Joint last authors; Center for Neurosurgery, Department of Neurosurgery, University Hospital Cologne; Center for Neurosurgery, Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne; Center for Neurosurgery, Department of Stereotactic and Functional Neurosurgery, former Department of Radiotherapy and Radiooncology, University Hospital Cologne; Center for Neurosurgery, Department of Neurosurgery, University Hospital Cologne; Department of Neurology, University Hospital Cologne; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich; Center for Neurosurgery, Department of Neurosurgery, University Hospital Cologne.
Dtsch Arztebl Int. 2018 May 21;115(20-21):356-364. doi: 10.3238/arztebl.2018.0356.
Gliomas are the most common intrinsic tumors of the brain, with an incidence of 6 per 100 000 persons per year. Recent years have seen marked changes in the diagnosis and treatment of gliomas, with molecular parameters now being an integral part of the diagnostic evaluation.
This review is based on pertinent articles retrieved by a selective search in PubMed, with special attention to the new WHO glioma classification.
The classification of gliomas on the basis of additional molecular parameters enables more accurate prognostication and serves as a basis for therapeutic decision-making and treatment according to precisely specified algorithms. PET scanning with 18F-fluoroethyl tyrosine and 11C-methionine for the measurement of metabolic activity in gliomas has further refined the diagnostic evaluation. The median overall survival of patients with glioblastoma who have undergone resection of all tumor tissue with a disrupted blood-brain barrier (i.e., all contrast-enhancing tumor tissue) has been prolonged to up to 20 months. The 5-year survival of patients with WHO grade II gliomas is now as high as 97% after near-total resection. The surgical resection of all contrast-enhancing tumor tissue and subsequent radiotherapy and chemotherapy remain the key elements of treatment. New surgical strategies and new methods of planning radiotherapy have made these techniques safer and more effective. The percutaneous application of tumor-treating fields is a new therapeutic option that has gained a degree of acceptance. Accompanying measures such as psycho-oncology and palliative care are very important for patients and should be considered mandatory.
The consistent application of the existing multimodal treatment options for glioma has led in recent years to improved survival. Areas of important current and future scientific activity include immunotherapy and targeted and combined chemotherapy, as well as altered neurocognition, modern approaches to palliative care, and complementary therapies.
脑胶质瘤是最常见的颅内原发性肿瘤，年发病率为 6/10 万。近年来，脑胶质瘤的诊断和治疗发生了显著变化，分子参数现已成为诊断评估的一个组成部分。
本综述基于在 PubMed 中进行的选择性搜索中检索到的相关文章，特别关注新的 WHO 脑胶质瘤分类。
基于附加分子参数对脑胶质瘤进行分类，可更准确地进行预后预测，并为根据精确规定的算法进行治疗决策和治疗提供依据。对脑胶质瘤进行 18F-氟乙基酪氨酸和 11C-蛋氨酸 PET 扫描以测量代谢活性，进一步完善了诊断评估。所有肿瘤组织（即所有增强对比的肿瘤组织）均经手术切除且血脑屏障破坏的胶质母细胞瘤患者的中位总生存期已延长至 20 个月。行全切除术后，WHO 分级 II 级脑胶质瘤患者的 5 年生存率现已高达 97%。所有增强对比的肿瘤组织的手术切除，以及随后的放疗和化疗仍然是治疗的关键要素。新的手术策略和新的放疗计划方法使这些技术更安全、更有效。肿瘤治疗电场的经皮应用是一种新的治疗选择，已获得一定程度的认可。伴随的措施，如心理肿瘤学和姑息治疗，对患者非常重要，应被视为强制性措施。
近年来，通过一致应用现有的多模式治疗方案，脑胶质瘤患者的生存率得到了提高。目前和未来的重要科学活动领域包括免疫治疗和靶向及联合化疗，以及神经认知改变、现代姑息治疗方法和补充疗法。
