusion coefficient and sphericity, extracted from preoperative MR images. Compared to models based on clinical features alone, models combining clinical, radiologic, and radiomic features demonstrated improved prediction accuracy for meningioma grade, local failure, and overall survival.\u003c\/p\u003e\n\n\u003cp\u003eThe same group of researchers developed integrated models taking into consideration all available demographic, clinical, radiographic, and pathologic data. With the integrated models, decision trees and nomograms were developed to identify patients with different risks of local failure or overall survival. These predictive models can be used as a decision support tool to provide individualized patient care.\u003c\/p\u003e\n\n\u003cp\u003eFunctional imaging modalities, including positron emission tomography (PET), are of particular interest for the detection and spatial assessment of meningiomas. In the vast majority of meningiomas of all grades, overexpression of somatostatin receptors (SSTR) is present.\u003c\/p\u003e\n\n\u003cp\u003eSeveral radiolabeled PET tracers targeting SSTR have been evaluated for assisting accurate target delineation. These include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e68Ga-DOTA-Tyr3-octreotide (68Ga-DOTATOC)\u003c\/li\u003e\n\u003cli\u003e68Ga-DOTA-D-Phe1-Tyr3-octreotate (68Ga-DOTATATE)\u003c\/li\u003e\n\u003cli\u003e68Ga-DOTA-l-Nal3-octreotide (68Ga-DOTANOC)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eMultiple studies supported the use of PET imaging with SSTR tracers for meningioma target volume delineation in treatment planning. This is especially important for SRS\/SRT treatment, where the margin is smaller.\u003c\/p\u003e\n\n\u003cp\u003eA joint practice guideline by EANM\/EANO\/RANO\/SNMMI for diagnostics and therapy of meningiomas using radiolabeled SSTR ligands was recently published. This guideline aims to harmonize data acquisition and interpretation across centers and facilitate comparability studies.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications: What This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eThe technological advances described in this review have several important implications for patients with meningiomas.\u003c\/p\u003e\n\n\u003cp\u003eFirst, patients now have access to a wider range of radiation treatment options than ever before. Each modality offers specific advantages depending on the tumor's size, location, grade, and the patient's overall health. This means that treatment can be more personalized to each patient's situation.\u003c\/p\u003e\n\n\u003cp\u003eSecond, the precision of modern radiation techniques has improved dramatically. Technologies like CyberKnife and GammaKnife can deliver high doses of radiation to the tumor while sparing nearby critical structures. This reduces the risk of side effects and complications.\u003c\/p\u003e\n\n\u003cp\u003eThird, for patients with high-grade or recurrent meningiomas, newer approaches like brachytherapy with GammaTile offer additional treatment options. These options may provide meaningful tumor control when other treatments have been exhausted.\u003c\/p\u003e\n\n\u003cp\u003eFourth, emerging technologies like artificial intelligence and molecular imaging may soon allow doctors to predict which tumors are more likely to recur. This could help tailor treatment intensity to each patient's risk level.\u003c\/p\u003e\n\n\u003cp\u003eHowever, patients should be aware that access to some of these technologies may be limited. Proton therapy and brachytherapy are not as widely available as conventional radiation treatments. Cost may also be a consideration for some patients.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations: What the Research Could Not Prove\u003c\/h2\u003e\n\n\u003cp\u003eThis review summarizes findings from many studies, but several limitations should be noted.\u003c\/p\u003e\n\n\u003cp\u003eMany of the studies described are retrospective, meaning they looked back at patient records rather than assigning patients to different treatments in a controlled way. Retrospective studies can show associations but cannot prove that one treatment is better than another.\u003c\/p\u003e\n\n\u003cp\u003eSome of the studies had small numbers of patients, particularly those examining brachytherapy and proton therapy for high-grade meningiomas. Small studies may not capture rare side effects or long-term outcomes.\u003c\/p\u003e\n\n\u003cp\u003eFollow-up times varied across studies. Some outcomes, particularly for slow-growing Grade I meningiomas, may not be fully captured with shorter follow-up periods.\u003c\/p\u003e\n\n\u003cp\u003eThe review notes that proton therapy remains costly, and more robust evidence is awaited from ongoing trials. Similarly, brachytherapy accessibility is inferior to other modalities, and it is an invasive procedure.\u003c\/p\u003e\n\n\u003cp\u003eDirect comparisons between different radiation modalities are limited. Most studies examined one modality at a time, making it difficult to determine which approach is best for specific patient scenarios.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on this review, patients with meningiomas should consider the following:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003e\n\u003cstrong\u003eDiscuss all treatment options with your care team.\u003c\/strong\u003e Radiation therapy is an important treatment for many meningiomas, especially when surgery is not possible or incomplete. Ask about the different radiation modalities available at your treatment center.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eAsk about tumor grade and molecular markers.\u003c\/strong\u003e The grade of your meningioma (I, II, or III) significantly affects treatment recommendations and outcomes. Molecular data may also inform treatment decisions.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eInquire about specialized techniques.\u003c\/strong\u003e If your tumor is near critical structures like the optic nerve or brainstem, ask whether specialized techniques like CyberKnife, GammaKnife, or proton therapy might be appropriate.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eConsider clinical trials.\u003c\/strong\u003e Several ongoing trials are evaluating new approaches for meningioma treatment. Ask your doctor whether any clinical trials might be suitable for your situation.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eUnderstand the risks and benefits.\u003c\/strong\u003e All radiation treatments carry some risk of side effects, including radiation necrosis. Discuss these risks with your care team and weigh them against the benefits of tumor control.