Trautmann T G, Shaw E G
Department of Radiation Oncology, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1030, USA.
Ann Acad Med Singap. 1996 May;25(3):392-6.
The supratentorial low-grade gliomas are a heterogeneous group of central nervous system tumours. Knowledge of their biology, primarily based on histologic subtype and patient age, is helpful in determining prognosis and guiding therapeutic recommendations. The pilocytic tumours usually occur in younger patients and carry a favourable prognosis. Recurrence following gross total excision is rare, and approximately 80% of patients undergoing subtotal removal with or without postoperative radiation therapy (RT) will survive 10 years or longer. In contrast, non-pilocytic, supratentorial low-grade tumours (including the diffuse fibrillary, protoplasmic and gemistocytic subtypes), as well as mixed oligoastrocytomas and oligodendrogliomas are infrequently cured, even with gross total excision. Survival benefit with postoperative RT has been suggested by several retrospective studies. When RT is prescribed, localized treatment fields are suggested for total doses of 4500 to 6500 cGy. Ongoing prospective, randomized studies hopefully will clarify the role of RT in these neoplasms, as well as the optimal dose.
幕上低级别胶质瘤是一组异质性的中枢神经系统肿瘤。对其生物学特性的了解，主要基于组织学亚型和患者年龄，有助于确定预后并指导治疗建议。毛细胞型肿瘤通常发生于较年轻患者，预后良好。全切术后复发罕见，约80%接受次全切除且无论有无术后放疗（RT）的患者能存活10年或更长时间。相比之下，非毛细胞型幕上低级别肿瘤（包括弥漫性纤维型、原浆型和肥胖细胞型亚型），以及混合性少突星形细胞瘤和少突胶质细胞瘤即使全切也很少能治愈。多项回顾性研究提示术后放疗有生存获益。当进行放疗时，建议局部治疗野，总剂量为4500至6500 cGy。正在进行的前瞻性随机研究有望阐明放疗在这些肿瘤中的作用以及最佳剂量。
