胶质瘤治疗策略
文章简介：编译并展示的目的......Clinical......MANAGEME......*GradeI(......WHO一级胶质瘤......*GradeII......WHO二级胶质瘤......*GradeII......WHO三级胶质瘤......*GradeIV......WHO四级胶质瘤......*Alltumo......所以的肿瘤标本都......*Primary......胶质瘤主要的治疗......*Low-gra......低度恶性的少枝胶......第1天：环己亚硝......第8天和第29天......从第8天到第21......2.替莫唑胺15......dr_weishep编译
编译并揭示(展现)(展示)的手段(目的)：旨在为那些得了(患有)胶质瘤病人及其家族(家属)，供给(提供)一些胶质瘤国际治疗的普通(一般)遵守(遵循)准绳(原则)。愿他们处乱不惊，安闲(自在)(从容)应对，把病人的好处(利益)放在第一位，让病人空虚(充实)(充分)享用(享受)生活生计(生涯)(生活)，而不是终年(长年)累月的和药物和医院相伴。21世纪是人和肿瘤共存的世纪。
Clinical Oncology, 3rd ed., Copyright (C) 2004 Churchill Livingstone
临床肿瘤学 第三版（2004）
MANAGEMENT APPROACH
胶质瘤治疗战略(策略)
* Grade I (pilocytic astrocytomas). Surgery is curative. If residual tumor is seen on postoperative imaging, the patient should have a second craniotomy to resect the entire tumor. Radiation therapy and chemotherapy have limited utility for these tumors.
WHO一级胶质瘤（毛细胞性星形细胞瘤）：手术是可以治愈性的。若是(如果)在术后影象(影像)上有剩余(残余)肿瘤，则可行第二次手术切除全部(整个)肿瘤。放疗和化疗对此类肿瘤极为(极其)有限。
* Grade II (low-grade astrocytoma). Surgery is the mainstay of therapy in noneloquent brain. In patients under the age of 40 who undergo gross total resection, no additional therapy is given. Patients under the age of 40 with incomplete resections and patients over the age of 40 with or without complete resections are treated with radiation therapy (54 to 60 Gy).
WHO二级胶质瘤（低度恶性胶质瘤）：手术长短(是非)功用(功能)区肿瘤的最首要(主要)的治疗手段。对(对于)40岁以下的肉眼全切的病人，无需额定(额外)的其他治疗。对(对于)40以下的不全切除的肿瘤病人和(以及)病人年齿(年龄)大约40岁不管是不是(是否)全切都应当(应该)停止(进行)放疗。
* Grade III astrocytoma (anaplastic astrocytoma). Surgery is required to establish a tissue diagnosis and debulk the mass. Patients should be treated with radiation therapy (60 Gy) and chemotherapy.
WHO三级胶质瘤（间变星形细胞瘤）：需求(需要)手术来抵达(到达)(达到)组织病理诊断和减小肿瘤体积。病人该当(应当)停止(进行)放疗和化疗。
* Grade IV gliomas (glioblastoma multiforme). Surgery is required to establish tissue diagnosis and debulk the lesion. Surgery is followed by radiation therapy to a dose of 60 Gy. Chemotherapy consisting of carmustine, combination PCV (procarbazine, lomustine, and vincristine), or temozolomide can be used for tumor control.
WHO四级胶质瘤（多形性胶质母细胞瘤）：一样(同样)需求(需要)手术来抵达(到达)(达到)组织病理诊断和减小肿瘤体积。术后放疗（剂量在60Gy阁下(左右)）。化疗手段包含(包罗)(包括)卡莫司汀，结合(联合)方案PCV（甲基苄肼，环己亚硝脲和长春新碱），或(或者)替莫唑胺用来对肿瘤生上进(长进)行掌握(控制)。
* All tumors should be sent for genetic analysis. Advances in molecular genetic analysis have led to improvements in predicting response to chemotherapy. Pure oligodendrogliomas are more chemosensitive than mixed tumors (related to different proportions of loss of heterozygosity of chromosomes 1p and 19q).
所以的肿瘤标本都应当(应该)送检染色体搜检(检查)，由于(因为)纯粹(纯正)(纯洁)(纯粹)的少枝胶质瘤能够(可能)会有1p或(或者)19q的贫乏(缺少)(缺乏)，此种胶质瘤对化疗出格(特别)迟钝(敏感)。
* Primary treatment is maximal feasible resection. Anaplastic tumors are treated with radiation therapy and 1 year of PCV chemotherapy. The role of preradiation chemotherapy is the subject of several ongoing clinical trials. At recurrence temozolomide is effective for anaplastic tumors; well-tolerated and probably equally effective is PCV used as adjuvant therapy.
胶质瘤首要(主要)的治疗是尽最大能够(可能)的切除肿瘤。间变胶质瘤该当(应当)给以放疗和1年阁下(左右)的PCV结合(联合)化疗。放疗前的化疗今朝(目前)还在停止(进行)临床实验(试验)中。对(对于)复发的病人，替莫唑胺对间变胶质瘤是有用(有效)的。作为辅佐(辅助)治疗，它和PCV方案有一概(一律)(同等)的后果(效果)。
* Low-grade oligodendrogliomas that are progressive by MRI can be treated with PCV or temozolomide. PCV is the best-studied regimen for recurrence but is associated with cumulative myelosuppression, nausea, vomiting, and peripheral neuropathy. Temozolomide is well tolerated and is emerging as a feasible first-line choice. Radiation therapy maybe useful for tumors that progress on chemotherapy.
低度恶性的少枝胶质瘤若是(如果)在MRI上发觉(发现)有停顿(进展)，则给以PCV或(或者)替莫唑胺化疗。PCV是被证实过对复发胶质瘤有用(有效)化疗方案，但有积累(累积)的骨髓抑止(抑制)，恶心，吐逆(呕吐)和周围神经病变。替莫唑胺耐受性杰出(良好)，是新兴的可行的一线化疗药物。对(对于)化疗中仍在停顿(进展)的胶质瘤，放疗能够(可能)会有用(有效)。
1. 典范(经典)的PCV化疗方案
第1天：环己亚硝脲（CCNU） 110mg/m2口服
第8天和第29天：长春新碱1.4mg/m2静脉滴注
从第8天到第21天：甲基苄肼60mg/m2逐日(每日)口服
2. 替莫唑胺150 ～200 mg/ m2 连用5天，每28天反复(重复)一次。
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