Garfield J
Neurosurg Rev. 1986;9(1-2):23-5. doi: 10.1007/BF01743049.
Despite a voluminous literature it remains difficult to draw conclusions about the precise place of surgery in the management of patients with supratentorial malignant gliomas (anaplastic astrocytoma and glioblastoma multiforme). If the beneficial effects of radiotherapy are discounted, excisional surgery itself probably achieves no more than a survival of 4 to 6 months. The apparently beneficial effects of excisional surgery are related more to radiotherapy than to the surgery itself, beyond the immediate relief of raised intracranial pressure. So far in EORTC Brain Tumour Group studies there is no evidence of any significant beneficial effect from chemotherapy after excisional surgery. Whatever adjuvant methods of therapy are developed in the future, it will remain necessary to separate the effects of surgery from those of the adjuvant therapy. There will therefore be a continuing need for a basic human model whereby the effects of surgery can be clarified, and for that reason it will always be necessary to have a treatment arm without excisional surgery. A format is proposed taking into account favorable prognostic factors such as age and Karnofsky index, which should provide a basis for critical evaluation. The difficulties of adhering to the format are stressed.
尽管有大量文献，但对于手术在幕上恶性胶质瘤（间变性星形细胞瘤和多形性胶质母细胞瘤）患者管理中的精确地位，仍难以得出结论。如果不考虑放疗的有益效果，单纯切除手术本身可能只能使患者存活4至6个月。切除手术明显的有益效果更多地与放疗有关，而非手术本身，超出了对颅内压升高的即时缓解。到目前为止，在欧洲癌症研究与治疗组织（EORTC）脑肿瘤组的研究中，没有证据表明切除手术后化疗有任何显著的有益效果。无论未来开发出何种辅助治疗方法，将手术效果与辅助治疗效果区分开来仍将是必要的。因此，将持续需要一个基础人体模型，借此可阐明手术效果，出于这个原因，始终需要有一个不进行切除手术的治疗组。提出了一种考虑年龄和卡诺夫斯基指数等有利预后因素的方案，这应为批判性评估提供基础。文中强调了遵循该方案的困难。
