Yttrium-90 Radioembolization (TARE) is a plausible treatment for recurrent meningioma due to vascular supply

For patients with meningioma, particularly recurrent or surgically inaccessible tumors, current therapeutic options like surgery and conventional radiotherapy often fall short, leaving a significant treatment gap for progressive higher-grade disease. Intra-arterial yttrium-90 (90Y) transarterial radioembolization (TARE) is a well-established technique for hepatocellular carcinoma, delivering high-dose, short-range β-brachytherapy via radioactive microspheres. This technology holds promise for meningiomas by exploiting their characteristic dominant dural arterial supply, potentially allowing for targeted, high-dose radiation delivery directly to the tumor while minimizing systemic exposure.

Researchers conducted systematic searches of PubMed and Google Scholar for literature directly addressing intracranial TARE planning or delivery. This was supplemented by a scoping review of adjacent fields, including meningioma radionuclide therapy, peptide receptor radionuclide therapy (PRRT), hepatic TARE, bland meningioma embolization, and relevant radiobiology concerning tumor vascular behavior, dosimetry, hypoxia, and imaging. The review aimed to synthesize existing knowledge to build a rationale and roadmap for neurointerventional translation of 90Y TARE for meningiomas, considering the physical properties of 20-60µm radioactive microspheres.

The systematic review identified 5 studies and 1 ongoing clinical trial directly addressing intracranial TARE or its planning, supported by 74 additional studies across related fields. These studies informed a synthesis of meningioma embolization, vascular anatomy, hepatic TARE dosimetry, device characteristics, and foundational radiobiology. Currently, two TARE platforms exist (glass and resin), differing in dose-per-sphere and physical density, which may impact deliverability. > The compartmentalized dural arterial supply of most meningiomas supports catheter-based access and may permit single-compartment dosimetry modeling, with generally low-to-moderate arterial shunting risk. The established, but often incomplete, efficacy of radioligand therapies provides a biological rationale for TARE, while underscoring the need for higher tumor radiation delivery, which early dosimetry work suggests may be achievable with TARE.