Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review.
Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review.
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DOI：
10.3171/2014.7.jns131644
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发表时间：
2015-01
影响因子：
4.1
通讯作者：
Vogelbaum MA
中科院分区：
文献类型：
--
作者：
Rogers L;Barani I;Chamberlain M;Kaley TJ;McDermott M;Raizer J;Schiff D;Weber DC;Wen PY;Vogelbaum MA
脑膜瘤是最常见的原发性脑肿瘤，随着人们对脑膜瘤的兴趣不断发展，这些肿瘤的当代治疗方法得到了改进。然而，问题是缺乏前瞻性临床试验，为脑膜瘤的治疗提供循证算法。本综述总结了关于新诊断和复发脑膜瘤治疗的已发表文献，重点介绍了世界卫生组织（WHO）肿瘤分级的结果。本综述特别关注手术或放射治疗（包括放射手术和分次照射）治疗后（辅助或复发）的患者结果。针对脑膜瘤患者的II期试验最近已在放射治疗肿瘤组（RTOG）和欧洲癌症研究和治疗组织（EORTC）联盟中完成，III期研究正在开发中。然而，目前还没有完整的前瞻性随机试验来评估手术或放疗的作用。未来研究的成功完成将需要多学科的努力，传播现有知识库，改进世卫组织分级标准的实施，标准化反应标准和其他结局终点，并共同努力解决当前治疗范例中的弱点，特别是对于进行性或复发性低级别脑膜瘤或高级别脑膜瘤患者。与此同时，神经肿瘤学反应评估（RANO）小组委员会正在编写一份关于脑膜瘤全身治疗的手稿，以及一篇提出脑膜瘤标准化终点和反应标准的单独文章。
Evolving interest in meningioma, the most common primary brain tumor, has refined contemporary management of these tumors. Problematic, however, is the paucity of prospective clinical trials that provide an evidence-based algorithm for managing meningioma. The current review summarizes the published literature regarding the treatment of newly diagnosed and recurrent meningioma, with an emphasis on outcomes stratified by World Health Organization (WHO) tumor grade. In particular this review focuses on patient outcomes following treatment (either adjuvant or at recurrence) with surgery or radiation therapy inclusive of radiosurgery and fractionated irradiation. Phase II trials for patients with meningioma have recently completed accrual within the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) consortia, and phase III studies are being developed. However, at present, there are no completed prospective, randomized trials assessing the role of either surgery or radiotherapy. Successful completion of future studies will require a multidisciplinary effort, dissemination of the current knowledge base, improved implementation of WHO grading criteria, standardization of response criteria and other outcome endpoints, and concerted efforts to address weaknesses in present treatment paradigms, particularly for patients with progressive or recurrent low grade meningioma, or with high-grade meningioma. In parallel efforts, Response Assessment in Neuro-Oncology (RANO) subcommittees are developing a manuscript on systemic therapies for meningioma, and a separate article proposing standardized endpoint and response criteria for meningioma.