Hydroxyurea chemotherapy for unresectable or residual meningioma

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.