Efficacy and Limitations of Stereotactic Radiosurgery in the Treatment of Glioblastoma
Efficacy and Limitations of Stereotactic Radiosurgery in the Treatment of Glioblastoma
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DOI：
10.2176/nmc.52.548
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发表时间：
2012-08-01
影响因子：
1.9
通讯作者：
Saito, Nobuhito
中科院分区：
文献类型：
--
作者：
Koga, Tomoyuki;Saito, Nobuhito
复发性胶质母细胞瘤的治疗仍然具有挑战性。立体定向放射外科手术已被接受为标准化疗和放疗后复发性胶质母细胞瘤的治疗选择。然而，立体定向放射外科治疗复发的疗效是有限的，主要是由于肿瘤的高度浸润性，使得病变难以确定为靶点。为了提高立体定向放射外科的疗效，采用了几种基于神经成像技术的靶向方法，如正电子发射断层扫描和磁共振成像，以照射尽可能多的活肿瘤细胞，并显示出一定的增强疗效。在一项通过扩大照射野进行强化治疗的试验中，局部控制的改善并没有导致更长的生存期。放射诱导的不良事件是立体定向放射外科治疗复发性胶质母细胞瘤后的另一个问题，因为几乎所有患者都接受了放射治疗作为初始治疗的一部分。为了克服与再照射相关的副作用，使用贝伐单抗（一种抗血管内皮生长因子的人源化单克隆抗体）已显示出一定的疗效。需要放射技术、神经影像学和辅助治疗的进步来提高立体定向放射外科治疗复发性胶质母细胞瘤的疗效，并降低与放射相关的发病率。
Treatment of recurrent glioblastoma is still challenging. Stereotactic radiosurgery has been accepted as a treatment option for recurrent glioblastoma after standard chemotherapy and irradiation. However, the efficacy of stereotactic radiosurgery at recurrence has been limited, mainly due to the highly infiltrative nature of the tumor which makes the lesion difficult to define as the target. To enhance the efficacy of stereotactic radiosurgery, several methods of targeting based on neuroimaging technology such as positron emission tomography and magnetic resonance imaging have been adopted to irradiate as many of the viable tumor cells as possible and showed some enhanced efficacy. In a trial of intensified treatment by extending the irradiation field, improvement of local control did not result in longer survival. Radiation-induced adverse event is another problem after stereotactic radiosurgery for recurrent glioblastoma because almost all patients underwent irradiation as a part of the initial treatment. To overcome the side effects associated with re-irradiation, use of bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, has shown some efficacy. Advances in irradiation technology, neuroimaging, and adjuvant treatment are needed to enhance the efficacy of stereotactic radiosurgery for recurrent glioblastoma and reduce the morbidity associated with irradiation.