Background/Objectives: Recurrent meningiomas remain difficult to manage due to the absence of effective systemic therapies and comparatively high treatment failure rates, particularly in high-grade tumors. Stereotactic radiosurgery (SRS) offers a minimally-invasive and precise option, particularly for tumors in surgically complex locations. However, the risks associated with re-irradiation, and recent changes in the WHO classification of CNS tumors highlight the need for more personalized and strategic treatment approaches. This systematic review evaluates the safety, efficacy, and clinical considerations for use of SRS for recurrent meningiomas.Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted using the PubMed, Scopus, and Web of Science databases for studies reporting outcomes of SRS in recurrent, pathologically confirmed intracranial meningiomas. Studies were excluded if they were commentaries, reviews, case reports with fewer than three cases, or had inaccessible full text. The quality and risk of bias of the included studies were assessed using the modified Newcastle-Ottawa Scale. Data on patient and tumor characteristics, SRS treatment parameters, clinical outcomes, adverse effects, and statistical analysis results were extracted.Results: Sixteen studies were included. For WHO Grade I tumors, 3- to 5-year progression-free survival (PFS) ranged from 85% to 100%. Grade II meningiomas demonstrated more variable outcomes, with 3-year PFS ranging from 23% to 100%. Grade III tumors had consistently poorer outcomes, with reported 1-year and 2-year PFS rates as low as 0% and 46%, respectively. SRS performed after surgery alone was associated with superior outcomes, with local control rates of 79% to 100% and 5-year PFS ranging from 40.4% to 91%. In contrast, tumors previously treated with radiotherapy, with or without surgery, showed substantially poorer outcomes, with 3- to 5-year PFS ranging from 26% to 41% and local control rates as low as 31%. Among patients with prior radiotherapy, outcomes were particularly poor in Grade II and III recurrent tumors. Toxicity rates ranged from 3.7% to 37%, and were generally higher for patients with prior radiation. Predictors of worse PFS included prior radiation, older age, and Grade III histology.Conclusions: SRS may represent a reasonable salvage option for carefully selected patients with recurrent meningioma, particularly following surgery alone. Outcomes were notably worse in high-grade recurrent meningiomas following prior radiotherapy, emphasizing the prognostic significance of both histological grade and treatment history. Notably, the lack of molecular and genetic data in most existing studies represents a key limitation in the current literature. Future prospective studies incorporating molecular profiling may improve risk stratification and support more personalized treatment strategies.
背景/目的：由于缺乏有效的全身性疗法且治疗失败率相对较高，复发性脑膜瘤的治疗仍具挑战性，尤其在高级别肿瘤中。立体定向放射外科（SRS）提供了一种微创且精准的治疗选择，尤其适用于手术复杂部位的肿瘤。然而，再程放疗的相关风险以及世界卫生组织（WHO）中枢神经系统肿瘤分类的最新变化，凸显了采取更个性化、更具策略性治疗方法的必要性。本系统综述旨在评估SRS治疗复发性脑膜瘤的安全性、有效性及临床考量因素。 方法：根据系统综述和荟萃分析优先报告条目（PRISMA）指南，我们在PubMed、Scopus和Web of Science数据库中系统检索了报告SRS治疗经病理证实的复发性颅内脑膜瘤疗效的研究。排除标准包括评论性文章、综述、病例数少于3例的病例报告以及无法获取全文的研究。采用改良版纽卡斯尔-渥太华量表评估纳入研究的质量和偏倚风险。提取的数据包括患者与肿瘤特征、SRS治疗参数、临床结局、不良反应及统计分析结果。 结果：共纳入16项研究。对于WHO I级肿瘤，3至5年无进展生存率（PFS）介于85%至100%。II级脑膜瘤的结局差异较大，3年PFS介于23%至100%。III级肿瘤的结局普遍较差，报告的1年和2年PFS分别低至0%和46%。单纯手术后进行SRS治疗的患者结局更优，局部控制率达79%至100%，5年PFS介于40.4%至91%。相比之下，既往接受过放疗（无论是否联合手术）的肿瘤结局显著较差，3至5年PFS介于26%至41%，局部控制率低至31%。在既往接受过放疗的患者中，II级和III级复发性肿瘤的结局尤其不佳。毒性反应发生率介于3.7%至37%，既往接受过放疗的患者发生率通常更高。PFS较差的预测因素包括既往放疗史、年龄较大以及III级组织学类型。 结论：对于经过严格筛选的复发性脑膜瘤患者，尤其是仅接受过手术治疗的患者，SRS可能是一种合理的挽救性治疗选择。既往接受过放疗的高级别复发性脑膜瘤患者结局明显更差，这强调了组织学分级和治疗史对预后的重要意义。值得注意的是，现有大多数研究缺乏分子和遗传学数据，这是当前文献的一个关键局限。未来结合分子谱分析的前瞻性研究可能有助于改善风险分层，并支持更个性化的治疗策略。
肿瘤(癌症)患者之家