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首页> 外文期刊>Neurosurgery >The neurosurgeon as local oncologist: cellular and molecular neurosurgery in malignant glioma therapy.
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The neurosurgeon as local oncologist: cellular and molecular neurosurgery in malignant glioma therapy.

机译：作为外科医生的神经外科医生：恶性神经胶质瘤治疗中的细胞和分子神经外科。

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Malignant gliomas are among the most challenging of all cancers to treat successfully, being characterized not only by aggressive proliferation and expansion but also by inexorable tumor invasion into distant brain tissue. Although considerable progress has been made in the treatment of these tumors with combinations of surgery, radiotherapy, and chemotherapy, these efforts have not been curative. Neurosurgeons as oncologists have increasingly turned their attention to therapies on a molecular scale. Of particular interest to neurosurgeons is the ability to deliver therapy locally to the tumor site or to take advantage of existing immunological mediators, enhancing drug concentrations or therapeutic cell numbers while bypassing the blood-brain barrier to maximize efficacy and minimize systemic toxicity. Exciting local-therapy approaches have been proposed for these devastating tumors. In this review, we discuss the potential applications of bioreactors, neural stem cells, immunotherapies, biodegradablepolymers, and convection-enhanced drug delivery in the treatment of malignant gliomas. These approaches are at different stages of readiness for application in clinical neurosurgery, and their eventual effects on the morbidity and mortality rates of gliomas among human patients are difficult to ascertain from successes in animal models. Nevertheless, we are entering an exciting era of "nanoneurosurgery," in which molecular therapies such as those discussed here may routinely complement existing surgical, radiological, and chemotherapeutic approaches to the treatment of neuro-oncological disease. The potential to deploy any of a number of eloquently devised molecular therapies may provide renewed hope for neurosurgeons treating malignant gliomas.
机译：恶性神经胶质瘤是成功治疗所有癌症中最具挑战性的癌症之一，其特征不仅在于侵袭性增殖和扩张，而且还在于肿瘤不可避免地侵入远处的脑组织。尽管通过外科手术，放射疗法和化学疗法的组合在治疗这些肿瘤方面已经取得了相当大的进展，但是这些努力尚未取得成功。神经外科医师作为肿瘤学家已经越来越多地将注意力转向分子水平的疗法。神经外科医生特别感兴趣的是能够将治疗局部地递送到肿瘤部位或利用现有的免疫介质，增强药物浓度或治疗细胞数，同时绕过血脑屏障以最大化功效和最小化全身毒性的能力。对于这些破坏性肿瘤，已经提出了激动人心的局部疗法。在这篇综述中，我们讨论了生物反应器，神经干细胞，免疫疗法，生物可降解聚合物以及对流增强药物递送在恶性神经胶质瘤治疗中的潜在应用。这些方法处于准备用于临床神经外科手术的不同阶段，并且很难通过动物模型的成功来确定它们最终对人类患者脑胶质瘤的发病率和死亡率的影响。尽管如此，我们正在进入一个令人兴奋的“纳米神经外科手术”时代，在这里，诸如本文所述的分子疗法可能会常规地补充现有的外科手术，放射线和化学疗法来治疗神经肿瘤疾病。部署许多雄辩的分子疗法中的任何一种的潜力可能为神经外科医师治疗恶性神经胶质瘤提供新的希望。

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