cns中枢神经系统肿瘤 NCCN 翻译

Meningiomas are also known to have high somatostatin生长抑素 receptor 受体density 密度allowing for the use of octreotide奥曲肽 brain scintigraphy闪烁扫描技术 to help delineate extent of disease and to pathologically病理地 define an extra-axial超出轴向 lesion.198-200脑膜瘤也被认为有高生长抑素受体密度可以使用奥曲肽脑闪烁扫描技术来帮助描绘病变范围以及病理上定义一个超过中线轴向的病灶。

Octreotide imaging with radiolabeled indium or more recently, gallium, may be particularly useful in distinguishing residual tumor from post-operative scarring in subtotally resected/recurrent tumors.放射性铟元素或者较新的、镓元素标记的奥曲肽成像，或许特别有益于区分在完整切除残余肿瘤还是手术后的瘢痕，或者复发的肿瘤Treatment Overview治疗综述Observation观察Studies that examined检查 the growth rate生长速度 of incidental偶发偶然 meningiomas in otherwise 另外的symptomatic有症状的 patients suggested建议 that many asymptomatic无症状的 meningiomas may be followed safely with serial连续 brain imaging until either the tumor enlarges增大 significantly明显 or becomes symptomatic.201, 202研究检查偶发的另外的有症状的脑膜瘤病人生长速度在建议许多无症状性脑膜瘤使用连续脑成像后可能安全地,直到任何肿瘤明显增大或变得有症状。

These studies confirm the tenet that many meningiomas grow very slowly and that a decision not to operate is justified 合理地in selected asymptomatic patients.这些研究证实的原则许多脑膜瘤生长非常缓慢,这决定在挑选出的无症状的病人不进行操作是合理的。

As the growth rate is unpredictable in any individual, repeat brain imaging is mandatory to monitor an incidental asymptomatic meningioma.但是任何个体的生长速度是不可预知的，反复强制性进行脑成像来监测偶发的雾症状的脑膜瘤SurgeryThe treatment of meningiomas is dependent upon both patient-related factors (age, performance status, medical co-morbidities) and treatment-related factors (reasons for symptoms, resectability and goals of surgery).脑膜瘤的治疗取决于与患者相关的因素 (年龄、性能状况、医学联合发病率)和治疗相关的因素(症状原因,resectability可治愈性和外科手术的目标)。

Most patients diagnosed with surgically-accessible symptomatic meningioma undergo surgical resection to relieve neurological symptoms.大多数病人被诊断为可手术的有症状的脑膜瘤经历手术切除缓解神经症状。

Complete surgical resection may be curative and is therefore the treatment of choice.完成手术切除可能治愈的,所以是治疗的首选。

Both the tumor grade and the extent of resection impact the rate of recurrence.肿瘤分级和切除的范围影响复发的几率。

In a cohort同期组群 of 581 patients, 10-year progression-free survival was 75% following GTR(gross total resection ) but dropped to 39% for patients receiving subtotal resection.203在一个581个病人的同期组群中，接受完全切除的患者10年无进展生存率是75%，但接受次全切除的病人下降到39%。

Short-term recurrences reported for grade I, II, and III meningiomas were 1% to 16%, 20% to 41%, and 56% to 63%, respectively.204-206据报道短期的复发率在1、2、3级脑膜瘤分别是1% to 16%, 20% to 41%, and 56% to 63%,The Simpson classification scheme that evaluates meningioma surgery based on extent of resection of the tumor and its dural attachment (grades I to V in decreasing degree of completeness) correlates with local recurrence rates.207辛普森分类方案,评估脑膜瘤手术基于肿瘤切除范围及硬脑膜的附件(1至V级在减少的完全程度)与局部复发率的关系First proposed in 1957, it is still being widely used by surgeons today.在1957年首次提出,今天它仍被外科医生广泛使用。

Radiation therapy放疗Safe GTR is sometimes not feasible due to tumor location.因为肿瘤位置安全的完整切除有时候是不可行的In this case, subtotal resection followed by adjuvant EBRT（external beam radiation therapy） has been shown to result in long-term survival comparable to GTR (86% vs. versus 88%, respectively),compared to only 51% with incomplete resection alone.208在这种情况下，次全切除,然后行辅助外放射治疗已被证明导致与完全切除相近的长期生存(分别是86%比88%),而单纯的不完整切除只有51%。

Of 92 patients with grade I tumors, Soyuer and colleagues found that radiation following subtotal resection reduced progression compared to incomplete resection alone, but has no effect on overall survival.20992位1级肿瘤的患者，Soyuer和他的同事们发现,次全切除后放疗相比单纯不完全切除减少肿瘤进展,但不影响总的生存Because high grade meningiomas have a significant probability of recurrence even following GTR,210 postoperative high-dose EBRT (above 54 Gy) has become the accepted standard of care for these tumors to improve local control.211因为高级别脑膜瘤甚至在完全切除后仍有很高的复发几率，手术后大剂量的外放射治疗（超过54GY）已经成为改善肿瘤局部控制率的公认的标准A review of 74 patients showed that adjuvant radiotherapy improves survival in patients with grade III meningioma and in those with grade II disease with brain invasion.212一项74名患者的回顾研究显示辅助放疗改善了3级脑膜瘤患者的生存，这些患者存在2级的脑浸润病变The role of post-GTR radiotherapy in benign cases remains controversial.完全切除之后的放射治疗的角色良性情况下存在争议Technical advances have enabled stereotactic administration of radiotherapy by linear accelerator (LINAC), Leksell Gamma Knife or Cyberknife radiosurgery.技术进步使立体定向放射治疗实施由直线加速器(直线加速器),立体定向伽玛刀或射波刀放射外科。

The use of stereotactic radiotherapy (either single fraction or fractionated) in the management of meningiomas continues to evolve. Advocates have suggested this therapy in lieu of EBRT for small (<35 mm) recurrent or partially resected tumors. 使用立体定向放射治疗(无论是单部分或分组)在脑膜瘤的治疗中得以持续发展。