Divisions of Hematology/Oncology & Neuro-Oncology, Departments of Medicine & Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Neuro Oncol. 2019 Jan 14;21(Suppl 1):i18-i31. doi: 10.1093/neuonc/noy136.
Surgery has long been established as the first-line treatment for the majority of symptomatic and enlarging meningiomas, and evidence for its success is derived from retrospective case series. Despite surgical resection, a subset of meningiomas display aggressive behavior with early recurrences that are difficult to treat. The decision to radically resect meningiomas and involved structures is balanced against the risk for neurological injury in patients. Radiation therapy has largely been used as a complementary and safe therapeutic strategy in meningiomas with evidence primarily stemming from retrospective, single-institution reports. Two of the first cooperative group studies (RTOG 0539 and EORTC 22042) evaluating the outcomes of adjuvant radiation therapy in higher-risk meningiomas have shown promising preliminary results. Historically, systemic therapy has resulted in disappointing results in meningiomas. However, several clinical trials are under way evaluating the efficacy of chemotherapies, such as trabectedin, and novel molecular agents targeting Smoothened, AKT1, and focal adhesion kinase in patients with recurrent meningiomas.
手术长期以来一直被确立为大多数有症状和增大的脑膜瘤的一线治疗方法，其成功的证据来自回顾性病例系列。尽管进行了手术切除，但一部分脑膜瘤表现出侵袭性行为，早期复发且难以治疗。在患者中，激进地切除脑膜瘤和受累结构的决策需要权衡神经损伤的风险。放射治疗在脑膜瘤中主要用作补充和安全的治疗策略，其证据主要来自回顾性单机构报告。两项首次合作组研究（RTOG 0539 和 EORTC 22042）评估了辅助放疗在高危脑膜瘤中的疗效，结果显示出有希望的初步结果。从历史上看，系统治疗在脑膜瘤中的结果令人失望。然而，目前正在进行几项临床试验，评估化疗药物（如 trabectedin）和针对 Smoothened、AKT1 和黏着斑激酶的新型分子药物在复发性脑膜瘤患者中的疗效。
