Meningiomas are the most common primary intracranial tumors, showing highly heterogeneous behavior and clinical outcomes. While the majority are benign, about one in five meningiomas are classified as higher grade (WHO Grade II–III), characterized by a more aggressive, treatment-resistant pathology. Although surgical resection remains the first-line therapy, peptide receptor radionuclide therapy is emerging as a novel and promising option for advanced, multifocal, or recurrent disease. The theranostic paradigm allows simultaneous detection and treatment of somatostatin receptor-expressing lesions using a single radiopharmaceutical. In this review, we explore the evolving role of PRRT in the management of meningiomas. We provide an integrated overview of preclinical findings—including radiosensitization mechanisms—and summarize the rapidly expanding clinical literature, which in recent years has grown both in patient numbers and in methodological sophistication. Particular emphasis is placed on advances in dosimetry, quantitative imaging, and radiomics, which are beginning to refine patient selection and improve response prediction. Together, current evidence highlights the therapeutic potential of radionuclide therapy in aggressive or refractory meningiomas and underscores the need for further prospective trials to define its optimal clinical application.
脑膜瘤是最常见的原发性颅内肿瘤，其生物学行为和临床结局具有高度异质性。大多数脑膜瘤为良性，但约五分之一的脑膜瘤属于高级别（WHO II–III级），表现为更具侵袭性且难以治疗的病理特征。虽然手术切除仍是一线治疗方案，但对于晚期、多灶性或复发性脑膜瘤，肽受体放射性核素治疗正成为一种新兴且前景广阔的选择。诊疗一体化范式使得利用单一放射性药物实现生长抑素受体阳性病灶的同步检测与治疗成为可能。本篇综述探讨了PRRT在脑膜瘤治疗中不断演进的定位，系统整合了临床前研究成果（包括放射增敏机制），并总结了近年来在病例数量与方法学复杂性上快速增长的临床研究文献。特别关注剂量学、定量成像及放射组学等领域的进展，这些技术正逐步优化患者筛选并提升疗效预测能力。现有证据共同凸显了放射性核素治疗在侵袭性或难治性脑膜瘤中的治疗潜力，同时强调需要开展进一步前瞻性试验以明确其最佳临床应用方案。
Radioligand Therapy in Meningiomas: Today’s Evidence, Tomorrow’s Possibilities
肿瘤(癌症)患者之家