High-grade gliomas are the most common malignant primary central nervous system tumors with poor prognosis. The operation based on the principle of maximum safe resection of tumors, combined with radiation therapy and chemotherapy, is the primary treatment method. This treatment only delays the progression of high-grade gliomas, and almost all patients eventually develop disease progression or relapse. With the development of molecular biology, immunology, and genomics, people have a deeper understanding of the pathogenesis of gliomas. Targeted therapy, immunotherapy, and other comprehensive treatments are expected to become potential treatments for high-grade gliomas. This article reviews the current status of medical treatment of primary and recurrent high-grade gliomas, and the research progress of high-grade gliomas in targeted therapy and immunotherapy.
ObjectiveTo explore the clinical features and prognostic factors of diffuse brain stem glioma in children. MethodsA retrospective analysis was conducted on pediatric diffuse brain stem glioma diagnosed by pathology in West China Hospital of Sichuan University between January 2016 and May 2019. The demographic data, clinical manifestations, MRI findings, pathological results, and treatment were included in the prognosis study.ResultsA total of 39 cases of pediatric diffuse brain stem glioma confirmed by pathology were enrolled, including 21 males and 18 females aged between 3 and 14 years with an average of (8.1±2.8) years and mostly between 5 and 10 years (29 cases). The mean maximum diameter of gliomas was (4.46±0.81) cm. Among the 39 cases, there were 15 cases complicated with hydrocephalus and 16 cases whose tumors completely surrounded the basilar artery. The median survival time was 6 months. The one-year survival rate was 15.4%, and the two-year survival rate was 5.1%. Univariate analyses showed that the tumor enhancement and completely enclosed basilar artery had significant impact on the prognosis (P<0.05). Multiple Cox regression analysis showed that whether the basilar artery was completely wrapped was related to the prognosis [hazard ratio=4.596, 95% confidence interval (1.839, 11.488), P=0.001]. ConclusionsPediatric diffuse brain stem gliomas are common in children aged 5-10 years with poor prognosis. Whether the tumor completely surrounds the basilar artery is closely related to the short overall survival time.
ObjectivesTo systematically review the efficacy and safety of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma.MethodsPubMed, EMbase, the Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were searched to obtain randomized controlled trials (RCTs) of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma patients from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 6 RCTs involving 2 835 patients were included. The results of meta-analysis showed that: the bevacizumab combined with STUPP regimen group was superior to the control group on PFS (HR=0.69, 95%CI 0.62 to 0.77, P<0.000 01). But the adverse events rate at the three and above three levels was significantly higher than the control group (P<0.05).ConclusionsCurrent evidence shows that bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma can significantly prolong the PFS. The treatment group performs not as well as the control group on adverse event rate. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
目的 探讨脑胶质瘤术后不同时期的MRI增强表现，客观分析其术后的手术切除程度。 方法 2009年2月－2012年10月32例脑胶质瘤患者均在术后1 d～2周进行第1次MRI平扫及增强扫描（其中21例在术后3 d内进行检查），术后1～3个月随访复查21例，术后6～12个月随访复查18例，术后1～3年MRI随访16例。分析不同时期的MRI平扫及增强表现，以期发现正确评价手术切除程度的指标。 结果 术后3 d内行MRI增强检查仅有4例出现反应性强化，肿瘤残余有7例，结合其影像学表现可较准确地区分术后反应性强化及肿瘤残余。 结论 胶质瘤术后早期（3 d内）进行MRI增强检查可准确评价肿瘤术后切除程度，便于制订下一步治疗计划。
ObjectiveTo analyze the electro-clinical characteristics and surgical outcome of low-grade developmental tumors in temporal lobe. MethodsThe onset age, seizure duration, seizure types, electroencephalogram and surgical outcome of 49 patients with low-grade developmental tumor of temporal lobe were analyzed retrospectively. ResultsTwo groups of the seizure types were divided. The first group was spasm, the other was focal onset. There were 12 cases in spasm group, with an average onset age of (1.00±0.59) years. The discharge was extensive and multi-brain-area locaded, especially in the temporal montages and the ipsilateral posterior montages. There were 37 cases in second group, with an average onset age of (8.90±8.84) years, mainly including autonomic seizure, tonic seizure and automotor seizure. In this group, the discharge was mainly recorded in the temporal montages, which could spread to the frontal montages and less locaded in posterior montages. The difference of onset age between the two groups was statistically significant (P<0.01). The average follow-up of spasm group was (2.80±1.57) years, and the surgical outcome of all patients in this group were all Engel I (100.00%, 12/12). The focal onset group was followed up for an average of (6.50±4.78) years, and the rate of Engel I was 91.80% (34/37). There was no significant difference between the two groups (P>0.05). ConclusionsFor low-grade developmental tumors in temporal lobe, there are two seizure types, including spasm and focal onset. The onset age of spasm is earlier, while patients with focal onset mostly start at childhood or older, rare in infancy. Surgery has a good effect on the treatment of temporal lobe developmental tumor epilepsy.
