# Radioligand Therapy in Meningiomas: Today’s Evidence, Tomorrow’s Possibilities

## TL;DR

This review discusses how radionuclide therapy, which targets specific receptors on meningioma tumors, is becoming a promising treatment for aggressive or hard-to-treat cases.

## Contribution

The paper provides a comprehensive overview of the emerging role of peptide receptor radionuclide therapy in meningioma treatment, emphasizing recent clinical and methodological advances.

## Key findings

- Peptide receptor radionuclide therapy is a promising option for advanced or recurrent meningiomas.
- Advances in imaging and dosimetry are improving patient selection and treatment outcomes.
- Current evidence supports further research to define the optimal clinical use of radionuclide therapy.

## Abstract

Meningioma is a tumor that arises from the membranes covering the brain. These lesions typically grow slowly, are often discovered incidentally, and may not cause any symptoms. When treatment is needed, surgery or radiotherapy are the most common options. However, in some cases, meningiomas can appear as multiple lesions, invade nearby bone, or develop into particularly aggressive and treatment-resistant forms that recur despite prior interventions. These more severe tumors are frequently associated with substantial clinical symptoms, such as epileptic seizures, and present major therapeutic challenges. In response to these difficulties, a rapidly evolving therapeutic approach has gained attention—radionuclide therapy, which delivers radioactive isotopes directly to tumor cells by targeting somatostatin receptors. Recent advances in molecular imaging, including PET- and SPECT-based receptor mapping, radiomics, and dose-based treatment planning, have further strengthened the biological rationale for this therapy. In this review, we summarize the current state of research on peptide receptor radionuclide therapy (PRRT) for meningioma.

Meningiomas are the most common primary intracranial tumors, showing highly heterogeneous behavior and clinical outcomes. While the majority are benign, about one in five meningiomas are classified as higher grade (WHO Grade II–III), characterized by a more aggressive, treatment-resistant pathology. Although surgical resection remains the first-line therapy, peptide receptor radionuclide therapy is emerging as a novel and promising option for advanced, multifocal, or recurrent disease. The theranostic paradigm allows simultaneous detection and treatment of somatostatin receptor-expressing lesions using a single radiopharmaceutical. In this review, we explore the evolving role of PRRT in the management of meningiomas. We provide an integrated overview of preclinical findings—including radiosensitization mechanisms—and summarize the rapidly expanding clinical literature, which in recent years has grown both in patient numbers and in methodological sophistication. Particular emphasis is placed on advances in dosimetry, quantitative imaging, and radiomics, which are beginning to refine patient selection and improve response prediction. Together, current evidence highlights the therapeutic potential of radionuclide therapy in aggressive or refractory meningiomas and underscores the need for further prospective trials to define its optimal clinical application.