Lan Tien-Li, Lin Chun-Fu, Lee Yi-Yen, Chang Feng-Chi, Lin Shih-Chieh, Chou Fong-In, Peir Jinn-Jer, Pan Po-Shen, Chen Jen-Kun, Lai Lu-Han, Tanaka Hiroki, Hsu Shih-Ming, Chen Yi-Wei
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Neurooncol. 2025 Nov;175(2):879-886. doi: 10.1007/s11060-025-05184-w. Epub 2025 Jul 31.
Boron neutron capture therapy (BNCT) is a targeted radiotherapy modality that has shown promise in the treatment of recurrent gliomas and head and neck cancers. Although meningiomas are generally slow-growing, recent studies have demonstrated favorable uptake of boron-containing compounds, particularly boronophenylalanine (BPA), suggesting a potential role for BNCT in recurrent meningioma.
We retrospectively analyzed 13 patients with recurrent meningiomas treated with salvage BNCT at the Tsing Hua Open-Pool Reactor between August 2020 and May 2024. Tumor uptake was assessed using either ¹⁸F-BPA or ¹⁸F-Fluciclovine PET. Treatment response was evaluated using RANO criteria, and outcomes were analyzed in relation to dosimetric and clinical factors.
Of the 13 patients (1 WHO grade 3, 6 grade 2, and 6 grade 1), 5 (38%) responded to BNCT. Responders had significantly higher tumor mean dose (45.10 vs. 25.85 GyE, p = 0.003). Tumor location influenced dosimetry; non-skull base tumors received higher doses and showed a trend toward better response. TNR and tumor size were not predictive of response. No severe adverse events were observed.
Salvage BNCT is a feasible and well-tolerated treatment for recurrent meningioma, with dose distribution and tumor location significantly influencing treatment response. Further studies are warranted to refine imaging and planning strategies, particularly for skull base lesions and in the context of Fluciclovine PET.
硼中子俘获疗法（BNCT）是一种靶向放射治疗方式，在复发性胶质瘤和头颈癌的治疗中已显示出前景。尽管脑膜瘤通常生长缓慢，但最近的研究表明含硼化合物，特别是硼苯丙氨酸（BPA）的摄取良好，提示BNCT在复发性脑膜瘤中可能发挥作用。
我们回顾性分析了2020年8月至2024年5月期间在清华开放池式反应堆接受挽救性BNCT治疗的13例复发性脑膜瘤患者。使用¹⁸F - BPA或¹⁸F - 氟代脱氧胸苷PET评估肿瘤摄取情况。使用RANO标准评估治疗反应，并分析与剂量学和临床因素相关的结果。
13例患者（1例世界卫生组织3级、6例2级和6例1级）中，5例（38%）对BNCT有反应。有反应者的肿瘤平均剂量显著更高（45.10 vs. 25.85 GyE，p = 0.003）。肿瘤位置影响剂量学；非颅底肿瘤接受的剂量更高，且有反应更好的趋势。TNR和肿瘤大小不能预测反应。未观察到严重不良事件。
挽救性BNCT是复发性脑膜瘤一种可行且耐受性良好的治疗方法，剂量分布和肿瘤位置对治疗反应有显著影响。有必要进一步研究以完善成像和治疗计划策略，特别是对于颅底病变以及在氟代脱氧胸苷PET背景下。
