多形性胶质母细胞瘤术前初诊探讨

目的:提高临床多形性胶质母细胞瘤诊断正确率.方法:总结分析62例多形性胶质母细胞瘤的临床表现及CT影像学特点.结果:多形性胶质母细胞瘤术前诊断与术后病理诊断符合率为85.9%.结论:大多数多形性胶质母细胞瘤术前均可得到初步诊断.     

多形性胶质母细胞瘤预后分级研究

目的总结成人多形性胶质母细胞瘤(GBM)的疗效,判定影响预后的相关因素,初步建立GBM预后的分级系统.方法回顾研究手术治疗的171例多形性胶质母细胞瘤患者的临床资料并根据随访,采用Kaplan-meier法计算生存率,绘出生存曲线;Logistic回归分析判定影响预后的因素.根据多因素分析结果,建立GBM预后的分级系统.结果 Logistic多因素回归分析显示病人的年龄、Karnofsky行为等级(KPS)评分、手术切除范围和术前影像学显示的肿瘤坏死程度等是多形性胶质母细胞瘤重要的预后不利因素.通过以上四种因素建立的GBM分级系统表明:分值越高,生存时间越短,分值与预后明显相关.结论初步建立的GBM分级系统对判定患者的预后有一定指导作用.     

多形性胶质母细胞瘤的适形放疗新进展

多形性胶质母细胞瘤(glioblastoma multiforme, GBM)是最常见的脑胶质瘤之一,为高分级脑胶质瘤,放疗是其重要的治疗手段。Chang等研究表明,接受肿瘤局部放疗患者的中位生存时间(7个     

多形性胶质母细胞瘤的硼中子俘获治疗研究进展

硼中子俘获治疗（Boron neutron capture therapy,BNCT）是一种理论上即使当肿瘤细胞已经扩散到正常组织中仍可以选择性杀伤肿瘤细胞而不损伤正常组织的治疗方法。这种肿瘤细胞选择性放射治疗依赖于同位素硼（10B）和热中子,通过硼中子俘获反应释放α粒子和7Li粒子,产生9μm有限长度的杀伤距离。BNCT研究进展缓慢因为缺乏新的硼携带制剂,目前应用较多的对二羟基苯丙氨酸硼（boronophenylalanine,BPA）和巯基硼烷（sodium borocaptate,BSH）还没有明确的最佳给药剂量和给药方式。另外一个主要问题是对中子核反应堆的依赖性。最近的的临床研究主要集中于高级别的胶质瘤和皮肤黑色素瘤的治疗。迄今为止全球已有350多例高级别胶质瘤的患者接受了这种方式治疗。将来不断进步的肿瘤靶向硼化合物研究、给药方式、硼制剂携带系统、医院中子源及医院内联合治疗方式的发展必将提高BNCT的疗效。     

miR-124抑制多形性胶质母细胞瘤的生长

目的:研究下调miR-124和过表达miR-124对恶性胶质瘤细胞增殖的影响,在分子病因学方面阐述miR-124在调控胶质瘤细胞的生长中起到的重要作用.方法:在胶质瘤细胞系中应用RT-PCR定量方法检测下调miR-124来评价miR-124的作用.应用病毒转染的过表达miR-124的稳定细胞系U87-124和U373-124,用qRT-PCR方法检测过表达miR-124对胶质瘤细胞增殖的影响.结果:miR-124在4个胶质瘤细胞系(U87、U373、SW1088和SW1073)中与对照组细胞系相比呈明显低表达水平.U87-miR-124和U373-miR-124的胶质瘤细胞增殖明显低于对照组.结论:在分子病因学方面,miR-124能明显抑制脑胶质瘤细胞的增殖,在调控脑胶质瘤细胞的生长中起到了重要作用,同时也为miR-124用于脑胶质瘤的治疗提供了一个可能性.     

安罗替尼联合替莫唑胺治疗复发性胶质母细胞瘤1例

患者女性,66岁.2020年8月于外院行右侧额颞顶开颅,右侧额顶叶胶质瘤显微切除术,术前术后头颅CT见图1,术后病理见图2.经复旦大学附属华山医院病理会诊(编号:H20-00962)整合诊断:(右额颞顶)胶质母细胞瘤(WHOⅣ级),IDH野生型.组织学诊断:高级别胶质瘤,胶质母细胞瘤表型;病理级别:WHOⅣ级;分子病理...     

