Kaba S E, Kyritsis A P
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.
Drugs. 1997 Feb;53(2):235-44. doi: 10.2165/00003495-199753020-00004.
Gliomas are the most frequent primary brain tumours. They include astrocytic gliomas, oligodendrocytic gliomas, ependymomas and gliomas with mixed cell populations. Each glioma type consists of both low-grade and malignant atypical varieties. The low-grade tumours occur predominantly in children and young adults, and the malignant forms in older people. The presenting symptoms are epileptic seizures, headache and mental confusion. Focal neurological symptoms and findings, such as hemiparesis, are mostly associated with the malignant forms. Magnetic resonance imaging (MRI) scan of the brain with and without gadolinium contrast demonstrates the tumour. However, stereotactic biopsy or surgical resection is necessary to obtain the correct pathological diagnosis, except for diffuse pontine astrocytomas, which have an unmistakeable imaging appearance and for which biopsy has substantial risks. Treatment depends on the pathological diagnosis. Complete surgical resection may be curative for low-grade tumours. Postoperative radiotherapy is recommended for partially resected tumours. Most malignant gliomas require aggressive combination therapy with radiotherapy and chemotherapy after maximal surgery. The standard initial regimens are nitrosourea-based chemotherapies, such as carmustine alone, a combination of procarbazine, lomustine and vincristine, or a combination of thioguanine, procarbazine, lomustine and hydroxycarbamide (hydroxyurea). Unfortunately, the prognosis of malignant gliomas is generally poor despite aggressive treatment, because of their infiltrative nature and high relapse rate.
神经胶质瘤是最常见的原发性脑肿瘤。它们包括星形细胞胶质瘤、少突胶质细胞胶质瘤、室管膜瘤以及具有混合细胞群的胶质瘤。每种神经胶质瘤类型都包括低级别和恶性非典型变种。低级别肿瘤主要发生在儿童和年轻人中，而恶性形式则多见于老年人。出现的症状有癫痫发作、头痛和精神错乱。局灶性神经症状和体征，如偏瘫，大多与恶性形式相关。脑部磁共振成像（MRI）扫描，无论有无钆造影剂，都能显示肿瘤。然而，除了具有明确影像学表现且活检有很大风险的弥漫性脑桥星形细胞瘤外，需要进行立体定向活检或手术切除以获得正确的病理诊断。治疗取决于病理诊断。完整的手术切除可能治愈低级别肿瘤。对于部分切除的肿瘤，建议术后放疗。大多数恶性神经胶质瘤在最大限度手术切除后需要放疗和化疗的积极联合治疗。标准的初始方案是以亚硝基脲为基础的化疗，如单独使用卡莫司汀、丙卡巴肼、洛莫司汀和长春新碱的联合方案，或硫鸟嘌呤、丙卡巴肼、洛莫司汀和羟基脲（羟基尿素）的联合方案。不幸的是，尽管进行了积极治疗，但由于恶性神经胶质瘤具有浸润性和高复发率，其预后通常很差。
