Yamanaka Ryuya, Hayano Azusa, Kanayama Tomohiko
Laboratory of Molecular Target Therapy for Cancer, Graduate School for Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Neurosurg Rev. 2018 Jul;41(3):719-731. doi: 10.1007/s10143-016-0786-8. Epub 2016 Oct 5.
By conducting a systemic search of the PubMed database, we performed a comprehensive literature review to characterize secondary gliomas following radiotherapy treatment and to determine the most appropriate treatment strategy. Our analysis included 296 cases of radiation-induced gliomas. The primary lesion was characterized as a hematological malignancy in 104 cases (35.1 %), pituitary adenoma in 35 (11.8 %), craniopharyngioma in 19 (6.4 %), medulloblastoma in 38 (12.8 %), germ cell tumor in 13 (4.3 %), low-grade glioma in 28 (9.4 %), cancer/sarcoma in 12 (4.0 %), scalp region disease in 15 (5.0 %), meningioma/schwannoma in 13 (4.3 %), metastatic brain tumor in 5 (1.6 %), and other types (e.g., arteriovenous malformations and angiomas) in 14 (4.7 %). The average age of onset for primary lesions was 16.0 ± 15.8 years, and the average radiation dose delivered to the primary lesion was 37.6 ± 20.0 Gy. Secondary gliomas could be divided into grade I (1), grade II (32), grade III (88), and grade IV (173) tumors. The median overall survival for all glioma cases was 11 months (95 % confidence interval [CI], 9-12), with a 2-year survival rate of 20.2 %. On multivariate analysis, combined modality treatment and the latency period from the radiotherapy treatment to the glioma diagnosis were variables associated with the overall survival of patients with grade III/IV secondary gliomas. For patients treated with cranial radiotherapy, the risk of secondary glioma incidence warrants a longer follow-up period beyond the standard time frame typically designated for determining the risk of primary tumor relapse. Moreover, combination therapy is a potential treatment option for radiation-induced gliomas.
通过对PubMed数据库进行系统检索，我们进行了全面的文献综述，以描述放疗后继发性胶质瘤的特征，并确定最合适的治疗策略。我们的分析纳入了296例放射性诱导胶质瘤病例。原发病变中，血液系统恶性肿瘤104例（35.1%），垂体腺瘤35例（11.8%），颅咽管瘤19例（6.4%），髓母细胞瘤38例（12.8%），生殖细胞瘤13例（4.3%），低级别胶质瘤28例（9.4%），癌症/肉瘤12例（4.0%），头皮区域疾病15例（5.0%），脑膜瘤/神经鞘瘤13例（4.3%），脑转移瘤5例（1.6%），其他类型（如动静脉畸形和血管瘤）14例（4.7%）。原发病变的平均发病年龄为16.0±15.8岁，原发病变接受的平均放射剂量为37.6±20.0 Gy。继发性胶质瘤可分为I级（1例）、II级（32例）、III级（88例）和IV级（173例）肿瘤。所有胶质瘤病例的中位总生存期为11个月（95%置信区间[CI]，9 - 12），2年生存率为20.2%。多因素分析显示，联合治疗以及从放疗至胶质瘤诊断的潜伏期是与III/IV级继发性胶质瘤患者总生存期相关的变量。对于接受颅脑放疗的患者，继发性胶质瘤发生风险需要在通常用于确定原发肿瘤复发风险的标准时间框架之外进行更长时间的随访。此外，联合治疗是放射性诱导胶质瘤的一种潜在治疗选择。
