Ehret Felix, El Baya Leon, Erridge Sara C, Bussière Marc, Verhoeff Joost J C, Niyazi Maximilian, Preusser Matthias, Minniti Giuseppe, Shih Helen A
Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité - Universitätsmedizin Berlin, Germany.
Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Int J Radiat Oncol Biol Phys. 2025 Mar 1;121(3):599-612. doi: 10.1016/j.ijrobp.2024.10.034. Epub 2024 Oct 28.
Radiation therapy, including conventionally fractionated external beam radiation therapy, stereotactic radiosurgery, and fractionated stereotactic radiation therapy, is a cornerstone in the interdisciplinary management of meningiomas. Recent advances in radiation oncology and also in other fields, such as neuropathology and imaging, have various implications for meningioma radiation therapy. This review aims to summarize current and anticipated developments, as well as active clinical trials related to the use of radiation therapy for meningiomas. In imaging, positron emission tomography has proven valuable for assessing the spatial extension of meningiomas and may enhance target delineation, treatment response monitoring, and recurrence assessment after radiation therapy. Particle therapy, including protons and carbon ions, as well as stereotactic radiosurgery and fractionated stereotactic radiation therapy, allow for conformal treatments that permit dose escalation in selected patients with high-grade meningiomas. Additionally, emerging integrated molecular and genetic classifications offer superior risk stratification and may refine patient selection for radiation therapy. However, there is a paucity of active meningioma trials directly investigating or refining the use of radiation therapy. In summary, significant advances in functional imaging, molecular and genetic diagnostics, and radiation treatment techniques hold the potential to improve patient outcomes and to avoid over- and undertreatment. Collaborative efforts and further clinical trials are essential to optimize meningioma radiation therapy.
放射治疗，包括传统分割外照射放疗、立体定向放射外科和分割立体定向放射治疗，是脑膜瘤多学科管理的基石。放射肿瘤学以及神经病理学和影像学等其他领域的最新进展对脑膜瘤放射治疗具有多方面的影响。本综述旨在总结当前和预期的发展情况，以及与脑膜瘤放射治疗应用相关的正在进行的临床试验。在影像学方面，正电子发射断层扫描已被证明对评估脑膜瘤的空间范围有价值，并且可能有助于增强靶区勾画、治疗反应监测以及放射治疗后的复发评估。粒子治疗，包括质子和碳离子，以及立体定向放射外科和分割立体定向放射治疗，能够实现适形治疗，从而允许对部分高级别脑膜瘤患者进行剂量递增。此外，新出现的综合分子和基因分类提供了更优的风险分层，可能会优化放射治疗的患者选择。然而，直接研究或完善放射治疗应用的正在进行的脑膜瘤试验较少。总之，功能成像、分子和基因诊断以及放射治疗技术的重大进展有可能改善患者预后，并避免过度治疗和治疗不足。合作努力和进一步的临床试验对于优化脑膜瘤放射治疗至关重要。
