Update for astrocytomas: medical and surgical management considerations.
Update for astrocytomas: medical and surgical management considerations.
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DOI：
10.37349/en.2023.00009
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发表时间：
2023-01-01
期刊：
影响因子：
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通讯作者：
Lucke-Wold, Brandon
中科院分区：
文献类型：
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作者：
Willman, Matthew;Willman, Jonathan;Lucke-Wold, Brandon
星形细胞瘤包括多种具有独特突变和不同级别恶性肿瘤的肿瘤。这些肿瘤均起源于星形胶质细胞，星形胶质细胞是一种星形胶质细胞，在支持中枢神经系统（CNS）功能中发挥着重要作用，包括血脑屏障（BBB）的发育和维持、水和离子调节、影响神经元突触发生和刺激免疫反应。从流行病学角度来看，胶质母细胞瘤（GB）是最常见的恶性星形细胞瘤，一般在澳大利亚、西欧和加拿大发病率较高，东南亚发病率最低。此外，男性和非西班牙裔白人的 GB 发病率明显较高。有人认为，在生物学男性中观察到的较高水平的睾酮可能是 GB 发病率增加的原因。 Cowden、Lynch、Turcot、Li-Fraumeni 和 1 型神经纤维瘤病等遗传综合征与星形细胞瘤发展率增加有关。虽然有许多特定的基因突变可能影响恶性肿瘤或成为星形细胞瘤治疗的目标，但 O 6-甲基鸟嘌呤-DNA 甲基转移酶 (MGMT) 基因功能是星形细胞瘤对化疗药物替莫唑胺 (TMZ) 反应的重要预测因子。用于原发性的TMZ和用于复发性肿瘤形成的贝伐珠单抗是目前批准用于治疗星形细胞瘤的两种主要化疗药物。虽然与全脑放射治疗 (WBRT) 相比，立体定向放射外科 (SRS) 对提高生存率的影响存在争议，但 SRS 证明了精确度提高，放射毒性降低。当考虑星形细胞瘤的手术切除时，要考虑切除范围（EoR）。次全切除 (STR) 保留 T1 增强磁共振成像 (MRI) 区域的边缘，大体全切除 (GTR) 包括边缘，超最大切除 (SMR) 延伸超出 T1 边缘并进入 T2 区域。手术切除、放疗和化疗是星形细胞瘤治疗的组成部分。
Astrocytomas include a wide range of tumors with unique mutations and varying grades of malignancy. These tumors all originate from the astrocyte, a star-shaped glial cell that plays a major role in supporting functions of the central nervous system (CNS), including blood-brain barrier (BBB) development and maintenance, water and ion regulation, influencing neuronal synaptogenesis, and stimulating the immunological response. In terms of epidemiology, glioblastoma (GB), the most common and malignant astrocytoma, generally occur with higher rates in Australia, Western Europe, and Canada, with the lowest rates in Southeast Asia. Additionally, significantly higher rates of GB are observed in males and non-Hispanic whites. It has been suggested that higher levels of testosterone observed in biological males may account for the increased rates of GB. Hereditary syndromes such as Cowden, Lynch, Turcot, Li-Fraumeni, and neurofibromatosis type 1 have been linked to increased rates of astrocytoma development. While there are a number of specific gene mutations that may influence malignancy or be targeted in astrocytoma treatment, O 6-methylguanine-DNA methyltransferase (MGMT) gene function is an important predictor of astrocytoma response to chemotherapeutic agent temozolomide (TMZ). TMZ for primary and bevacizumab in the setting of recurrent tumor formation are two of the main chemotherapeutic agents currently approved in the treatment of astrocytomas. While stereotactic radiosurgery (SRS) has debatable implications for increased survival in comparison to whole-brain radiotherapy (WBRT), SRS demonstrates increased precision with reduced radiation toxicity. When considering surgical resection of astrocytoma, the extent of resection (EoR) is taken into consideration. Subtotal resection (STR) spares the margins of the T1 enhanced magnetic resonance imaging (MRI) region, gross total resection (GTR) includes the margins, and supramaximal resection (SMR) extends beyond the margin of the T1 and into the T2 region. Surgical resection, radiation, and chemotherapy are integral components of astrocytoma treatment.