Salvage boron neutron capture therapy for recurrent intracranial malignant meningioma: Case report and literature review.

RATIONALE

Meningiomas are the most common central nervous system tumors in adults, accounting for approximately one-third of the total. Although only 1% to 3% of meningiomas are malignant, these cases exhibit a high degree of aggression and frequent recurrence, resulting in a poor prognosis. There are no accepted treatment standards for salvage re-irradiation. Therefore, detailed case descriptions are essential for treatment guidance.

PATIENT CONCERNS

A 56-year-old female with malignant meningioma underwent curative resection and adjuvant radiotherapy (66 Gy in 33 fractions). However, the tumor recurred repeatedly despite curative and salvage therapies. The safety and efficacy of salvage re-irradiation may be limited by potential brain toxicity.

DIAGNOSES

Recurrent malignant meningioma.

INTERVENTIONS

The meningioma recurred at the surgical dural bed 4 months after adjuvant radiotherapy, as evidenced by histological analysis following salvage craniotomy. Progressive meningioma was also evident, with invasion to the adjacent skull bone and scalp. Compassionate salvage boron neutron capture therapy (BNCT) was prescribed to eradicate both the recurrent meningioma and bone invasion. The 2 courses of BNCT were administered with mean tumor doses of 41.52 and 50.22 GyE.

OUTCOMES

No clinically significant toxicity was observed following irradiation, and imaging showed near-total regression of the brain meningioma and the adjacent invasive skull bone and scalp tumor. Brain symptoms of headache and dizziness also abated after treatment.

LESSONS

A favorable tumor response with no cranial toxicity was achieved using targeted BNCT therapy. We review the literature on recurrent malignant meningioma and relevant BNCT salvage for further therapeutic guidance.