对携带血小板衍生生长因子受体α(PDGFRA)、干细胞生长因子受体(KIT)和激酶插入结构域受体(KDR)共扩增的放射性胶质瘤采用传统放化疗的良好反应:一例报告及文献综述
Favorable Response to Conventional Chemoradiotherapy in Radiation-induced Glioma Harboring Coamplification of PDGFRA, KIT, and KDR: A Case Report and Literature Review.
作者信息
Tanikawa Daisuke, Shirahata Mitsuaki, Sakurada Kokyo, Fukuoka Masayoshi, Mizuno Reina, Sakakibara Ayaka, Kaneko-Mishima Masayo, Ehara Takuro, Ozawa Tatsuya, Suzuki Tomonari, Homma Taku, Kato Shingo, Mishima Kazuhiko
机构信息
Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
出版信息
NMC Case Rep J. 2025 Apr 11;12:139-146. doi: 10.2176/jns-nmc.2024-0269. eCollection 2025.
One of the most serious complications of cranial radiotherapy is the development of radiation-induced glioma, which is estimated to occur in 1%-4% of patients who have received cranial irradiation and has a worse prognosis than sporadic glioblastoma. Although comprehensive genetic analysis has recently uncovered the molecular characteristics of radiation-induced glioma, the full picture remains unclear due to its rarity. A 45-year-old man presented with generalized seizures caused by multiple brain tumors involving the right frontal lobe, thalamus, and brainstem. The patient had a history of whole-brain radiotherapy for recurrent Burkitt's lymphoma at the age of 12. He underwent craniotomy, and the histological diagnosis revealed a high-grade glioma with isocitrate dehydrogenase-wildtype, which was presumed to be a radiation-induced glioma that developed 33 years after whole-brain irradiation. Next-generation sequencing identified a deletion, as well as coamplification of several receptor tyrosine kinases-encoding genes, including , , and , all of which are located at 4q12. Amplification of this region is broadly observed across cancers and is associated with poor prognosis in sporadic glioblastoma. Nevertheless, the patient received chemoradiotherapy with temozolomide, followed by temozolomide maintenance therapy, resulting in a complete response of all lesions. Although radiation-induced gliomas are generally difficult to treat, our patient unexpectedly responded well to conventional chemoradiotherapy despite the coamplification of multiple receptor tyrosine kinases-encoding genes, which is typically suggestive of an aggressive phenotype. Our case indicates that some radiation-induced gliomas may have distinct molecular characteristics influencing the therapeutic response, which differ from those of sporadic glioblastomas.
颅脑放疗最严重的并发症之一是放射性诱发胶质瘤的发生,据估计,在接受过颅脑照射的患者中,有1%-4%会出现这种情况,其预后比散发性胶质母细胞瘤更差。尽管最近全面的基因分析揭示了放射性诱发胶质瘤的分子特征,但由于其罕见性,全貌仍不清楚。一名45岁男性因累及右额叶、丘脑和脑干的多发性脑肿瘤出现全身性癫痫发作。该患者在12岁时因复发性伯基特淋巴瘤接受过全脑放疗。他接受了开颅手术,组织学诊断显示为异柠檬酸脱氢酶野生型的高级别胶质瘤,推测为全脑照射33年后发生的放射性诱发胶质瘤。二代测序确定了一个缺失,以及几个编码受体酪氨酸激酶的基因的共扩增,包括位于4q12的 、 和 。该区域的扩增在多种癌症中广泛观察到,并且与散发性胶质母细胞瘤的不良预后相关。尽管如此,该患者接受了替莫唑胺同步放化疗,随后进行替莫唑胺维持治疗,所有病灶均完全缓解。虽然放射性诱发胶质瘤通常难以治疗,但我们的患者尽管多个编码受体酪氨酸激酶的基因共扩增,这通常提示侵袭性表型,却意外地对传统放化疗反应良好。我们的病例表明,一些放射性诱发胶质瘤可能具有影响治疗反应的独特分子特征,这与散发性胶质母细胞瘤不同。