Meningioma: lines of therapy

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5 standard-of-care settings across 2 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Second line	1
Other settings	4

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Recurrent, no surgical or radiotherapy option	No approved drug. Bevacizumab, sunitinib or everolimus with a somatostatin analogue on phase 2 evidence; mutation-matched trials (Alliance A071401) and peptide receptor radionuclide therapy studies preferred.	BevacizumabSunitinibEverolimusPeptide receptor radionuclide therapy (PRRT)	NCCN Guidelines: Central Nervous System Cancers	98

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Incidental or small asymptomatic	Observation with serial MRI; many never grow. Treatment when growth or symptoms appear.	Active surveillanceMRI	NCCN Guidelines: Central Nervous System Cancers	63
All comers	Symptomatic or growing, accessible	Surgical resection as complete as safely possible; complete resection of a grade 1 tumour is usually curative and needs no adjuvant treatment.	MRIDNA methylation profiling	NCCN Guidelines: Central Nervous System Cancers	71
All comers	Small, skull base or surgically inaccessible	Stereotactic radiosurgery (Gamma Knife, CyberKnife or linac) or fractionated stereotactic radiotherapy, with high long-term control rates for grade 1 tumours.	Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)Gamma KnifeCyberKnife robotic radiosurgeryIMRT / IGRT (modern external beam)	NCCN Guidelines: Central Nervous System Cancers	93
All comers	Grade 2, incompletely resected, and all grade 3	Fractionated radiotherapy after surgery (EORTC 22042-26042, RTOG 0539); proton therapy for large or re-irradiated skull base tumours; observation versus radiotherapy after complete resection of grade 2 tumours is under trial (ROAM/EORTC 1308, NRG BN003).	IMRT / IGRT (modern external beam)Proton therapy	NCCN Guidelines: Central Nervous System Cancers	93

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.