Atypical Meningioma: An Evolving Landscape and Moving Target

While World Health Organization (WHO) grade 2, or atypical, meningiomas comprise approximately 25% of meningiomas, they represent the population with increased propensity for local recurrence and even decreased survival (1). Unfortunately, there are a paucity of prospective data to guide clinical management, as the largely retrospective studies on this disease are fraught with patient selection bias, insufficient follow-up, and small numbers of events. Unanswered clinical questions for grade 2 meningiomas include the role of adjuvant radiation therapy for gross totally resected tumors (2, 3) and the use of stereotactic radiosurgery given the higher local and marginal failure rate after stereotactic radiosurgery (4). Proton radiation therapy is also being explored, allowing for treatment of larger volumes more suitable for conventional fractionation but with decreased integral dose than photon therapy.

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