Khatua Soumen, Jalali Rakesh
Division of Pediatric Oncology, Tata Memorial Center, Mumbai, India.
Pediatr Hematol Oncol. 2005 Jul-Aug;22(5):361-71. doi: 10.1080/08880010590964174.
Pediatric brain tumors are the commonest cause of cancer-related death in children. The last four decades have seen only a 35% increase in 5-year survival rate of children with these tumors. The therapeutic successes achieved are due to advances in neuroimaging, surgical techniques, radiotherapy, and induction of newer chemotherapeutic agents along with molecular targeted therapy. Neuroimaging advances include the use of MRA, MRS, DSA, and PET scans. With the use of stereotactic surgery, intraoperative mapping, and imaging, surgical resection has improved with significant decrease in morbidity. A major development has been the use of precision guided radiotherapy utilizing technologies like 3D-CRT, SRS, and IMRT, thereby decreasing radiation to normal tissues. Induction of newer drugs and high-dose chemotherapy with peripheral stem cell support has improved survival and delayed radiation in younger children and infants with brain tumors. Intense ongoing research is profiling novel molecular targets for therapeutic intervention. Newer therapeutic strategies like blood brain barrier disruption, immunotherapy, and gene therapy are in clinical trials. This review article intends to give the reader an overview of current therapeutic strategies and research involved in the treatment of children with brain tumors.
小儿脑肿瘤是儿童癌症相关死亡的最常见原因。在过去的四十年里，患有这些肿瘤的儿童的5年生存率仅提高了35%。取得的治疗成功归因于神经影像学、手术技术、放射治疗以及新型化疗药物的引入和分子靶向治疗的进展。神经影像学进展包括磁共振血管造影（MRA）、磁共振波谱（MRS）、数字减影血管造影（DSA）和正电子发射断层扫描（PET）的应用。随着立体定向手术、术中定位和成像技术的使用，手术切除得到了改善，发病率显著降低。一个重大进展是使用了如三维适形放疗（3D-CRT）、立体定向放射外科（SRS）和调强放疗（IMRT）等技术的精确制导放疗，从而减少了对正常组织的辐射。新型药物的引入以及外周干细胞支持下的高剂量化疗提高了患有脑肿瘤的年幼儿童和婴儿的生存率，并推迟了放疗时间。正在进行的深入研究正在确定用于治疗干预的新型分子靶点。血脑屏障破坏、免疫疗法和基因疗法等新型治疗策略正在进行临床试验。这篇综述文章旨在让读者全面了解当前治疗小儿脑肿瘤所涉及的治疗策略和研究情况。