多形性胶质母细胞瘤33例影像学特点及手术治疗评估

 【摘要】　目的　总结分析多形性胶质母细胞瘤（GBM）的临床表现、影像学特点及手术治疗预后,为其临床诊断和治疗提供一定参考依据。方法　回顾性总结分析33例经病理证实的GBM患者的临床资料特点。结果　GBM患者临床症状多以头痛为主诉,磁共振成像（MRI）表现均为不规则形稍长T1、稍长T2混杂信号,水肿与占位效应明显,钆喷酸葡胺（GD-DTPA）增强后病灶不规则形环状强化;行手术切除（其中8例行显微手术）,31例无严重并发症;随访3个月,32例无肿瘤复发,1例死亡。结论　GBM其临床诊治及影像学具有相对特征性,通过这些指标能明显优化术前评估,以提高术后患者生存率与生活质量。     

表皮生长因子受体与多形性胶质母细胞瘤放疗抵抗

多形性胶质母细胞瘤(glioblastoma multiforme,GBM)是一类在形态学上具有异质性的原发性脑肿瘤,恶性程度极高,其标准治疗方法是手术+术后放疗+以替莫唑胺(temozolomide,TMZ)为基础的化疗.但GBM患者易对放疗产生抵抗以及对化疗耐药,该治疗方案的有效率有限,患者中位生存期约15个月.40％～50％GBM患者体内存在表皮生长因子受体(epidermal growth factor receptor,EGFR)的扩增和过表达.全文对EGFR表达与GBM放疗抵抗的相关机制作一综述.     

多形性胶质母细胞瘤术前初诊探讨

目的：提高临床多形性胶质母细胞瘤诊断正确率。方法：总结分析62例多形性胶质母细胞瘤的临床表现及CT影像学特点。结果：多形性胶质母细胞瘤术前诊断与术后病理诊断符合率为85．9％。结论：大多数多形性胶质母细胞瘤术前均可得到初步诊断。     

脑多形性胶质母细胞瘤水肿带大小与预后相关性的分析

目的评价肿瘤外周水肿带对脑多形性胶质母细胞瘤(GBM)的预后影响。方法回顾性分析74例接受适形放射治疗(CRT)多形性胶质母细胞瘤患者的资料。所有患者均经病理组织学证实,其中62例患者经手术全切或次全切术,12例仅行立体定向活检术。55例采用了不同方式的化疗,另外19例患者行单纯放疗,放疗剂量均为60Gy。结果中位生存期为13.9个月,1、2及3年总生存率分别为57.0%、18.0%和12.9%。水肿带最大径≤70mm者中位生存期为19.9个月,>70mm者为9.9个月(P<0.0001);水肿带与肿瘤最大径比值(E/T)≤1.8与>1.8者中位生存期分别为16.6个月和9.9个月(P=0.0004)。中位肿瘤进展时间为7.8个月,1、2年的局部控制率分别为22.4%和8.2%。结论肿瘤边缘水肿带大小以及与肿瘤的比值是影响GBM预后的重要因素,提示水肿带应包括在照射野内,同时在不增加并发症的前提下是否应进一步提高水肿带照射剂量?     

Unexpected case of aplastic anemia in a patient with glioblastoma multiforme treated with Temozolomide

Summary We report the case of a 30-year-old woman with glioblastoma multiforme (GBM) treated with surgery followed by concomitant Temozolomide (TMZ) and external beam radiation, which she tolerated well without any interruptions. However, when she was being evaluated for adjuvant Temozolomide, she developed progressive decline in leukocyte counts and platelet counts and subsequently, febrile neutropenia with bleeding manifestations. A bone marrow aspiration and biopsy done showed a gross hypocellular bone marrow with very few erythriod and myeloid cells and no suggestion of progenitor cells, consistent with aplastic anemia.     

High-Dose Conformal Radiotherapy Influenced the Pattern of Failure But Did Not Improve Survival in Glioblastoma Multiforme

Background and Purpose: Although glioblastoma multiforme is clearly radiation-resistant, there is evidence of a dose–dependent response relationship. The purpose of the study was to evaluate the impact of higher dose by rotational multileaf collimator (MLC) conformal radiation therapy.

Materials and Methods: From 1984 to 1995, 38 consecutive cases with intracranial glioblastoma multiforme were treated using the rotational MLC conformal therapy. There were 25 men and 13 women with a median age of 47 years (12–73 years, mean 46.5 years). Median Karnofsky performance score was 80 (30–100, mean 78.2). Median tumor volume was 64 cc (8–800 cc, mean 110.3 cc). All underwent surgical intervention (only biopsy in 1, partial resection in 13, subtotal resection in 21, and gross total resection in 3). Radiation dose to was 60 to 80 Gy (median 68.5 Gy, mean 68.3 Gy) in 21 patients treated before 1990 and 90 Gy in the 17 patients thereafter. Biweekly i.v. chemotherapy was also administered for both arms.

