Adult Brainstem Gliomas

被引:65
作者
Reyes-Botero, German [1 ,4 ,5 ,6 ]
Mokhtari, Karima [2 ,4 ,5 ,6 ]
Martin-Duverneuil, Nadine [3 ]
Delattre, Jean-Yves [1 ,4 ,5 ,6 ]
Laigle-Donadey, Florence [1 ,4 ,5 ,6 ]
机构
[1] Grp Hosp Pitie Salpetriere, APHP, Div Mazarin, Serv Neurol 2, F-75013 Paris, France
[2] Grp Hosp Pitie Salpetriere, APHP, Serv Neuropathol, F-75013 Paris, France
[3] Grp Hosp Pitie Salpetriere, APHP, Serv Neuroradiol, F-75013 Paris, France
[4] Univ Paris 06, Ctr Rech, Inst Cerveau & Moelle Epiniere, UMR S975,Fac Med Pitie Salpetriere, Paris, France
[5] INSERM, U975, Paris, France
[6] CNRS, UMR 7225, Paris, France
关键词
Brainstem glioma; Classification; MRI; Treatment; Adults; PROGNOSTIC-FACTORS; NATURAL-HISTORY; STEREOTACTIC BIOPSIES; MALIGNANT GLIOMA; TECTAL GLIOMAS; CHILDREN; TUMORS; MANAGEMENT; RECURRENT; LESIONS;
D O I
10.1634/theoncologist.2011-0335
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Brainstem gliomas are uncommon in adults and account for only 1%-2% of intracranial gliomas. They represent a heterogeneous group of tumors that differ from those found in their pediatric counterparts. In adults, a low-grade phenotype predominates, which is a feature that likely explains their better prognosis compared to that in children. Because biopsies are rarely performed, classifications based on the radiological aspect of magnetic resonance imaging results have been proposed to establish treatment strategies and to determine outcomes: (a) diffuse intrinsic low-grade, (b) enhancing malignant glioma, (c) focal tectal gliomas, and (d) exophytic gliomas. Despite significant advances in neuroradiology techniques, a purely radiological classification remains imperfect in the absence of a histological diagnosis. Whereas a biopsy may often be reasonably avoided in the diffuse nonenhancing forms, obtaining histological proof seems necessary in many contrast-enhanced brainstem lesions because of the wide variety of differential diagnoses in adults. Conventional radiotherapy is the standard treatment for diffuse intrinsic low-grade brainstem gliomas in adults (the median survival is 5 years). In malignant brainstem gliomas, radiotherapy is the standard treatment. However, the possible benefit of combined radiotherapy and chemotherapy (temozolomide or other agents) has not been thoroughly evaluated in adults. The role of anti-angiogenic therapies in brainstem gliomas remains to be defined. A better under-standing of the biology of these tumors is of primary importance for identifying homogeneous subgroups and for improving therapy options and outcomes. The Oncologist 2012; 17: 388-397
引用
收藏
页码:388 / 397
页数:10
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