[关于对20至40岁人群进行弥漫性低级别胶质瘤筛查的提议]

[Proposal of screening for diffuse low-grade gliomas in the population from 20 to 40years].

作者信息

Mandonnet Emmanuel, Taillandier Luc, Duffau Hugues

机构信息

Hôpital Lariboisière, département de neurochirurgie, 2, rue Ambroise-Paré, 75010 Paris, France; IMNC, UMR 8165, 91405 Orsay, France.

CHU de Nancy, département de neurologie, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.

出版信息

Presse Med. 2017 Oct;46(10):911-920. doi: 10.1016/j.lpm.2017.07.005. Epub 2017 Sep 18.

Abstract

Diffuse low-grade gliomas (DLGG) are cerebral tumors occurring in young adults, with an inescapable progression to higher grade of malignancy, resulting in functional impairment and death. DLGG evolve in several phases: an asymptomatic period despite a slow radiological growth; a period in which inaugural symptoms occur, usually epilepsy with possible mild cognitive disorders; then a phase with malignant transformation generating disabling neurological deficits; and ultimately the terminal stage. Early maximal surgical resection significantly increases overall survival while preserving quality of life. Surgeries are conducted under local anesthesia in order to map neural networks crucial for brain functions, and with the goal to use neuroplasticity mechanisms by sparing cerebral connectivity. Adjuvant oncological treatments such as chemotherapy and/or radiotherapy are kept for partial resection or non-operable recurrences. Because of an increase of incidentally discovered DLGG, explained by a facilitated access to brain imaging, awake surgery has been proposed in asymptomatic patients, with the aim of maximizing the rate of total or even "supratotal" resection in smaller tumors. Outcomes have been optimized, both regarding oncological results thanks to minimization of malignant transformation, as well as regarding functional results, with neither neurological deficit nor epilepsy in this sub-group of incidental DLGG. Thus, it seems legitimate to set up a screening by cerebral MRI in the population from 20 to 40years, to propose adapted therapeutic strategies based upon an upfront radical surgery, and so to create the foundations of a prophylactic and personalized functional neuro-oncologie.

摘要

弥漫性低级别胶质瘤(DLGG)是发生于年轻人的脑肿瘤,不可避免地会进展为更高等级的恶性肿瘤,导致功能障碍和死亡。DLGG的发展经历几个阶段:尽管影像学显示生长缓慢,但处于无症状期;出现首发症状的时期,通常为癫痫并可能伴有轻度认知障碍;然后是恶性转化阶段,产生致残性神经功能缺损;最终是终末期。早期进行最大程度的手术切除可显著提高总生存率,同时保持生活质量。手术在局部麻醉下进行,以绘制对脑功能至关重要的神经网络,并旨在通过保留脑连接性来利用神经可塑性机制。辅助性肿瘤治疗,如化疗和/或放疗,用于部分切除或不可手术的复发情况。由于脑成像检查的普及,偶然发现的DLGG有所增加,因此对于无症状患者,有人提出进行清醒手术,目的是在较小肿瘤中最大化全切甚至“超全切”率。在偶然发现的DLGG这一亚组中,无论是肿瘤学结果(由于恶性转化最小化)还是功能结果(既无神经功能缺损也无癫痫)都得到了优化。因此,在20至40岁人群中通过脑部MRI进行筛查,基于前期根治性手术提出合适的治疗策略,从而建立预防性和个性化功能神经肿瘤学的基础,似乎是合理的。

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