Oligodendrogliomas: Molecular Biology and Treatment
Oligodendrogliomas: Molecular Biology and Treatment
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DOI：
10.1634/theoncologist.2008-0248
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发表时间：
2009-01-01
期刊：
影响因子：
5.8
通讯作者：
van den Bent, Martin J.
中科院分区：
文献类型：
--
作者：
Bromberg, Jacolien E. C.;van den Bent, Martin J.
少突胶质肿瘤因其对化疗的相对敏感性而继续受到广泛关注。少突胶质肿瘤的组织学诊断在观察者之间存在相当大的差异。2007年修订的世界卫生组织脑肿瘤分类不再接受出现坏死的“混合性间变性少星形细胞瘤”的诊断；这些肿瘤应考虑成胶质细胞瘤（可能具有少突胶质特征）。与化疗敏感性相关的1p/19q编码是由19p到1q的不平衡易位介导的。随机研究表明，1p/19q编码肿瘤患者接受放疗也有更好的预后。组织学上更不典型的肿瘤不太可能有这种1p/19q编码；此处常发现与星形细胞肿瘤相关的其他改变。一些肿瘤具有典型的组织学特征，但没有1p/19q密码缺失的患者仍然有很好的预后。目前，新诊断的间变性少突胶质肿瘤的最佳方法尚不清楚。早期辅助化疗并不比进展时的化疗提供更好的结果。替莫唑胺联合化疗在这些肿瘤中的价值尚未得到证实，至少在理论上可能与更大的神经毒性有关。1p和19q丢失的肿瘤也可以通过早期化疗进行治疗，同时将放疗推迟到进一步进展的时间。目前可用的二线化疗效果一般，需要更好的挽救性治疗。对于1p/19q编码肿瘤更高敏感性的分子解释尚不清楚，这可能部分地由更频繁的MGMT启动子基因甲基化来解释。肿瘤学家2009；14: 155 - 163
Oligodendroglial tumors continue to receive much attention because of their relative sensitivity to chemotherapy. The histological diagnosis of oligodendroglial tumors is subject to considerable interobserver variation. The revised 2007 World Health Organization classification of brain tumors no longer accepts the diagnosis "mixed anaplastic oligoastrocytoma" if necrosis is present; these tumors should be considered glioblastomas ( perhaps with oligodendroglial features). The 1p/19q codeletion that is associated with sensitivity to chemotherapy is mediated by an unbalanced translocation of 19p to 1q. Randomized studies have shown that patients with 1p/19q codeleted tumors also have a better outcome with radiotherapy. Histologically more atypical tumors are less likely to have this 1p/19q codeletion; here, other alterations usually associated with astrocytic tumors are often found. Some patients with tumors with classic histological features but no 1p/19q codeletion still have a very favorable prognosis.Currently, the best approach for newly diagnosed anaplastic oligodendroglial tumors is unclear. Early adjuvant chemotherapy does not provide a better outcome than chemotherapy at the time of progression. The value of combined chemoirradiation with temozolomide has not been proven in these tumors, and could at least theoretically be associated with greater neurotoxicity. Tumors with 1p and 19q loss can also be managed with early chemotherapy, while deferring radiotherapy to time of further progression. The presently available second-line chemotherapy results are modest, and better salvage treatments are necessary. The molecular explanation for the greater sensitivity of 1p/19q codeleted tumors is still unclear, and this could, in part, be explained by more frequent MGMT promoter gene methylation. The Oncologist 2009; 14: 155-163