経口抗エストロゲン薬（メピチオスタン）により腫瘍縮小効果を認めた高齢者頭蓋内髄膜腫の検討

Effect of an Oral Anti-estrogen Agent (Mepitiostane) on the Regression of Intracranial Meningiomas in the Elderly

頭部造影MRIで髄膜腫と診断した高齢者髄膜腫6例に対し，抗エストロゲン薬（メピチオスタン10～20mg/日）の経口投与を行ったところ，3例において腫瘍縮小効果を示した。平均年齢は77歳で，全例女性であった。投与期間は平均65.3カ月で，投与後の腫瘍退縮率は平均84%であった。抗エストロゲン薬の投与は，手術治療が困難な高齢者の髄膜腫に対する治療の選択肢となりうる可能性が示唆された。

Abstract

We report here the regression of meningioma following treatment with the anti-estrogen agent mepitiostane in a series of cases. The first case was that of a 72-year-old woman who presented with coma status due to non-communicating hydrocephalus. A large presumed meningioma within the cerebello-pontine angle was detected on gadolinium-enhanced magnetic resonance imaging (MRI). The patient recovered from the neurological deficit following endoscopic third ventriculostomy treatment, and was administered mepitiostane (10mg/day) orally. Gadolinium-enhanced MRI showed a marked regression (85%) of the meningioma following 60 months of oral medication. The second case was that of a 79-year-old woman with no neurological deficit; however, a presumed meningioma located in the frontal skull base was detected on gadolinium-enhanced MRI. Mepitiostane (10mg/day) was administered orally. Again, a marked regression (88%) of the meningioma was demonstrated after 115 months of oral medication. The third case was that of a 71-year-old woman who presented with right visual disturbance and a visual field defect. Gadolinium-enhanced MRI demonstrated a presumed meningioma located in the left sphenoidal bone. Mepitiostane (20mg/day) was administered orally. An 79% regression of the meningioma was observed after 21 months of oral medication. In these three cases, the marked reduction in meningioma following anti-estrogen agent (mepitiostane) administration suggested that this oral medication could be an effective therapeutic option in elderly patients.

(Received September 9, 2013; Accepted January 14, 2014; Published August 1, 2014)