胶质瘤的多学科协作治疗
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中山大学肿瘤医院神经外科 / 神经肿瘤科 陈忠平
【 Abstract 】 Glioma is the most common primary tumor in central nervous system and the prognosis was still poor even though in the modern days with advanced treatment technology. Some benign (low grade) gliomas can be cured by surgical removal, while malignant gliomas are not possible cured by surgery alone. And thus post-operative radiotherapy and chemotherapy are also essential treatments for the patients with glioma. Currently, the fundamental importance of surgery has been recognized to deal with both low grade as well as high grade gliomas. Although there was still contravention to low grade glioma, radiotherapy does beneficial to high grade glioma patients. However, the clinical chemotherapeutic efficacy for glioma patient is not satisfactory yet. Fortunately, through understanding molecular mechanism of drug resistance and new regimen including recently used new drug temozolomide (TMZ), the clinical efficiency of chemotherapy for patients with gliomas have been improved considerably. Moreover, Chemotherapy sensitivity and resistance assays (CSRAs) offer the potential of selecting treatment based on responsiveness of individual tumors as measured by in vitro assays, while determination of drug resistance gene expression in tumor sample, such as O(6)- methylguanine-DNA methyltransferase (MGMT), may role out resistant agents, and thus provide the possibility of tailoring treatment to individual patient, using effective agents while sparing unnecessary ones. Unfortunately, in clinic, some patients treated without reasonable multimodal treatments are not uncommon. In these cases, quality of life was poorer, and overall survival of the patient was shorter. Therefore, it is important to improve the therapeutic effect, prevent the recurrence and prolong the survival by treating the patients individually with reasonable multimodal treatments according to the histological type and grade of the tumors as well as condition of the patients. In this talk, I will share with you our experience on multimodal treatments and emphasizing the importance of multimodal treatments to the patients with gliomas.
全身恶性肿瘤中，颅内肿瘤居第九位。在儿童，颅内肿瘤所占的比例较大，约为全身肿瘤的 7% ，是仅次于白血病的第二肿瘤。死亡率方面颅内肿瘤在 12 岁以下儿童占肿瘤死亡的 12% ，居第一位，成人则居第十位。根据世界卫生组织 1992 年的统计，随地区和种族不同，原发性脑肿瘤(包括良性和恶性)的年发病率为 2 ～ 19/10 万人。在美国，原发恶性脑肿瘤的发病率为 6.6/10 万人，在所有的原发性脑肿瘤中约 60 %为胶质细胞瘤，其中大多数为高度恶性的星形细胞瘤。北京市城区中枢神经系统肿瘤患病率为 36.6/10 万人。国内颅内原发肿瘤中胶质瘤占 35.26 %～ 60.96 %(平均 44.69 %)。胶质瘤的年龄发病高峰在 10 ～ 20 岁和 30 ～ 40 岁之间，男女性别比为 1.1∶1 ，多为青壮年，对家庭及社会的危害极大。
由于胶质瘤多呈浸润性生长，所以治疗也就十分困难。目前，胶质瘤病人的预后还很不乐观，特别是恶性胶质细胞瘤的平均生存时间还不超过一年，高度恶性的胶质母细胞瘤的 5 年生存率则不足 5% 。脑胶质瘤需要以手术为主，术后辅助放疗、化疗、生物治疗等综合治疗已经得到临床医师的共识。由于 任何单一的手段，难以治愈胶质瘤，特别是恶性的胶质瘤，所以，综合治疗是提高胶质瘤治疗效果的有效措施。但由于国内还没有一个统一的胶质瘤治疗规范， 临床上，经常可以见到各种未行系统综合治疗的胶质瘤患者，其生存质量和生存时间明显较差。因此，在胶质瘤的临床治疗实践中，如何根据肿瘤的特征和患者的具体情况，合理地选择和制定个体化的治疗方案，多学科协作有计划地综合治疗，对提高疗效、防止复发，延长患者生存时间，有着十分重要的意义。
一、胶质瘤的治疗现状
胶质瘤是中枢神经系统最常见、也是最难根治的肿瘤。目前以手术为主的综合治疗使胶质瘤的疗效有了明显提高。 在神经胶质瘤的治疗手段中，手术治疗的效果已被肯定。近二十年来 ......
