Medina-Lopes Maria das Dores, Augusto Casulari Luiz
The Secretariat of Health of the Federal District and the Ministry of Health, Brasília, DF, Brazil.
The University Hospital of Brasília and Clinic of Endocrinology and Neurology (CLINEN), Brasília, DF, Brazil.
Case Rep Neurol Med. 2020 Feb 11;2020:5162918. doi: 10.1155/2020/5162918. eCollection 2020.
Meningioma treatment includes observation of its growth or surgery with or without associated radiotherapy. However, drug treatment can be used for tumors deemed inoperable because of their size and location. Due to the presence of progesterone receptors, the use of antiprogestin mifepristone is recommended. This study describes a case of inoperable meningioma treated with mifepristone for 26 years without interruption. The patient is a 45-year-old woman diagnosed with plaque meningioma, extending from the bottom of her right orbit, through the length of the small wing of the sphenoid, part of the large wing of the sphenoid, especially near the superior orbital fissure, and at the ceiling of the orbit. As this meningioma was considered inoperable, treatment with 200 mg oral mifepristone was administered uninterruptedly for 26 years. This treatment initially halted the growth of the meningioma and subsequently resulted in a small reduction of its volume; however, the meningioma has persisted until the last evaluation. After five years of mifepristone use, hydroxyurea was added for nine months but was discontinued due to anemia and leucopenia. In conclusion, mifepristone was useful for the survival of the patient for those 26 years. The drug interfered with the natural history of the meningioma, which generally evolves to death in such long follow-up durations without associated surgery or radiation therapy.
脑膜瘤的治疗方法包括观察其生长情况，或进行手术，可联合或不联合放疗。然而，对于因大小和位置而被认为无法手术切除的肿瘤，可采用药物治疗。由于存在孕激素受体，推荐使用抗孕激素米非司酮。本研究描述了一例无法手术切除的脑膜瘤患者，使用米非司酮治疗26年未间断。患者为一名45岁女性，诊断为斑块状脑膜瘤，从右眼眶底部延伸，穿过蝶骨小翼全长、蝶骨大翼部分，尤其是靠近眶上裂处以及眼眶顶部。由于该脑膜瘤被认为无法手术切除，遂连续26年不间断给予200毫克口服米非司酮治疗。这种治疗最初阻止了脑膜瘤的生长，随后使其体积略有缩小；然而，脑膜瘤一直持续到最后一次评估。使用米非司酮五年后，加用羟基脲九个月，但因贫血和白细胞减少而停药。总之，米非司酮对该患者26年的生存起到了作用。该药物干扰了脑膜瘤的自然病程，在如此长的随访期内，若无相关手术或放疗，脑膜瘤通常会发展至患者死亡。
