胶质母细胞瘤治疗:超越赫拉克勒斯柱。
Glioblastoma therapy: going beyond Hercules Columns.
机构信息
Institute of Neurosurgery, Catholic University School of Medicine, L.go A. Gemelli 8, 00168 Rome, Italy.
出版信息
Expert Rev Neurother. 2010 Apr;10(4):507-14. doi: 10.1586/ern.09.158.
Glioblastoma multiforme is the most common primary brain tumor in adults. Median survival from the time of diagnosis is 14 months, with less than 5% of patients surviving 5 years. Despite advances in deciphering the complex biology of these tumors, the overall prognosis has only slightly improved in the past three decades. The clinical failure of many therapeutic approaches can be explained by the following considerations: the location of tumors within the brain presents a special set of challenges, including ability of drugs to cross the BBB; cancer cells have unstable genetic structures, very susceptible to mutations; cancer cells have an amalgam of different genetic defects that respond in different ways to any given treatment agent; and, infiltrating and apparently normal but 'activated' cells are evident in the brain surrounding the main tumor. In this way, the biologic phenomena of the 'normal brain' adjacent to the enhanced tumor could allow us to understand the first steps of cancerogenesis and, consequently, to interfere with the pathways responsible for tumor growth and recurrence.
多形性胶质母细胞瘤是成年人中最常见的原发性脑肿瘤。从诊断到死亡的中位生存期为 14 个月,不到 5%的患者能存活 5 年。尽管在破译这些肿瘤的复杂生物学方面取得了进展,但在过去的三十年中,整体预后仅略有改善。许多治疗方法的临床失败可以用以下几点来解释:肿瘤在大脑中的位置带来了一系列特殊的挑战,包括药物穿过血脑屏障的能力;癌细胞的遗传结构不稳定,非常容易发生突变;癌细胞存在不同的遗传缺陷,对任何给定的治疗药物的反应方式不同;并且,在主要肿瘤周围的大脑中可以看到浸润性和看似正常但“激活”的细胞。这样,毗邻增强肿瘤的“正常大脑”的生物学现象可以使我们了解癌症发生的最初步骤,并因此干扰肿瘤生长和复发的途径。