An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas
An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas
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DOI：
10.3171/2015.1.focus14757
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发表时间：
2015-03-01
影响因子：
4.1
通讯作者：
Kim, Albert H.
中科院分区：
文献类型：
--
作者：
Sun, Sam Q.;Hawasli, Ammar H.;Kim, Albert H.
世卫组织II级“非典型”脑膜瘤（AMs）和III级“恶性”脑膜瘤（mm）的治疗仍然存在争议，在前瞻性研究中调查不足。外科手术、放射治疗、放射外科手术和化疗的作用尚未完全界定。这使得医生们不得不根据具体情况来判断他们应该如何治疗病人。在本研究中，作者回顾了使用WHO 2000/2007分级标准诊断的AMs和mm相关的管理和临床结果的英文文献。详细分析了22项AMs研究和7项mm研究。作者使用循证医学的文献和概念检查了临床决策点。承认有关AM和MM研究的回顾性，作者确实发现了以下临床策略的证据：1)最大限度地安全切除AM和MM；2) AM总切除后主动监测；3) AM次全切除术后的辅助放射治疗，特别是在没有放射耐药特征的情况下；4) MM切除术后辅助放射治疗。
The management of WHO Grade II "atypical" meningiomas (AMs) and Grade III "malignant" meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.