Subscribe to RSS
DOI: 10.1055/a-0965-2007
Neues zur Einteilung und Therapie von Meningeomen
Meningeome gehören zu den häufigsten Hirntumoren bei Erwachsenen. Während die meisten Meningeome gutartig sind, treten seltener auch atypische oder anaplastische Meningeome auf. Der Goldstandard zur Behandlung von Meningeomen ist die Tumorresektion, die ggf. postoperativ um eine Strahlentherapie ergänzt wird. Relevante Systemtherapien gibt es nicht. Aktuell werden verschiedene molekular zielgerichtete Substanzen zur Behandlung von lokal nicht mehr therapierbaren Meningeomen untersucht.
-
Bildgebung der Wahl bei Verdacht auf ein Meningeom ist die kontrastmittelgestützte MRT. Das cCT kann zur Beurteilung der Knocheninfiltration wertvoll sein.
-
Kleine asymptomatische Meningeome bei älteren und vorerkrankten Patienten können verlaufskontrolliert werden, ansonsten ist prinzipiell eine histologische Sicherung anzustreben.
-
Die Behandlung von symptomatischen Meningeomen sollte in einem interdisziplinären Tumorboard festgelegt werden.
-
Goldstandard ist die möglichst komplette operative Tumorresektion.
-
Bei inkomplett entfernten atypischen Meningeomen sollte eine adjuvante Bestrahlung erfolgen.
-
Bei anaplastischen Meningeomen sollte immer eine adjuvante Bestrahlung erfolgen.
-
Die medikamentöse Tumortherapie hat bisher keinen etablierten Stellenwert zur Behandlung von Meningeomen.
-
Kleinere Studien ergaben Hinweise auf eine Wirksamkeit von antiangiogenen Substanzen zur Behandlung von therapierefraktären Meningeomen.
-
In aktuellen Studien werden molekular zielgerichtete Substanzen u. a. gegen NF-2, AKT1 und SMO zur Behandlung von Meningeomen untersucht.
Publication History
Article published online:
09 November 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Ostrom QT, Cioffi G, Gittleman H. et al. CBTRUS Statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012–2016. Neuro-Oncology 2019; 21: v1-v100 DOI: 10.1093/neuonc/noz150.
- 2 Cordera S, Bottacchi E, DʼAlessandro G. et al. Epidemiology of primary intracranial tumours in NW Italy, a population based study: stable incidence in the last two decades. J Neurol 2002; 249: 281-284 DOI: 10.1007/s004150200005.
- 3 Holleczek B, Zampella D, Urbschat S. et al. Incidence, mortality and outcome of meningiomas: A population-based study from Germany. Cancer Epidemiol 2019; 62: 101562 DOI: 10.1016/j.canep.2019.07.001.
- 4 Strojan P, Popovic M, Jereb B. Secondary intracranial meningiomas after high-dose cranial irradiation: report of five cases and review of the literature. Int J Radiat Oncol Biol Phys 2000; 48: 65-73 DOI: 10.1016/s0360–3016(00)00609-x.
- 5 Lekanne DeprezRH, Bianchi AB, Groen NA. et al. Frequent NF2 gene transcript mutations in sporadic meningiomas and vestibular schwannomas. Am J Hum Genet 1994; 54: 1022-1029
- 6 Huang H, Buhl R, Hugo HH. et al. Clinical and histological features of multiple meningiomas compared with solitary meningiomas. Neurol Res 2005; 27: 324-332 DOI: 10.1179/016164105X39932.
- 7 Louis DN, Perry A, Reifenberger G. et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016; 131: 803-820 DOI: 10.1007/s00401–016–1545–1.
- 8 Lee YS, Lee YS. Molecular characteristics of meningiomas. J Pathol Transl Med 2020; 54: 45-63 DOI: 10.4132/jptm.2019.11.05.
- 9 Nassiri F, Mamatjan Y, Suppiah S. et al. DNA methylation profiling to predict recurrence risk in meningioma: development and validation of a nomogram to optimize clinical management. Neuro-Oncology 2019; 21: 901-910 DOI: 10.1093/neuonc/noz061.
- 10 Sahm F, Schrimpf D, Jones DT. et al. Next-generation sequencing in routine brain tumor diagnostics enables an integrated diagnosis and identifies actionable targets. Acta Neuropathol 2016; 131: 903-910 DOI: 10.1007/s00401–015–1519–8.
- 11 Preusser M, Brastianos PK, Mawrin C. Advances in meningioma genetics: novel therapeutic opportunities. Nat Rev Neurol 2018; 14: 106-115 DOI: 10.1038/nrneurol.2017.168.
- 12 Brastianos PK, Horowitz PM, Santagata S. et al. Genomic sequencing of meningiomas identifies oncogenic SMO and AKT1 mutations. Nat Genet 2013; 45: 285-289 DOI: 10.1038/ng.2526.
- 13 Sahm F, Schrimpf D, Olar A. et al. TERT Promoter Mutations and Risk of Recurrence in Meningioma. J Natl Cancer Inst 2016; 108 DOI: 10.1093/jnci/djv377.
- 14 Lusis EA, Scheithauer BW, Yachnis AT. et al. Meningiomas in pregnancy: a clinicopathologic study of 17 cases. Neurosurgery 2012; 71: 951-961 DOI: 10.1227/NEU.0b013e31826adf65.