ObjectiveTo summarize the surgical experiences of low-grade glioma on functional areas. MethodsFifty-four patients with low-grade glioma on functional areas were treated in our department from December 2009 to December 2012. We retrospectively analyzed their clinical data. ResultsThirty-six cases were located preoperatively by diffusion tensor imaging, 13 patients underwent intraoperative B ultrasound tumor localization, and 5 underwent intraoperative wake-up anesthesia. Total resection of tumors was performed on 42 patients, subtotal resection on 10, and partial resection on 2, and no patient died during the operation. The follow-up ranged from 6 to 24 months averaging 12. There was no significant difference in Karnofsky performance scale before and after surgery (P>0.05). ConclusionThe comprehensive application of various localization methods can protect function to the best advantage and resect tumor to the largest degree, and thus improves patients' quality of life.
【摘要】 目的 探讨成人幕上低级别胶质瘤（WHO Ⅱ级）患者术后生活质量的影响因素。 方法 回顾性分析2008年10月—2010年5月经手术切除病变、术后病理证实为低级别胶质瘤的115例患者临床资料，术后随访6~24个月。以患者年龄、性别、主要临床症状、病变部位、病变大小及病理结果为自变量，以术后Karnofsky评分（KPS）改善为因变量，采用Logistic回归分析研究相关影响因素。采用秩和检验比较不同组间KPS差异。 结果 随访至术后6个月，患者年龄、病变大小、病变部位、切除范围以及是否有癫痫史在KPS比较中，其结果有统计学意义（Plt;0.05）。随访至术后12个月，切除范围和癫痫史对KPS评分已无影响（Pgt;0.05）。病理类型、术前是否存在神经功能障碍与术后KPS改善在单因素和多因素比较中无统计学意义。 结论 患者年龄≤50岁、术前有癫痫史、肿瘤直径≤4 cm、病变表浅、肿瘤全切除的患者术后KPS改善好于年龄gt;50岁、术前无癫痫史、肿瘤直径gt;4 cm、病变深在、肿瘤次全切除的患者。患者术前是否存在神经功能障碍和病理类型与术后生活质量是否改善无明显关系。复发也是影响患者术后KPS改善的因素。【Abstract】 Objective To assess the quality of life in adults with surgically managed cerebral supratentorial low grade glioma (WHO grade Ⅱ) and the relevant factors. Methods We retrospectively analyzed the clinical data of 115 patients with histologically proven supratentorial low grade glioma enrolled at West China Hosptial from October 2008 to May 2010. Follow-up lasted for 6 to 24 months after operation. Logisitc regression analysis is used to test the relevant factors with age, gender, main clinical manifestations, lesion location, lesion size and pathological results as the independent variables, and Kamofsky postoperative scale (KPS) scores as dependent variable. KPS scores of different groups were analyzed using the rank test. Results After 6 months of follow-up, we found that age, size, location, extent of surgical excision and eplispy history showed a statistical significance in KPS comparison (Plt;0.05). Till the 12th month in the follow-up, the extent of surgical excision and eplispy history were not statistically significant any more (Pgt;0.05). Histology type and neurological deficit had no relationship with KPS improvement in both single factor analysis and multivariate analysis. Conclusions Patients with an age older than 50 years, preoperative epilepsy history, the largest diameter of the tumor less than 4 cm, shallow lesions, and complete tumor resection have a better KPS improvement after operation than those with corresponding opposite conditions. There is no obvious relationship between histology type, neurologic deficits and KPS improvement after operation. Recurrence is also a factor influencing KPS improvement after operation.
ObjectiveTo apply a multimodal preoperative evaluation system to guide the operation of patients with low-grade glioma with focal cortical dysplasia epilepsy.MethodsThe clinical data of 5 patients with glioma complicated with focal cortical dysplasia who underwent surgical treatment at the Second Hospital of Lanzhou University were collected. The perioperative evaluation was performed using a multimodal evaluation system—multidisciplinary discussion, multi-image combination and multi-method evaluation, so as to improve the total resection rate of epileptic foci and achieve the goal of complete remission. After a follow-up of more than 5 months, the Engel I was defined as a good prognosis and Engel II-IV was defined as a poor prognosis according to the Engel assessment method.ResultsThe postoperative examination of 5 patients showed 4 cases of ganglion cell glioma and 1 case of diffuse astrocytoma, the 5 cases were all found with focal cortical dysplasia. Two of the patients had a small amount of bleeding in the operation area and disappeared at the time of discharge. One lesion was located in the left occipital cortex, one in the upper frontal lobe, two in the temporal lobe and hippocampus, and one in the insula. Five cases of epileptic foci were followed up for 5~16 months without seizures, all graded as Engel I.ConclusionsMultimodal assessment system can improve the prognosis of patients with low-grade intracranial tumors with focal cortical dysplasia. In the development of surgical strategies for patients with epilepsy secondary to intracranial tumors, attention should not be paid only to the tumor itself, dysplasia may be associated with tumors, often the underlying cause of epilepsy.