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首页> 外文期刊>Advances and technical standards in neurosurgery >Is there a place for radiotherapy in low-grade gliomas?
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Is there a place for radiotherapy in low-grade gliomas?

机译：低度神经胶质瘤有放疗的地方吗？

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The optimal management of supratentorial low-grade glioma remains controversial, and only limited definitive data is available to guide recommendations. Treatment decisions have to take into account both the management of symptoms and of tumour control, and must balance the benefits against the potential for treatment-related complications. Overall outcome is more dependent on patient and tumour-related characteristics such as age, tumour grade, histology and neurological function than treatment. From the pooled analysis of 2 randomized EORTC trials a prognostic score has been derived, median survival is varying from 3.2 to 7.8 years. Radiation therapy is usually the primary treatment modality; however its benefit on initial tumour control may be outweighed by potential late toxicity. To, date only 4 large randomized trials in patients with low-grade glioma have been reported. It allows concluding that early radiotherapy does not improve overall survival and supports an initially expectative approach. Similarly, higher radiation doses above 45-50 Gy (fractions of 1.8-2.0 Gy) do not confer a better outcome but may be associated with increased toxicity. The adjuvant use of PCV-chemotherapy in high-risk patients also failed to improve progression-free and overall survival. An ongoing large randomized EORTC/NCIC trial is investigating the primary treatment with temozolomide chemotherapy versus standard radiotherapy in patients "at need for treatment". Tumour material will be collected in all patients, which ultimately may allow identifying on a molecular basis patients for whom one or another treatment strategy may fit best. Irrespective of new chemotherapeutic agents, radiotherapy is also evolving. Highly conformal techniques based on modern imaging as co-registered MRI scans, limiting the amount of normal tissue irradiated without compromising tumour control, will be the future approach in order to reduce neurotoxicity.
机译：幕上低度神经胶质瘤的最佳治疗仍存在争议，并且仅有有限的确定数据可用于指导建议。治疗决策必须同时考虑症状的控制和肿瘤控制，并且必须在收益与潜在的治疗相关并发症之间取得平衡。总体结果比治疗更取决于患者和与肿瘤相关的特征，例如年龄，肿瘤等级，组织学和神经功能。通过对2项随机EORTC试验的汇总分析，得出了预后评分，中位生存期从3.2年到7.8年不等。放射治疗通常是主要的治疗方式。然而，其潜在的后期毒性可能会抵消其在最初控制肿瘤方面的益处。迄今为止，仅报道了针对低度神经胶质瘤患者的4项大型随机试验。它可以得出结论，早期放疗不能改善总体生存率，并支持最初的预期方法。同样，高于45-50 Gy的较高辐射剂量（1.8-2.0 Gy的分数）不会带来更好的结果，但可能与毒性增加有关。在高危患者中辅助使用PCV化疗也未能改善无进展生存期和总生存期。正在进行的一项大型随机EORTC / NCIC试验正在研究替莫唑胺化疗与标准放疗对“需要治疗”的患者的主要治疗方法。将在所有患者中收集肿瘤材料，最终可以从分子角度确定一种或另一种治疗策略最适合的患者。与新的化学治疗剂无关，放射治疗也在发展。基于现代成像技术作为共注册的MRI扫描的高度保形技术，将是减少神经毒性的未来方法，它可以在不损害肿瘤控制的情况下限制照射的正常组织的数量。

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