- 15 Qi ST, Liu Y, Pan J. et al. A radiopathological classification of dural tail sign of meningiomas. J Neurosurg 2012; 117: 645-653 DOI: 10.3171/2012.6.JNS111987.
- 16 Afshar-Oromieh A, Giesel FL, Linhart HG. et al. Detection of cranial meningiomas: comparison of (6)(8)Ga-DOTATOC PET/CT and contrast-enhanced MRI. Eur J Nucl Med Mol Imaging 2012; 39: 1409-1415 DOI: 10.1007/s00259–012–2155–3.
- 17 Sughrue ME, Rutkowski MJ, Aranda D. et al. Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 2010; 113: 1036-1042 DOI: 10.3171/2010.3.JNS091966.
- 18 Al-Mefty O, Holoubi A, Rifai A. et al. Microsurgical removal of suprasellar meningiomas. Neurosurgery 1985; 16: 364-372 DOI: 10.1227/00006123–198503000–00014.
- 19 Omay SB, Barnett GH. Surgical navigation for meningioma surgery. J Neuro-Oncology 2010; 99: 357-364 DOI: 10.1007/s11060–010–0359–6.
- 20 Topsakal C, Al-Mefty O, Bulsara KR. et al. Intraoperative monitoring of lower cranial nerves in skull base surgery: technical report and review of 123 monitored cases. Neurosurg Rev 2008; 31: 45-53 DOI: 10.1007/s10143–007–0105–5.
- 21 Hoefnagel D, Kwee LE, van Putten EH. et al. The incidence of postoperative thromboembolic complications following surgical resection of intracranial meningioma. A retrospective study of a large single center patient cohort. . Clin Neurol Neurosurg 2014; 123: 150-154 DOI: 10.1016/j.clineuro.2014.06.001.
- 22 Pollock BE, Stafford SL, Link MJ. Stereotactic radiosurgery of intracranial meningiomas. Neurosurg Clin N Am 2013; 24: 499-507 DOI: 10.1016/j.nec.2013.05.006.
- 23 Lee JY, Niranjan A, McInerney J. et al. Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 2002; 97: 65-72 DOI: 10.3171/jns.2002.97.1.0065.
- 24 Debus J, Wuendrich M, Pirzkall A. et al. High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 2001; 19: 3547-3553 DOI: 10.1200/JCO.2001.19.15.3547.
- 25 Jenkinson MD, Weber DC, Haylock BJ. et al. Radiotherapy versus observation following surgical resection of atypical meningioma (the ROAM trial). Neuro-Oncology 2014; 16: 1560-1561 DOI: 10.1093/neuonc/nou149.
- 26 El Shafie RA, Czech M, Kessel KA. et al. Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning. Radiat Oncol 2018; 13: 54 DOI: 10.1186/s13014-018-1002-5.
- 27 Coggins WS, Pham NK, Nguyen AV. et al. A Systematic review of ion radiotherapy in maintaining local control regarding atypical and anaplastic meningiomas. World Neurosurg 2019; 132: 282-291 DOI: 10.1016/j.wneu.2019.08.149.
- 28 Lou E, Sumrall AL, Turner S. et al. Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series. J Neuro-Oncology 2012; 109: 63-70 DOI: 10.1007/s11060-012-0861-0.
- 29 Kaley TJ, Wen P, Schiff D. et al. Phase II trial of sunitinib for recurrent and progressive atypical and anaplastic meningioma. Neuro-Oncology 2015; 17: 116-121 DOI: 10.1093/neuonc/nou148.
- 30 Seystahl K, Stoecklein V, Schuller U. et al. Somatostatin receptor-targeted radionuclide therapy for progressive meningioma: benefit linked to 68Ga-DOTATATE/-TOC uptake. Neuro-Oncology 2016; 18: 1538-1547 DOI: 10.1093/neuonc/now060.
- 31 Preusser M, Le RhunE, Soffietti R. et al. Trabectedin for recurrent WHO grade II or III meningioma: A randomized phase II study of the EORTC Brain Tumor Group (EORTC-1320-BTG). J Clinl Oncol 2019; 37: no. 15_suppl DOI: 10.1200/JCO.2019.37.15_suppl.2007.
- 32 Goldbrunner R, Minniti G, Preusser M. et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 2016; 17: e383-391 DOI: 10.1016/S1470-2045(16)30321-7.
- 33 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiat 1957; 20: 22-39 DOI: 10.1136/jnnp.20.1.22.
- 34 Mirimanoff RO, Dosoretz DE, Linggood RM. et al. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985; 62: 18-24 DOI: 10.3171/jns.1985.62.1.0018.
- 35 van Alkemade H, de Leau M, Dieleman EM. et al. Impaired survival and long-term neurological problems in benign meningioma. Neuro-Oncology 2012; 14: 658-666 DOI: 10.1093/neuonc/nos013.
- 36 Glaholm J, Bloom HJ, Crow JH. The role of radiotherapy in the management of intracranial meningiomas: the Royal Marsden Hospital experience with 186 patients. Int J Radiat Oncol Biol Phys 1990; 18: 755-761 DOI: 10.1016/0360-3016(90)90394-y.
- 37 Palma L, Celli P, Franco C. et al. Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 1997; 86: 793-800 DOI: 10.3171/jns.1997.86.5.0793.
- 38 Sahm F, Schrimpf D, Stichel D. et al. DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 2017; 18: 682-694 DOI: 10.1016/S1470-2045(17)30155-9.