The majority of meningiomas are World Health Organization (WHO) grade 1 and have favorable outcomes when managed with surgery or radiotherapy. However, approximately 18% of meningiomas are grade 2 and 2% are grade 3.¹ Even with aggressive multi-modal management for high-grade meningiomas, outcomes remain modest. The high-risk arm of RTOG 0539 included WHO grade 2 meningiomas which were subtotally resected or recurrent after surgery alone, and any WHO grade 3 meningiomas, regardless of the extent of resection.² After fractionated external beam photon radiotherapy to a dose of 60 Gy in 30 fractions, the progression-free survival (PFS) at 3 years was just 59%. Post hoc analysis demonstrated that recurrent grade 2 meningiomas had worse PFS than newly diagnosed grade 3 meningiomas (5-year PFS 30% vs 58.2%), suggesting that recurrent high-grade meningiomas represent a particularly aggressive entity. Furthermore, grade 2 and 3 meningiomas which recur following multimodality therapy with surgery and radiotherapy are even more difficult to manage with an estimated 6-month PFS of just 26%.³ Multiple systemic agents, such as cytotoxic chemotherapies, targeted therapies,⁴ and more recently immune checkpoint inhibitor therapies,⁵ have failed to improve outcomes over these historical estimates, leading to a critical and unmet need to evaluate innovative treatment approaches for this patient population.

中文翻译：

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超越基准：硼中子俘获疗法治疗复发性和难治性脑膜瘤

大多数脑膜瘤是世界卫生组织 (WHO) 的 1 级，并且在通过手术或放疗进行管理时具有良好的结果。然而，大约 18% 的脑膜瘤为 2 级，2% 为 3 级^。1即使对高级别脑膜瘤采用积极的多模式管理，结果仍然不大。RTOG 0539 的高风险组包括仅在手术后被次全切除或复发的 WHO 2 级脑膜瘤，以及任何 WHO 3 级脑膜瘤，无论切除程度如何。²在 30 次分割外束光子放疗至 60 Gy 剂量后，3 年的无进展生存期 (PFS) 仅为 59%。事后分析表明，复发性 2 级脑膜瘤的 PFS 比新诊断的 3 级脑膜瘤更差（5 年 PFS 30% vs 58.2%），这表明复发性高级别脑膜瘤是一种特别具有侵袭性的实体。此外，在手术和放疗的多模式治疗后复发的 2 级和 3 级脑膜瘤更加难以控制，估计 6 个月的 PFS 仅为 26%。³多种全身性药物，例如细胞毒性化学疗法、靶向疗法，⁴以及最近的免疫检查点抑制剂疗法，⁵未能改善这些历史估计的结果，导致评估该患者群体的创新治疗方法的关键和未满足的需求。