68Ga-Dotatate PET and MRI Guided Radiation Dose Escalation for High Risk Meningioma

Inclusion Criteria:

* Individuals must meet all the following inclusion criteria in order to be eligible to participate in the study:

  1. Adult patients, age ≥ 18 years
  2. Patients with RTOG Group III meningioma (high risk) defined as:

     * Patients with newly diagnosed or a recurrent WHO grade 3 meningioma of any resection extent.
     * or patients with a recurrent WHO grade 2 meningioma of any resection extent.
     * or patient with a newly diagnosed sub-totally resected (residual nodular enhancement or PET enhancement on postoperative imaging, or Simpson grade IV or V excision) WHO grade 2 meningioma.
  3. In the setting of newly diagnosed meningioma, the histologic diagnosis must be within 6 months of registration.
  4. In the setting of a recurrent meningioma, there are no such time constraints. However, additional resection or biopsy is encouraged for patients with recurrence but is not requisite. If further biopsy or resection is performed at recurrence, it must be within 6 months of registration.
  5. Karnofsky Performance Status 60-100
  6. MRI brain and ⁶⁸Ga-Dotatate PET must be performed within 6 weeks prior to registration.
  7. For woman of childbearing potential:

     * A negative serum pregnancy test is required within 14 days prior to registration.
     * The patient must agree to practice adequate contraception from the time of the negative serum pregnancy test throughout the entire course of EBRT.

Exclusion Criteria:

* An individual who meets any of the following criteria will be excluded from participation in this study:

  1. Extracranial meningioma
  2. Prior radiation therapy to the scalp, cranium, brain, or skull base
  3. Prior malignancy (except for non-melanomatous skin cancer), unless disease free for at least 3 years
  4. Pregnancy or lactation
  5. Treatment with another investigational drug or other intervention at time of registration
  6. Inability to receive gadolinium or undergo MRI brain or ⁶⁸Ga-Dotatate PET imaging.
  7. Serious medical or psychiatric illness likely to interfere with participation in this clinical trial.
  8. Evidence of increased intracranial pressure (midline shift \> 5mm, clinically significant papilledema)
  9. Uncontrolled seizure