Khan M K, Hunter G K, Vogelbaum M, Suh J H, Chao S T
Department of Radiation Oncology, Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Indian J Cancer. 2009 Apr-Jun;46(2):96-107. doi: 10.4103/0019-509x.49147.
The incidence of gliomas is increasing worldwide, including India. Of the 18,820 new cases of primary central nervous system (CNS) tumors diagnosed annually in the United States, gliomas account for over 60% with 30-40% of them being glioblastoma multiforme (GBM), 10% being anaplastic astrocytoma (AA), and 10% being low grade gliomas (LGGs). This is in contrast to one study from West Bengal, India, in which only 7.9% of the brain tumors were GBMs, while 46.8% were astrocytomas. Of all adult primary CNS tumors, GBM is the most common and the most malignant with about 7,000 to 8,000 new cases annually in the United States. Given poor outcomes, a number of treatment approaches have been investigated. Common to these approaches is the use of adjuvant radiation therapy, even as surgery alone, with or without chemotherapy, may be the mainstay for some lower grade and low-risk gliomas. Today, treatment typically involves external beam radiation, with concurrent and adjuvant chemotherapy for more aggressive histologies. Although gliomas are relatively uncommon, active research is ongoing. Results of landmark trials along with some of the recently published trials are presented. These trials and management strategies as well as evolving concepts are found by reviewing over 200 articles in the National Library Medical (NLM) database, PubMed, more than 60 of which are refrenced. Specifically, the database is searched using the following keywords, with various combinations: glioma, low-grade, anaplastic, astrocytoma, oligodendroglioma, oligoastrocytoma, glioblastoma multiforme, chemotherapy, radiation, new concepts, phase III, MGMT, CDX-110 (Celldex), temozolomide, 1p/19q deletion, and bevacizumab.
全球范围内，包括印度，胶质瘤的发病率都在上升。在美国，每年诊断出的18,820例原发性中枢神经系统（CNS）肿瘤新病例中，胶质瘤占60%以上，其中30%-40%为多形性胶质母细胞瘤（GBM），10%为间变性星形细胞瘤（AA），10%为低级别胶质瘤（LGG）。这与印度西孟加拉邦的一项研究结果形成对比，在该研究中，只有7.9%的脑肿瘤是GBM，而46.8%是星形细胞瘤。在所有成人原发性CNS肿瘤中，GBM最为常见且恶性程度最高，在美国每年约有7000至8000例新病例。鉴于预后不佳，人们已经研究了多种治疗方法。这些方法的共同之处在于使用辅助放射治疗，即使单独手术，无论有无化疗，可能是一些低级别和低风险胶质瘤的主要治疗手段。如今，治疗通常包括外照射放疗，对于侵袭性更强的组织学类型则采用同步和辅助化疗。尽管胶质瘤相对不常见，但相关的积极研究仍在进行。文中呈现了具有里程碑意义的试验结果以及一些最近发表的试验结果。通过查阅国立医学图书馆（NLM）数据库PubMed中的200多篇文章找到了这些试验、管理策略以及不断发展的概念，其中60多篇被引用。具体而言，使用以下关键词的各种组合在该数据库中进行搜索：胶质瘤、低级别、间变性、星形细胞瘤、少突胶质细胞瘤、少突星形细胞瘤、多形性胶质母细胞瘤、化疗、放疗、新概念、III期、MGMT、CDX-110（Celldex）、替莫唑胺、1p/19q缺失和贝伐单抗。