Results: The 1-year, 2-year, 5-year, and 10-year overall survival rates were 75%, 42%, 20%, and 15%, respectively. Univariate analysis showed the initial tumor volume, residual tumor volume, and Karnofsky performance score were statistically significant factors for survival. Only the residual tumor volume was statistically significant by multivariate analysis. The 5-year survival rate of patients with residual tumors of 5 cc or less in volume was as good as 37%. Survival of the 90-Gy Group appeared inferior to that of the Low-Dose Group, though no statistical difference was seen (the 3-year survival was 40% vs. 22%). Local failure was observed in 16 of the 19 recurrences in the Low-Dose Group, whereas it was observed in only 4 of the 13 recurrences in the 90-Gy Group. The difference in pattern of failure was statistically significant. Two patients of the High-Dose Group developed radiation necrosis and one died of it.

Conclusions: The high-dose conformal radiotherapy did not improve survival in the disease, but did change the pattern of failure.     

Local Chemotherapy with Cisplatin-depot for Glioblastoma Multiforme

Glioblastoma multiforme (GBM) makes up as many as 30% of all primary brain tumors. Despite the employment of multimodal antitumor treatment, the overall survival is less than one year. Between 06/01/1998 and 06/01/2000 17 patients (Group A) with GBM (11 males, 6 females; median age 54.3 years) were administered local chemotherapy with cisplatin incorporated into biodegradable 6-carboxylcellulose polymer (cisplatin-depot (CDDP-D)). After the subtotal removal of GBM, twenty 1.5 × 1.5cm polymer plates with a total area of 45cm² (the density of cisplatin immobilization on 6-carboxylcellulose being 1mg/cm², a total cisplatin dose of 45mg) were implanted into the tumor bed. Group B (21 patients with GBM; 11 males, 10 females; median age 53.2 years) was control: the subtotal tumor ablation without CDDP-D implantation. Two to three weeks after the surgery all the patients of Groups A and B started a course of radiation therapy. A total dose of cranial irradiation was 20Gy (1 fraction/day, 5 days/week; a daily dose of 2Gy) followed by a boost tumor bed irradiation (1 fraction/day, 5 days/week; a daily dose of 2Gy) up to the conventional dose of 60Gy. Survival data for the patients were processed using the Kaplan–Meier method and analyzed by logrank test.All the patients of Group A tolerated surgical ablation of the brain tumor without side effects (brain edema, seizures, etc.). No patient of Group A had a reduction in blood cell counts during six weeks that would indicate systemic exposure to cisplatin. Blood chemistry and urinalysis did not show evidence of renal injury. No side effects of radiotherapy were registered in Group B either, regarding both the psychoneurological status of the patients and the basic values of homeostasis. Karnofsky performance scale (KPS) score of Group A and Group B patients demonstrated no significant differences before and after the surgery. The median overall survivals for patients of Group A and Group B were 427.5 and 211.0 days respectively (p=0.00001; overall logrank test). Conclusion. Local chemotherapy of GBM with CDDP-D followed by irradiation is well tolerated and effective.     

Short-course Radiotherapy in Elderly and Frail Patients with Glioblastoma Multiforme. A Phase II Study

Purpose. To evaluate efficacy of short-course radiotherapy (RT) in elderly (60 years) and frail [Karnofsky performance status (KPS) 50–70] patients with glioblastoma multiforme (GBM).Materials and methods. Between January 1987 and June 1993, a total of 47 elderly and frail patients with histological diagnosis of GBM entered into a phase II study. RT alone was administered with tumor dose of 45 Gy in 15 daily fractions in 15 treatment days in 3 weeks to a target volume described as tumor visible on CT scan and a 2-cm margin.Results. Forty-four patients were evaluable for this analysis. There were 15 (34%) CR and 11 (25%) PR, making the overall response rate of 60%. Median duration of response was 9 months (range, 2–36 months). Improvement in pretreatment performance status was observed in 20/44 (45%) patients, 5 of which improved their KPS for 20%. Median survival time is 9 months, and 1–4 year survival rates are 39%, 6.8%, 4.5%, and 0, respectively, while median time to tumor progression is 8 months, and 1–4 year progression-free survival rates are 30%, 4.5%, 4.5%, and 0, respectively. Females did significantly better than males, patients with KPS 60–70 did significantly better than those with KPS 50, patients having tumors 4–5 cm did significantly better than those with tumors 6–8 cm as well as did those with more radical surgery when compared to those with biopsy only. On multivariate analysis, only tumor size and extent of surgery were found to independently influence survival. Acute toxicity was generally assessed as mild. One of the 12 (8%) autopsied patients had RT-induced brain necrosis.Conclusion This shortened RT appears to be an effective tool in palliation of elderly and frail patients with GBM. Further studies with more patients are needed before testing it against more aggressive treatment approaches in this patient population.