Department of Radiation Oncology, City of Hope, Duarte, California.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; European Radiosurgery Center Munich, Munich, Germany.
Pract Radiat Oncol. 2024 Nov-Dec;14(6):499-511. doi: 10.1016/j.prro.2024.02.009. Epub 2024 Jul 8.
Meningiomas represent the most common primary tumor of the central nervous system. Current treatment options include surgical resection with or without adjuvant radiation therapy (RT), definitive RT, and observation. However, the radiation dose, fractionation, and margins used to treat patients with WHO grade 2 meningiomas, which account for approximately 20% of all meningiomas, are not clearly defined, and deciding on the optimal treatment modality can be challenging owing to the lack of randomized data.
In this manuscript, 3 cases of patients with WHO grade 2 meningiomas are presented with descriptions of treatment options after gross total resection, subtotal resection, and previous irradiation. Treatment recommendations were compiled from 9 central nervous system radiation oncology and neurosurgery experts from The Radiosurgery Society, and the consensus of treatment recommendations is reported.
Both conventional and stereotactic RT are treatment options for WHO grade 2 meningiomas. The majority of prospective data in the setting of WHO grade 2 meningiomas involve larger margins. Stereotactic radiosurgery/hypofractionated stereotactic RT are less appropriate in this setting. Conventionally fractionated RT to at least 59.4 Gy is considered standard of care with utilization of preoperative and postoperative imaging to evaluate the extent of disease and possible osseous involvement. After careful discussion, stereotactic radiosurgery/hypofractionated stereotactic RT may play a role for the subset of patients who are unable to tolerate the standard lengthy conventionally fractionated treatment course, for those with prior RT, or for small residual tumors. However, more studies are needed to determine the optimal approach.
This case-based evaluation of the current literature seeks to provide examples for the management of grade 2 meningiomas and give examples of both conventional and stereotactic RT.
脑膜瘤是中枢神经系统最常见的原发性肿瘤。目前的治疗选择包括手术切除加或不加辅助放疗（RT）、根治性 RT 和观察。然而，用于治疗占所有脑膜瘤约 20%的世界卫生组织（WHO）2 级脑膜瘤的患者的放射剂量、分割和边缘并不明确，由于缺乏随机数据，决定最佳治疗方式具有挑战性。
在本手稿中，介绍了 3 例 WHO 2 级脑膜瘤患者，描述了在大体全切除、次全切除和先前照射后的治疗选择。治疗建议由来自放射外科协会的 9 名中枢神经系统放射肿瘤学和神经外科学专家编写，并报告了治疗建议的共识。
常规和立体定向 RT 都是 WHO 2 级脑膜瘤的治疗选择。在 WHO 2 级脑膜瘤的背景下，大多数前瞻性数据都涉及更大的边缘。立体定向放射外科/低分割立体定向 RT 在这种情况下不太合适。常规分割 RT 至至少 59.4 Gy 被认为是标准治疗，利用术前和术后影像学评估疾病的范围和可能的骨受累。经过仔细讨论，立体定向放射外科/低分割立体定向 RT 可能对那些无法耐受标准长程常规分割治疗的患者、那些有既往 RT 的患者或小残余肿瘤的患者发挥作用。然而，需要更多的研究来确定最佳方法。
基于案例的对当前文献的评估旨在为 2 级脑膜瘤的管理提供示例，并提供常规和立体定向 RT 的示例。
