Recommendation ID

Managing meningioma: immediate versus deferred radiotherapy for incompletely excised grade I meningioma:- Is immediate or deferred radiotherapy better for incompletely excised grade I meningioma?

Any explanatory notes
(if applicable)

Why this is important:- There are no randomised studies on the use of radiotherapy/radiosurgery in the treatment of grade I meningioma. Though case series have shown that people with inoperable and incompletely excised grade I meningioma treated with radiotherapy have high rates of control of their tumour, treatment risks significant side effects. The side effects include: neuropathy, radionecrosis, significant oedema, neuro-cognitive effects, increased risk of stroke and secondary tumours.
Therefore the timing of treatment is a balance between control of tumour and side effects. It is not known if early treatment has a greater or lesser chance of long-term tumour control or risk of tumour complications, or if this just risks complications of treatment earlier.
People with grade I meningioma have traditionally been overlooked as a priority area for research. This is likely because of the slow nature of the disease resulting in need for long-term follow-up and the difficulty to obtain funding for radiotherapy-only studies. However, this lack of research is inequitable, hence the reason for its prioritisation by the committee.
A study on this topic would provide clear information to guide clinicians and people with meningiomas, hopefully leading to overall improvement in quality of life. Because of the slowgrowing characteristics of grade I meningioma, treatment decisions made early in the management pathway will have long-term effects on the person with the meningioma's overall quality of life outcomes, and potentially overall survival.
To find out why the committee made the research recommendation on managing meningioma, see rationale and impact.

Source guidance details

Comes from guidance
Brain tumours (primary) and brain metastases in adults
Date issued
July 2018

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/07/2018