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高级别胶质瘤的化疗方案
\n\n间变性胶质细胞瘤术后推荐辅以放疗和化疗,方案同 GBM(glioblastoma,胶质母细胞瘤)的 TMZ(timorazole,替莫唑胺)方案或其他方案,建议根据分子标记物确定个体化治疗方案。
\n\n对于高龄的高级别胶质瘤患者,有研究指出 TMZ 也有获益[1]。老年及虚弱者可采用单独 TMZ 化疗。对于老年身体状况良好的患者,仍推荐采用标准 STUPP 方案。总之,TMZ 用于高级别胶质瘤患者可以延长其生存时间,延长肿瘤无进展期,对患者的生活质量没有明确的负面影响。
\n\n低级别胶质瘤的化疗方案
\n\n以往低级别胶质瘤的化疗一直存在争议。随着化疗新药的不断研发、肿瘤分子遗传学的研究深入和随机对照临床试验的开展,化疗在低级别胶质瘤患者中的作用逐渐得到重视和肯定。
\n\n化疗主要用于高危新诊断患者的辅助化疗和复发患者的挽救化疗,具体应用如下:
\n\n\n\t- 新发低级别胶质瘤患者的辅助治疗,应根据是否存在高危因素实施个体化的治疗方案。
\n\t- 高危患者术后辅助治疗,推荐放疗联合 TMZ 或放疗联合替莫唑胺同步和辅助化疗,但对 1p19q 联合缺失的患者可以选择单纯化疗。
\n\t- 对于低级别胶质瘤如能做到彻底切除,预后较好的低危患者则可以观察。
\n\t- 对于进展和复发的患者应再次手术,以往没有进行放疗的患者可以选择放疗。已行放疗的患者应进行化疗。如果肿瘤继续进展,需考虑选择另外一种化疗药、考虑再次放疗及更好的支持治疗。
\n\t- 挽救化疗根据患者的情况实施个体化的化疗,包括替莫唑胺、亚硝脲类、铂类为基础的方案。
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\n\n\n\n儿童胶质瘤包括低级别和高级别胶质瘤,对于位置深而不能全切的肿瘤,辅助放化疗有着重要的作用,具体应用如下:
\n\n\n\t- 儿童低级别胶质瘤手术全切不推荐其他辅助治疗,出现复发时推荐放化疗。
\n\t- 如果手术未能全切,需要放疗或化疗。
\n\t- 儿童高级别胶质瘤术后推荐行放化疗。<3 岁者建议先行化疗,>3 岁后再行放疗。
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\n\n目前儿童高级别胶质瘤尚无标准的化疗方案,而且效果也不理想。
\n\n\n\n\n',op_keyword:[],url:a,releasetime:"2021-09-17",op_sole:0,ref:[],tid:6,op_class:0,op_copyright:a,ref_info:["Braun K, Ahluwalia MS.Treatment of Glioblastoma in Older Adults[J].Curr Oncol Rep,2017 Oct 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