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSeek care at a center with experience.\u003c\/strong\u003e Multidisciplinary collaboration among neurosurgery, radiation oncology, and medical physics is crucial for optimal outcomes, especially for complex cases.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat are meningiomas and how common are they?\u003c\/h3\u003e\n\u003cp\u003eMeningiomas are the most common tumors that start in the brain and spinal cord in the United States. They make up more than 35% of primary central nervous system tumors. They start from arachnoid cells, which form the middle protective layer covering the brain. Most grow slowly. The World Health Organization classifies them into three grades: Grade I (about 80% of cases), Grade II (about 18%), and Grade III (about 2%).\u003c\/p\u003e\n\u003ch3\u003eWhen is radiation therapy used for meningiomas?\u003c\/h3\u003e\n\u003cp\u003eRadiotherapy is important when surgery is impossible or incomplete, when the tumor is high-grade, or when tumors come back after treatment. Current NCCN guidelines recommend radiotherapy as a primary treatment for selected Grade I meningiomas. They also recommend radiotherapy after surgery for incompletely removed Grade II tumors and for all Grade III tumors. About one-third of meningiomas cannot be removed by surgery, usually because of location or other medical considerations.\u003c\/p\u003e\n\u003ch3\u003eWhat is the difference between CyberKnife and GammaKnife?\u003c\/h3\u003e\n\u003cp\u003eCyberKnife is a robotic system that uses a compact linear accelerator on a multi-axis robotic arm and near-continuously tracks the tumor with X-ray imaging. GammaKnife uses multiple cobalt-60 sources to deliver focused gamma-ray beams. GammaKnife produces a sharper dose fall-off to spare healthy brain tissue. CyberKnife generally allows quicker treatment due to a higher dose rate. Both are used for meningiomas, including difficult locations.\u003c\/p\u003e\n\u003ch3\u003eWhat is proton therapy and who might it suit?\u003c\/h3\u003e\n\u003cp\u003eProton therapy uses protons (positively charged particles) that deposit most of their energy at a specific depth, called the Bragg peak. This minimizes exit dose and limits irradiation of normal tissues. It may be valuable for meningiomas near critical structures such as the brainstem, optic apparatus, and hippocampus. In a review of about 500 WHO Grade I patients, proton therapy showed excellent local control and minimal toxicities. It remains costly and less widely available.\u003c\/p\u003e\n\u003ch3\u003eWhat is brachytherapy and when is it considered?\u003c\/h3\u003e\n\u003cp\u003eBrachytherapy involves placing radioactive sources in or near the tumor. For recurrent high-grade meningiomas, permanent seed implants with isotopes like Iodine-125 or Cesium-131 have been used after resection. GammaTile is an emerging platform using a resorbable collagen-based carrier with Cesium-131. Brachytherapy is invasive and less accessible than other modalities. It may offer tumor control when other treatments have been exhausted, but carries a risk of radiation necrosis.\u003c\/p\u003e\n\u003ch3\u003eWhat side effects and risks are associated with radiation for meningiomas?\u003c\/h3\u003e\n\u003cp\u003eAll radiation treatments carry some risk of side effects, including radiation necrosis (tissue death caused by radiation). In one series of 42 patients with recurrent high-grade meningiomas treated with I-125 brachytherapy, 19% experienced radiation necrosis. In a study of 59 WHO Grade I patients receiving proton therapy, the rate of Grade 3 or higher toxicities was 2%. Discuss risks with your care team and weigh them against the benefits of tumor control.\u003c\/p\u003e\n\u003ch3\u003eHow might artificial intelligence and molecular imaging change meningioma care?\u003c\/h3\u003e\n\u003cp\u003eMachine learning and deep learning have been applied to predict meningioma grading from MRI images before surgery. Models combining clinical, radiologic, and radiomic features improved prediction accuracy for tumor grade, local failure, and overall survival compared to clinical features alone. Molecular imaging with PET tracers targeting somatostatin receptors helps delineate tumor targets for radiation planning. These advances may allow more personalized treatment and prediction of recurrence risk.\u003c\/p\u003e\n\u003ch3\u003eMy meningioma is near my optic nerve and I've been offered radiation — when should I get a second opinion on which radiation modality is right?\u003c\/h3\u003e\n\u003cp\u003eA second opinion is worth seeking when the tumor sits near critical structures such as the optic nerve, brainstem, or hippocampus, because modality choice matters there. CyberKnife, GammaKnife, and proton therapy each spare nearby tissue differently, and proton therapy and brachytherapy are less widely available than photon-based treatments. Grade also changes recommendations: local control is high for Grade I but falls for Grade II and III. Direct comparisons between modalities are limited, so an independent review of your imaging and pathology can clarify whether the plan fits your tumor's location and grade. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Recent technology development in radiotherapy for intracranial meningiomas.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Ungar R, Kilian-Meneghin J, Eckroate B, Motwani S, Yue N, Nie K, Xiong Z, Zhang Y.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor affiliations:\u003c\/strong\u003e Department of Physics and Astronomy, Rutgers University, Piscataway, NJ, United States; Department of Radiation Oncology, Rutgers Cancer Institute, New Brunswick, NJ, United States\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Frontiers in Neurology, Volume 16, Article 1568898\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication date:\u003c\/strong\u003e April 28, 2025\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e 10.3389\/fneur.2025.1568898\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eArticle type:\u003c\/strong\u003e Mini Review\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research. The original article was published as an open-access article under the terms of the Creative Commons Attribution License (CC BY).\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47828089929884,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-new-technology-in-radiation-treatment-for-brain-meningiomas-what-patients-should-know-hero.png?v=1793168605","url":"https:\/\/diagnosticdetectives.com\/de\/products\/new-technology-in-radiation-treatment-for-brain-meningiomas-what-patients-should-know","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}