Advances in multidisciplinary therapy for meningiomas
Advances in multidisciplinary therapy for meningiomas
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DOI：
10.1093/neuonc/noy136
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发表时间：
2019-01-01
期刊：
影响因子：
15.9
通讯作者：
Zadeh, Gelareh
中科院分区：
文献类型：
--
作者：
Brastianos, Priscilla K.;Galanis, Evanthia;Zadeh, Gelareh
长期以来，手术一直被确定为大多数有症状和增大的脑膜瘤的一线治疗方法，其成功的证据来自于回顾性病例系列。尽管进行了手术切除，但部分脑膜瘤表现出攻击性行为，早期复发，难以治疗。根治性切除脑膜瘤和受累结构的决定与患者神经损伤的风险进行了权衡。放射治疗在很大程度上被用作脑膜瘤的一种补充和安全的治疗策略，证据主要来自于回顾性的、单一机构的报告。评估高危脑膜瘤辅助放射治疗结果的两项首批合作小组研究(RTOG0539和EORTC 22042)显示了有希望的初步结果。从历史上看，系统治疗脑膜瘤的结果令人失望。然而，一些临床试验正在评估化疗的疗效，如曲贝替丁，以及针对Smoothened，AKT1，和焦点黏附激酶的新型分子药物治疗复发脑膜瘤患者。
Surgery has long been established as the first-line treatment for the majority of symptomatic and enlarging meningiomas, and evidence for its success is derived from retrospective case series. Despite surgical resection, a subset of meningiomas display aggressive behavior with early recurrences that are difficult to treat. The decision to radically resect meningiomas and involved structures is balanced against the risk for neurological injury in patients. Radiation therapy has largely been used as a complementary and safe therapeutic strategy in meningiomas with evidence primarily stemming from retrospective, single-institution reports. Two of the first cooperative group studies (RTOG 0539 and EORTC 22042) evaluating the outcomes of adjuvant radiation therapy in higher-risk meningiomas have shown promising preliminary results. Historically, systemic therapy has resulted in disappointing results in meningiomas. However, several clinical trials are under way evaluating the efficacy of chemotherapies, such as trabectedin, and novel molecular agents targeting Smoothened, AKT1, and focal adhesion kinase in patients with recurrent meningiomas.