Sheba Medical Center, Tel Aviv Medical School, Tel Aviv University, Tel Aviv, Israel.
Radiat Oncol. 2024 Oct 2;19(1):135. doi: 10.1186/s13014-024-02486-7.
Anaplastic meningiomas, categorized as WHO grade 3 tumors, are rare and highly aggressive, accounting for 1-2% of all meningioma cases. Despite aggressive treatment, including surgery and Radiation, they exhibit a high recurrence rate and poor survival outcomes. The aggressive histopathological features emphasize the urgent need for effective management strategies.
A retrospective multi-institutional analysis was conducted on patients with recurrent anaplastic meningioma who underwent re-irradiation between 2017 and 2023. Clinical, dosimetric, and outcome data were collected and analyzed, focusing on local control, progression free survival and treatment-related adverse events.
Thirty-four cases were analyzed, with a median follow-up 11 months after re-irradiation. Progression-free survival at 12 months was 61.9%, with higher doses correlating with better outcomes. Concomitant Bevacizumab improves progression-free survival and reduces the risk of radiation necrosis. CDKN2A homozygote deletion correlated with a higher risk of local failure. Symptomatic radiation necrosis occurred in 20.5% of cases, but its incidence was lower with concomitant Bevacizumab treatment.
Re-irradiation presents a viable option for recurrent anaplastic meningioma despite the associated risk of radiation necrosis. Higher doses with concomitant Bevacizumab improve clinical outcomes and reduce toxicity. Individualized treatment approaches are necessary, emphasizing the importance of further research to refine management strategies for this challenging disease.
间变性脑膜瘤，归类为世界卫生组织（WHO）分级 3 级肿瘤，较为罕见且侵袭性强，占所有脑膜瘤病例的 1-2%。尽管采用了积极的治疗方法，包括手术和放疗，但其仍具有较高的复发率和较差的生存结局。侵袭性的组织病理学特征强调了迫切需要有效的管理策略。
对 2017 年至 2023 年间接受再放疗的复发性间变性脑膜瘤患者进行了回顾性多机构分析。收集并分析了临床、剂量学和结局数据，重点关注局部控制、无进展生存期和与治疗相关的不良事件。
分析了 34 例患者，再放疗后中位随访 11 个月。12 个月无进展生存率为 61.9%，较高剂量与更好的结局相关。贝伐珠单抗联合治疗可改善无进展生存期并降低放射性坏死的风险。CDKN2A 纯合缺失与局部失败风险增加相关。有 20.5%的病例发生症状性放射性坏死，但贝伐珠单抗联合治疗可降低其发生率。
尽管存在放射性坏死的风险，但再放疗仍是复发性间变性脑膜瘤的可行选择。高剂量联合贝伐珠单抗可改善临床结局并降低毒性。需要个体化治疗方法，强调进一步研究对于完善这种挑战性疾病的管理策略的重要性。
