Meningiomas represent 18-20% of all intracranial tumors and have a 10-year
recurrence rate of 20-50%, despite aggressive surgery and irradiation. In a
ddition, many tumors are not amenable to surgery due to their deep location
or proximity to delicate structures. Chemotherapy is being explored as ano
ther potential treatment option for unresectable or refractory meningiomas.
Hydroxyurea is an agent that inhibits ribonucleotide reductase and can ind
uce apoptosis in meningioma cell cultures and animal models. We have placed
17 patients with unresectable or residual meningioma on hydroxyurea chemot
herapy (20 mg/kg/d orally). The mean age of our cohort was 57.2 years; 13 p
atients were female. Eleven patients had actively growing tumors or neurolo
gical progression at the onset of chemotherapy. Sixteen patients were evalu
able for response. Fourteen of the 16 patients (88%) responded with stable
disease ranging from 20 to 144+ weeks (median 80 weeks; 10 patients still a
ccruing time). Three of the responders progressed after 20, 36, and 56 week
s, respectively. Two patients had progressive disease after 10 weeks. Toxic
ity was hematologic in most patients; leukopenia was most common. Nine pati
ents (53%) required dosage reductions (250-500 mg/d) secondary to hematolog
ic toxicity. Hydroxyurea appears to have modest activity against meningioma
s and should be considered in patients with unresectable tumors or large re
sidual tumors following surgical resection.