Třebický F, Kubeš J, Bartoš R, Malucelli A, Sameš M, Navrátil M, Vondráček V, Medková S, Mašek M, Zárubová J
Ustav radiacni onkologie, Praha.
Klin Onkol. 2012;25(4):294-8.
Low-grade gliomas WHO II (LGG) are mostly detected in patients with neurological symptomatology between 20 and 45 years of age very often as secondary epilepsy. We present two cases in which low-grade gliomas attacked neurological zones. Neurosurgical resection was subtotal because of the risk of the damage in neurocognitive functions in both these patients. After the operation, both patients were followed at neurosurgery department in regular intervals using different imaging methods (MRI, MRS and PET). After resections, the MRI detected the enlargement of the volumes of the tumor residua in both patients.
Owing to the risk of up-grading to high-grades glial tumors (overexpression of EGFR and VEGF), both patients were indicated for curative treatment by external beam radiotherapy combined with chemotherapy (Temodal®) and adjuvant chemotherapy.
After the end of this treatment, the MRI proved considerable partial regressions in both patients. Moreover, three months later, the MRI did not prove any residual disease.
Radiotherapy combined with the administration of Temodal should prolong the OS and TTP in patients with a high risk of up-grading of low-grade gliomas of the brain. Both the patients are in a follow-up program, also because of the risk of duplicite brain tumor.
世界卫生组织（WHO）二级低级别胶质瘤（LGG）大多在20至45岁有神经系统症状的患者中被检测到，常表现为继发性癫痫。我们报告两例低级别胶质瘤侵犯神经区域的病例。由于这两名患者存在神经认知功能受损的风险，神经外科手术均为次全切除。术后，两名患者在神经外科定期接受不同影像学检查（MRI、MRS和PET）。切除术后，MRI检测到两名患者的肿瘤残腔体积均增大。
由于存在向高级别胶质瘤升级的风险（表皮生长因子受体（EGFR）和血管内皮生长因子（VEGF）过表达），两名患者均接受了外照射放疗联合化疗（替莫唑胺）及辅助化疗的根治性治疗。
该治疗结束后，MRI显示两名患者均有显著的部分缓解。此外，三个月后，MRI未发现任何残留病灶。
放疗联合替莫唑胺给药应可延长脑低级别胶质瘤有升级高风险患者的总生存期（OS）和无进展生存期（TTP）。两名患者均在随访项目中，这也是因为存在患双侧脑肿瘤的风险。
