Hundsberger Thomas, Tonder Michaela, Hottinger Andreas, Brügge Detlef, Roelcke Ulrich, Putora Paul Martin, Stupp Roger, Weller Michael
Department of Neurology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.
Department of Hematology and Oncology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.
J Neurooncol. 2014 Jun;118(2):321-328. doi: 10.1007/s11060-014-1434-1. Epub 2014 Apr 16.
Because of low incidence, mixed study populations and paucity of clinical and histological data, the management of adult brainstem gliomas (BSGs) remains non-standardized. We here describe characteristics, treatment and outcome of patients with exclusively histologically confirmed adult BSGs. A retrospective chart review of adults (age >18 years) was conducted. BSG was defined as a glial tumor located in the midbrain, pons or medulla. Characteristics, management and outcome were analyzed. Twenty one patients (17 males; median age 41 years) were diagnosed between 2004 and 2012 by biopsy (n = 15), partial (n = 4) or complete resection (n = 2). Diagnoses were glioblastoma (WHO grade IV, n = 6), anaplastic astrocytoma (WHO grade III, n = 7), diffuse astrocytoma (WHO grade II, n = 6) and pilocytic astrocytoma (WHO grade I, n = 2). Diffuse gliomas were mainly located in the pons and frequently showed MRI contrast enhancement. Endophytic growth was common (16 vs. 5). Postoperative therapy in low-grade (WHO grade I/II) and high-grade gliomas (WHO grade III/IV) consisted of radiotherapy alone (three in each group), radiochemotherapy (2 vs. 6), chemotherapy alone (0 vs. 2) or no postoperative therapy (3 vs. 1). Median PFS (24.1 vs. 5.8 months; log-rank, p = 0.009) and mOS (30.5 vs. 11.5 months; log-rank, p = 0.028) was significantly better in WHO grade II than in WHO grade III/IV tumors. Second-line therapy considerably varied. Histologically verification of adult BSGs is feasible and has an impact on postoperative treatment. Low-grade gliomas can simple be followed or treated with radiotherapy alone. Radiochemotherapy with temozolomide can safely be prescribed for high-grade gliomas without additional CNS toxicities.
由于成人脑干胶质瘤（BSG）发病率低、研究人群混杂以及临床和组织学数据匮乏，其治疗仍未标准化。我们在此描述经组织学确诊的成人BSG患者的特征、治疗及预后情况。对成年患者（年龄>18岁）进行了回顾性病历审查。BSG定义为位于中脑、脑桥或延髓的胶质肿瘤。分析了患者的特征、治疗及预后情况。2004年至2012年间，21例患者（17例男性；中位年龄41岁）经活检（n = 15）、部分切除（n = 4）或完全切除（n = 2）确诊。诊断包括胶质母细胞瘤（世界卫生组织IV级，n = 6）、间变性星形细胞瘤（世界卫生组织III级，n = 7）、弥漫性星形细胞瘤（世界卫生组织II级，n = 6）和毛细胞型星形细胞瘤（世界卫生组织I级，n = 2）。弥漫性胶质瘤主要位于脑桥，常表现为MRI对比增强。浸润性生长常见（16例对比5例）。低级别（世界卫生组织I/II级）和高级别胶质瘤（世界卫生组织III/IV级）的术后治疗包括单纯放疗（每组3例）、放化疗（2例对比6例）、单纯化疗（0例对比2例）或无术后治疗（3例对比1例）。世界卫生组织II级肿瘤的中位无进展生存期（PFS）（24.1个月对比5.8个月；对数秩检验，p = 0.009）和总生存期（mOS）（30.5个月对比11.5个月；对数秩检验，p = 0.028）显著优于世界卫生组织III/IV级肿瘤。二线治疗差异很大。对成人BSG进行组织学验证是可行的，且对术后治疗有影响。低级别胶质瘤可单纯随访或仅行放疗。替莫唑胺放化疗可安全用于高级别胶质瘤，且无额外的中枢神经系统毒性。