中山大学肿瘤医院神经外科 / 神经肿瘤科 陈忠平
【 Abstract 】 Glioma is the most common primary tumor in central nervous system and the prognosis was still poor even though in the modern days with advanced treatment technology. Some benign (low grade) gliomas can be cured by surgical removal, while malignant gliomas are not possible cured by surgery alone. And thus post-operative radiotherapy and chemotherapy are also essential treatments for the patients with glioma. Currently, the fundamental importance of surgery has been recognized to deal with both low grade as well as high grade gliomas. Although there was still contravention to low grade glioma, radiotherapy does beneficial to high grade glioma patients. However, the clinical chemotherapeutic efficacy for glioma patient is not satisfactory yet. Fortunately, through understanding molecular mechanism of drug resistance and new regimen including recently used new drug temozolomide (TMZ), the clinical efficiency of chemotherapy for patients with gliomas have been improved considerably. Moreover, Chemotherapy sensitivity and resistance assays (CSRAs) offer the potential of selecting treatment based on responsiveness of individual tumors as measured by in vitro assays, while determination of drug resistance gene expression in tumor sample, such as O(6)- methylguanine-DNA methyltransferase (MGMT), may role out resistant agents, and thus provide the possibility of tailoring treatment to individual patient, using effective agents while sparing unnecessary ones. Unfortunately, in clinic, some patients treated without reasonable multimodal treatments are not uncommon. In these cases, quality of life was poorer, and overall survival of the patient was shorter. Therefore, it is important to improve the therapeutic effect, prevent the recurrence and prolong the survival by treating the patients individually with reasonable multimodal treatments according to the histological type and grade of the tumors as well as condition of the patients. In this talk, I will share with you our experience on multimodal treatments and emphasizing the importance of multimodal treatments to the patients with gliomas.
全身恶性肿瘤中，颅内肿瘤居第九位。在儿童，颅内肿瘤所占的比例较大，约为全身肿瘤的 7% ，是仅次于白血病的第二肿瘤。死亡率方面颅内肿瘤在 12 岁以下儿童占肿瘤死亡的 12% ，居第一位，成人则居第十位。根据世界卫生组织 1992 年的统计，随地区和种族不同，原发性脑肿瘤(包括良性和恶性)的年发病率为 2 ～ 19/10 万人。在美国，原发恶性脑肿瘤的发病率为 6.6/10 万人，在所有的原发性脑肿瘤中约 60 %为胶质细胞瘤，其中大多数为高度恶性的星形细胞瘤。北京市城区中枢神经系统肿瘤患病率为 36.6/10 万人。国内颅内原发肿瘤中胶质瘤占 35.26 %～ 60.96 %(平均 44.69 %)。胶质瘤的年龄发病高峰在 10 ～ 20 岁和 30 ～ 40 岁之间，男女性别比为 1.1∶1 ，多为青壮年，对家庭及社会的危害极大。
由于胶质瘤多呈浸润性生长，所以治疗也就十分困难。目前，胶质瘤病人的预后还很不乐观，特别是恶性胶质细胞瘤的平均生存时间还不超过一年，高度恶性的胶质母细胞瘤的 5 年生存率则不足 5% 。脑胶质瘤需要以手术为主，术后辅助放疗、化疗、生物治疗等综合治疗已经得到临床医师的共识。由于 任何单一的手段，难以治愈胶质瘤，特别是恶性的胶质瘤，所以，综合治疗是提高胶质瘤治疗效果的有效措施。但由于国内还没有一个统一的胶质瘤治疗规范， 临床上，经常可以见到各种未行系统综合治疗的胶质瘤患者，其生存质量和生存时间明显较差。因此，在胶质瘤的临床治疗实践中，如何根据肿瘤的特征和患者的具体情况，合理地选择和制定个体化的治疗方案，多学科协作有计划地综合治疗，对提高疗效、防止复发，延长患者生存时间，有着十分重要的意义。
一、胶质瘤的治疗现状
胶质瘤是中枢神经系统最常见、也是最难根治的肿瘤。目前以手术为主的综合治疗使胶质瘤的疗效有了明显提高。 在神经胶质瘤的治疗手段中，手术治疗的效果已被肯定。近二十年来 ......
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