Cerebellar pilocytic astrocytoma: A treatment protocol based upon analysis of 73 cases and a review of the literature
Cerebellar pilocytic astrocytoma: A treatment protocol based upon analysis of 73 cases and a review of the literature
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DOI：
10.1007/s003810050033
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发表时间：
1997-01-01
影响因子：
1.4
通讯作者：
Molenaar, WM
中科院分区：
文献类型：
--
作者：
Dirven, CMF;Mooij, JJA;Molenaar, WM
回顾性分析了73例小脑毛细胞型星形细胞瘤患者的治疗结果、预后和残留肿瘤的生物学行为。仅69%的病例在术后1年内通过CT或MRI扫描证实肿瘤完全切除。在31%的情况下，外科医生的意见，手术切除的程度是不支持的结果，术后神经影像学。19%的患者出现残留肿瘤进展或肿瘤复发，1例患者显示转移性肿瘤沿颅脊髓轴沿着扩散，1例患者在随访期间出现恶性变性。在14%的患者中观察到稳定的残留肿瘤或残留肿瘤消退。手术治疗后的结果，其中10例（14%）合并放疗，是有利的80%和不利的20%的患者。这种治疗结果不受残留肿瘤或复发肿瘤进展的第二次手术的影响。第一次手术后肿瘤进展患者的特征与整个组的特征没有差异。有17例因肿瘤残留或复发而再次手术，其中10例发生在初次手术治疗后4年内。手术相关的发病率为15%，死亡率为4%。对s例患者的残留肿瘤进行照射后，1例患者完全消退，4例患者进展，1例患者无变化。对于其余2例患者，放射对残留肿瘤的影响尚不清楚。决定预后的因素进行了讨论的基础上，这种回顾性分析和文献中的数据。它的结论是，小脑毛细胞星形细胞瘤的最佳治疗并不完全包括在手术中的目的是总肿瘤切除和仔细的肿瘤处理，以避免扩散的肿瘤细胞和随后的转移和额外的放射治疗，在严格选择的情况下，但也在治疗后的后续行动的基础上直接术后神经影像学，最好是通过MRI。提出了一种用于术后随访管理的算法。
In a retrospective study of 73 patients operated on for cerebellar pilocytic astrocytomas, results of treatment, outcome and biological behaviour of residual tumour were analysed. Complete tumour resection proven by CT or MRI scans within 1 year after surgery was achieved only in 69% of cases. In 31% of cases the surgeon's opinion on the extent of surgical resection was not borne out by the result of postoperative neuroimaging. Progression of residual tumour or tumour recurrence appeared in 19% of patients, 1 patient showed metastatic spread along the craniospinal axis, and in 1 patient malignant degeneration appeared during follow-up. Stable residual tumour or regression of residual tumour was seen in 14% of patients. Outcome after surgical treatment, which was combined with irradiation in 10 patients (14%), was favourable in 80% and unfavourable in 20% of patients. This outcome of treatment was not influenced by a second operation for progression of residual tumour or recurrent tumour. Characteristics of patients with tumour progression after the first operation did not differ from those of the whole group. There were 17 reoperations for residual or recurrent tumour, 10 of which took place within 4 years after the initial surgical treatment. Surgery-related morbidity was 15% and mortality 4%. Irradiation to residual tumour in s patients was followed by complete regression in 1 patient, progression in 4 patients and no changes in 1 patient. For the remaining 2 patients the effect of irradiation on the residual tumour is unknown. Factors that determine the prognosis are discussed on the basis of this retrospective analysis and the data from the literature. It is concluded that optimal treatment for a cerebellar pilocytic astrocytoma does not consist solely in surgery with the aim of total tumour removal and careful tumour handling in order to avoid spread of tumour cells and subsequent metastases and additional radiation therapy in strictly selected cases, but also in posttreatment follow-up based on direct postoperative neuroimaging, preferably by MRI. An algorithm for postoperative follow-up management is presented.