Supratentorial high-grade astrocytoma and diffuse brainstem glioma: Two challenges for the pediatric oncologist
Supratentorial high-grade astrocytoma and diffuse brainstem glioma: Two challenges for the pediatric oncologist
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DOI：
10.1634/theoncologist.9-2-197
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发表时间：
2004-01-01
期刊：
影响因子：
5.8
通讯作者：
Gajjar, A
中科院分区：
文献类型：
--
作者：
Broniscer, A;Gajjar, A
小儿高级胶质瘤是一种异质性的肿瘤，占小儿中枢神经系统肿瘤的15%-20%。这些肿瘤主要累及幕上半球或脑桥，在这种情况下肿瘤通常被称为弥漫性脑干胶质瘤。幕上肿瘤的诊断依赖于其组织学表现。由于手术切除程度是这些患者的主要预后因素，因此总是尝试最大可能的手术切除。年龄较大的幕上肿瘤儿童（bb0 - 3岁）接受包括手术切除、放射治疗和化疗在内的多模式治疗。化疗的增加似乎提高了这些儿童的生存率，特别是那些患有多形性胶质母细胞瘤的儿童。然而，患有幕上肿瘤的儿童2年生存率仍然很低，在10%-30%之间。弥漫性脑干胶质瘤的诊断是基于典型的影像学，在大多数情况下不需要手术。放射治疗是儿童弥漫性脑干胶质瘤的主要治疗方法。化疗对这些儿童的作用尚不清楚，通常是在调查研究的背景下使用的。只有不到10%的弥漫性脑干胶质瘤患儿能存活2年。由于使用任何一种类型的患者的结果，当标准的多模式治疗是治疗方法时，这些儿童是创新肿瘤的理想候选者。
Pediatric high-grade gliomas represent a heterogeneous group of tumors that accounts for 15%-20% of all pediatric central nervous system tumors. These neoplasms predominantly involve the supratentorial hemispheres or the pons, in which case the tumors are usually called diffuse brainstem gliomas. The diagnosis of supratentorial neoplasms is dependent on their histologic appearance. The maximum possible surgical resection is always attempted since the degree of surgical resection is the main prognostic factor for these patients. Older children (>3 years) with supratentorial neoplasms undergo a multimodality treatment comprised of surgical resection, radiation therapy, and chemotherapy. The addition of chemotherapy seems to improve the survival of a subset of these children, particularly those with glioblastoma multiforme. However, 2-year survival rates remain poor for children with supratentorial neoplasms, ranging from 10%-30%.The diagnosis of a diffuse brainstem glioma is based upon typical imaging, dispensing with the need for surgery in the majority of cases. Radiation therapy is the mainstay of treatment for children with diffuse brainstem gliomas. The role of chemotherapy for these children is not clear, and it is, in general, employed in the context of an investigational study. Less than 10% of children with diffuse brainstem gliomas survive 2 years. Because the outcome for patients with either type of used, these children are ideal candidates for innovative tumor is poor when standard multimodality therapy is treatment approaches.