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颅内脑膜瘤的放射外科治疗:解剖学挑战综述及证据更新

Radiosurgery for Intracranial Meningiomas: A Review of Anatomical Challenges and an Update on the Evidence.

作者信息

Goldman Matthew J, Teh Bin S, Lo Simon S, Butler E Brian, Baskin David S

机构信息

Department of Neurological Surgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA.

Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA.

出版信息

Cancers (Basel). 2024 Dec 27;17(1):45. doi: 10.3390/cancers17010045.

Abstract

Radiation has been used to treat meningiomas since the mid-1970s. Traditionally, radiation was reserved for patients unfit for major surgery or those with surgically inaccessible tumors. With an increased quantity and quality of imaging, and an aging population, there has been a rise in incidentally diagnosed meningiomas with smaller tumors at diagnosis time. Deciding if, how, and when to intervene must be determined on a case-by-case basis. Anatomical location and adjacent vital structures are crucial for decision-making. Prior review articles have detailed outcomes of radiosurgery in broad anatomical regions such as the skull base, but a recent deluge of research on increasingly specific anatomical subregions deserves attention. This narrative review synthesizes information regarding specific anatomical subregions, including anatomical challenges, radiosurgical outcomes, and unique considerations. Via MEDLINE and ascendancy search, we utilized evidence available for each anatomical region and herein discuss details of published research and explore future directions. Meningioma management remains individualized based on patient comorbidities, tumor location/characteristics, symptomatic burden, and patient age. In addition to stereotactic radiosurgery's established role for surgically inaccessible, recurrent, and high-grade meningiomas, its use as upfront management for small asymptomatic meningiomas is increasingly investigated. For all subregions reported, radiosurgical intervention resulted in high tumor control rates and acceptably low adverse radiation events.

摘要

自20世纪70年代中期以来,放射治疗一直被用于治疗脑膜瘤。传统上,放射治疗仅适用于不适合进行大型手术的患者或肿瘤无法通过手术切除的患者。随着影像学数量和质量的提高以及人口老龄化,偶然诊断出的脑膜瘤数量有所增加,且诊断时肿瘤较小。必须根据具体情况决定是否干预、如何干预以及何时干预。解剖位置和相邻重要结构对于决策至关重要。先前的综述文章详细介绍了在颅底等广泛解剖区域进行放射外科手术的结果,但最近关于越来越具体的解剖亚区域的大量研究值得关注。本叙述性综述综合了有关特定解剖亚区域的信息,包括解剖学挑战、放射外科手术结果和独特考虑因素。通过MEDLINE和优势搜索,我们利用了每个解剖区域的现有证据,在此讨论已发表研究的细节并探索未来方向。脑膜瘤的治疗仍需根据患者的合并症、肿瘤位置/特征、症状负担和患者年龄进行个体化。除了立体定向放射外科手术在无法通过手术切除、复发性和高级别脑膜瘤方面已确立的作用外,其作为小的无症状脑膜瘤的初始治疗方法的应用也在越来越多地得到研究。对于所有报告的亚区域,放射外科手术干预均导致了较高的肿瘤控制率和可接受的低辐射不良事件。

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