Koga Tomoyuki, Saito Nobuhito
Department of Neurosurgery, The University of Tokyo Hospital, Japan.
Neurol Med Chir (Tokyo). 2012;52(8):548-52. doi: 10.2176/nmc.52.548.
Treatment of recurrent glioblastoma is still challenging. Stereotactic radiosurgery has been accepted as a treatment option for recurrent glioblastoma after standard chemotherapy and irradiation. However, the efficacy of stereotactic radiosurgery at recurrence has been limited, mainly due to the highly infiltrative nature of the tumor which makes the lesion difficult to define as the target. To enhance the efficacy of stereotactic radiosurgery, several methods of targeting based on neuroimaging technology such as positron emission tomography and magnetic resonance imaging have been adopted to irradiate as many of the viable tumor cells as possible and showed some enhanced efficacy. In a trial of intensified treatment by extending the irradiation field, improvement of local control did not result in longer survival. Radiation-induced adverse event is another problem after stereotactic radiosurgery for recurrent glioblastoma because almost all patients underwent irradiation as a part of the initial treatment. To overcome the side effects associated with re-irradiation, use of bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, has shown some efficacy. Advances in irradiation technology, neuroimaging, and adjuvant treatment are needed to enhance the efficacy of stereotactic radiosurgery for recurrent glioblastoma and reduce the morbidity associated with irradiation.
复发性胶质母细胞瘤的治疗仍然具有挑战性。立体定向放射外科已被公认为是复发性胶质母细胞瘤在接受标准化疗和放疗后的一种治疗选择。然而，立体定向放射外科在复发时的疗效有限，主要是由于肿瘤具有高度浸润性，使得病变难以明确界定为靶区。为提高立体定向放射外科的疗效，已采用了几种基于正电子发射断层扫描和磁共振成像等神经影像技术的靶向方法，以尽可能多地照射存活的肿瘤细胞，并显示出一定的疗效增强。在一项通过扩大照射野进行强化治疗的试验中，局部控制的改善并未带来更长的生存期。放射诱导的不良事件是复发性胶质母细胞瘤立体定向放射外科治疗后的另一个问题，因为几乎所有患者在初始治疗时都接受过放疗。为克服与再次放疗相关的副作用，使用贝伐单抗（一种针对血管内皮生长因子的人源化单克隆抗体）已显示出一定疗效。需要在放射技术、神经影像和辅助治疗方面取得进展，以提高复发性胶质母细胞瘤立体定向放射外科的疗效，并降低与放疗相关的发病率。
