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胶质母细胞瘤:临床表现、多学科管理及长期预后

Glioblastoma: Clinical Presentation, Multidisciplinary Management, and Long-Term Outcomes.

作者信息

Sipos David, Raposa Bence L, Freihat Omar, Simon Mihály, Mekis Nejc, Cornacchione Patrizia, Kovács Árpád

机构信息

Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary.

Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, "Moritz Kaposi" Teaching Hospital, Guba Sándor Street 40, 7400 Kaposvár, Hungary.

出版信息

Cancers (Basel). 2025 Jan 5;17(1):146. doi: 10.3390/cancers17010146.

Abstract

Glioblastoma, the most common and aggressive primary brain tumor in adults, presents a formidable challenge due to its rapid progression, treatment resistance, and poor survival outcomes. Standard care typically involves maximal safe surgical resection, followed by fractionated external beam radiation therapy and concurrent temozolomide chemotherapy. Despite these interventions, median survival remains approximately 12-15 months, with a five-year survival rate below 10%. Prognosis is influenced by factors such as patient age, molecular characteristics, and the extent of resection. Patients with IDH-mutant tumors or methylated MGMT promoters generally have improved survival, while recurrent glioblastoma is associated with a median survival of only six months, as therapies in these cases are often palliative. Innovative treatments, including TTFields, add incremental survival benefits, extending median survival to around 20.9 months for eligible patients. Symptom management-addressing seizures, headaches, and neurological deficits-alongside psychological support for patients and caregivers is essential to enhance quality of life. Emerging targeted therapies and immunotherapies, though still limited in efficacy, show promise as part of an evolving treatment landscape. Continued research and clinical trials remain crucial to developing more effective treatments. This multidisciplinary approach, incorporating diagnostics, personalized therapy, and supportive care, aims to improve outcomes and provides a hopeful foundation for advancing glioblastoma management.

摘要

胶质母细胞瘤是成人中最常见且侵袭性最强的原发性脑肿瘤,因其进展迅速、对治疗耐药以及生存预后差而构成巨大挑战。标准治疗通常包括最大程度的安全手术切除,随后进行分次外照射放疗和同步替莫唑胺化疗。尽管采取了这些干预措施,中位生存期仍约为12至15个月,五年生存率低于10%。预后受患者年龄、分子特征和切除范围等因素影响。异柠檬酸脱氢酶(IDH)突变型肿瘤或O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)启动子甲基化的患者通常生存期更长,而复发性胶质母细胞瘤的中位生存期仅为六个月,因为这些情况下的治疗往往是姑息性的。包括肿瘤治疗电场(TTFields)在内的创新疗法能带来额外的生存益处,使符合条件的患者中位生存期延长至约20.9个月。症状管理——解决癫痫、头痛和神经功能缺损——以及为患者和护理人员提供心理支持对于提高生活质量至关重要。新兴的靶向治疗和免疫治疗虽然疗效仍有限,但作为不断发展的治疗格局的一部分显示出前景。持续的研究和临床试验对于开发更有效的治疗方法仍然至关重要。这种多学科方法,包括诊断、个性化治疗和支持性护理,旨在改善治疗结果,并为推进胶质母细胞瘤的管理提供了充满希望的基础。

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