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.

Kernaussagen

• 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

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