Platten M, Wick W
Abteilung Neuroonkologie, Universitätsklinikum Heidelberg, INF 400, 69120 Heidelberg, Deutschland.
Nervenarzt. 2012 Aug;83(8):982-7. doi: 10.1007/s00115-012-3569-7.
Despite considerable advancements in the therapy of malignant glioma in recent years with modern radiation and surgical techniques, alkylating and antiangiogenic chemotherapy, as well as molecular-based treatment decisions, treatment outcomes are mostly unsatisfactory. Understandably, patients often ask for experimental, sometimes unusual therapeutic modalities and this should be integrated into the clinical practice. In addition to experimental therapeutic approaches based on novel drugs, viral agents, immunotherapy and radiation approaches, experimental procedures of interest for patients particularly encompass mechanical approaches with the aim at physically altering the tumor tissue by temperature, oxygenation or magnetization. These mechanical procedures are based on intuitive concepts and promise fewer side effects than other experimental approaches. In addition, the requirements for approval by medical device regulations in terms of proof of efficacy are generally less stringent. As a consequence approaches, such as hyperbaric oxygenation, hyperthermia and electric fields, which are often heavily advertised and in part reimbursed by health insurances, have been used for many years, often by centers not specialized in the treatment of brain tumor patients, although sound data from prospective controlled clinical trials that determine which patients in which situation may benefit, are generally lacking. In this review we review these clinical therapeutic approaches.
尽管近年来采用现代放疗和手术技术、烷化剂及抗血管生成化疗以及基于分子的治疗决策，恶性胶质瘤的治疗取得了显著进展，但治疗结果大多不尽人意。可以理解的是，患者常常寻求实验性的、有时甚至是非常规的治疗方式，而这应该融入临床实践。除了基于新型药物、病毒制剂、免疫疗法和放疗方法的实验性治疗方法外，患者感兴趣的实验性程序尤其包括旨在通过温度、氧合或磁化物理改变肿瘤组织的机械方法。这些机械程序基于直观的概念，与其他实验性方法相比，副作用有望更少。此外，就疗效证明而言，医疗器械法规的批准要求通常没那么严格。因此，诸如高压氧疗、热疗和电场等方法，尽管缺乏来自前瞻性对照临床试验的可靠数据来确定哪些患者在何种情况下可能受益，但多年来一直在使用，这些方法经常被大力宣传，部分还可由医疗保险报销，而且使用这些方法的往往并非专门治疗脑肿瘤患者的中心。在本综述中，我们将对这些临床治疗方法进行回顾。
