Privorotskiy Ann, Bhavsar Shreyas P, Lang Frederick F, Hu Jian, Cata Juan P
Eastern Virginia Medical School, Norfolk, Virginia, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Neurooncol Adv. 2020 Sep 16;2(1):vdaa123. doi: 10.1093/noajnl/vdaa123. eCollection 2020 Jan-Dec.
Glioblastoma (GBM) is an aggressive malignant CNS tumor with a median survival of 15 months after diagnosis. Standard therapy for GBM includes surgical resection, radiation, and temozolomide. Recently, anesthetics and analgesics have received attention for their potential involvement in mediating tumor growth. This narrative review investigated whether various members of the 2 aforementioned classes of drugs have a definitive impact on GBM progression by summarizing pertinent in vitro, in vivo, and clinical studies. Recent publications regarding general anesthetics have been inconsistent, showing that they can be pro-tumoral or antitumoral depending on the experimental context. The local anesthetic lidocaine has shown consistent antitumoral effects in vitro. Clinical studies looking at anesthetics have not concluded that their use improves patient outcomes. In vitro and in vivo studies looking at opioid involvement in GBM have demonstrated inconsistent findings regarding whether these drugs are pro-tumoral or antitumoral. Nonsteroidal anti-inflammatory drugs, and specifically COX-2 inhibitors, have shown inconsistent findings across multiple studies looking at whether they are beneficial in halting GBM progression. Until multiple repeatable studies show that anesthetics and analgesics can suppress GBM growth, there is no strong evidence to recommend changes in the anesthetic care of these patients.
胶质母细胞瘤（GBM）是一种侵袭性恶性中枢神经系统肿瘤，诊断后的中位生存期为15个月。GBM的标准治疗包括手术切除、放疗和替莫唑胺。最近，麻醉药和镇痛药因其在介导肿瘤生长中的潜在作用而受到关注。这篇叙述性综述通过总结相关的体外、体内和临床研究，调查了上述两类药物的各种成分是否对GBM进展有决定性影响。关于全身麻醉药的最新出版物结果并不一致，表明它们根据实验背景可能具有促肿瘤或抗肿瘤作用。局部麻醉药利多卡因在体外显示出一致的抗肿瘤作用。观察麻醉药使用情况的临床研究尚未得出其使用能改善患者预后的结论。观察阿片类药物在GBM中作用的体外和体内研究，在这些药物是促肿瘤还是抗肿瘤方面得出了不一致的结果。非甾体抗炎药，特别是COX-2抑制剂，在多项关于它们是否有利于阻止GBM进展的研究中结果并不一致。在多项可重复研究表明麻醉药和镇痛药能够抑制GBM生长之前，没有充分证据推荐改变对这些患者的麻醉护理。
