Nesvick Cody L, Nageswara Rao Amulya A, Raghunathan Aditya, Biegel Jaclyn A, Daniels David J
Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Neurooncol Pract. 2019 May;6(3):163-178. doi: 10.1093/nop/npy037. Epub 2018 Oct 5.
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare CNS cancer that typically occurs in children younger than 3 years of age. Histologically, AT/RTs are embryonal tumors that contain a rhabdoid component as well as areas with primitive neuroectodermal, mesenchymal, and epithelial features. Compared to other CNS tumors of childhood, AT/RTs are characterized by their rapid growth, short symptomatic prodrome, and large size upon presentation, often leading to brain compression and intracranial hypertension requiring urgent intervention. For decades, the mainstay of care has been a combination of maximal safe surgical resection followed by adjuvant chemotherapy and radiotherapy. Despite advances in each of these modalities, the relative paucity of data on these tumors, their inherently aggressive course, and a lack of molecular data have limited advances in treatment over the past 3 decades. Recent large-scale, multicenter interdisciplinary studies, however, have significantly advanced our understanding of the molecular pathogenesis of these tumors. Multiple clinical trials testing molecularly targeted therapies are underway, offering hope for patients with AT/RT and their families.
非典型畸胎样/横纹肌样瘤(AT/RT)是一种罕见的中枢神经系统癌症,通常发生在3岁以下的儿童中。从组织学上看,AT/RT是胚胎性肿瘤,包含横纹肌样成分以及具有原始神经外胚层、间充质和上皮特征的区域。与儿童期其他中枢神经系统肿瘤相比,AT/RT的特点是生长迅速、症状前驱期短、就诊时体积大,常导致脑受压和颅内高压,需要紧急干预。几十年来,主要的治疗方法是最大程度的安全手术切除,随后进行辅助化疗和放疗。尽管这些治疗方式都有进展,但关于这些肿瘤的数据相对较少、其固有的侵袭性病程以及缺乏分子数据,限制了过去30年治疗方面的进展。然而,最近的大规模、多中心跨学科研究显著推进了我们对这些肿瘤分子发病机制的理解。多项测试分子靶向疗法的临床试验正在进行中,为患有AT/RT的患者及其家人带来了希望。