多形性胶质母细胞瘤术后放化疗的分析进展-临床医学;外科学(神经外科学)专业论文.docxVIP

多形性胶质母细胞瘤术后放化疗的研究进展 中文摘要 胶质瘤是颅内最常见的原发肿瘤，世界卫生组织（WHO）根据病理学将其分为 Ⅰ-Ⅳ级，其中多形性胶质母细胞瘤（Glioblastoma multiforme，GBM）约占所有胶质瘤的一半。GBM是一种最常见但致死率最高的病 理类型，具有高浸润性，且与正常组织混合，难以分离，使得手术切除尤其困难。 而肿瘤的切除程度、患者的年龄、一般情况等因素均有一定的流行病学数据证明对 其预后的意义；近年来由于肿瘤分子标志物在临床上的地位日渐提高，对GBM的分 子指标的研究也越来越多，目前已有证据证明一些分子指标对GBM的预后有影响， 甚至有望用于指导其个体化治疗。GBM的治疗方式目前仍以手术尽可能切除为主， 辅以合理的放化疗方案，总体上可以有效提高总生存期。近年来，一些新的分子靶 向药物以及更先进的影像学技术的出现为提高恶性胶质瘤的生存提供了一线希望。 而由于放化疗以及某些靶向药物的出现，使得经治疗后的患者出现假性进展或假性 好转的发生率明显增高，且影像学特征与真性进展、真性好转、放射性坏死等难以 区分，从而干扰临床医生对疾病发展的判断，影响进一步诊疗计划的确定。因此， 本文从GBM的预后、诊断、治疗方式等几个方面来进行讨论，旨在为临床实践提供 一定的参考。 关键词：多形性胶质母胞瘤 预后因素 放射治疗 化疗 靶向治疗 作 者：鲍淑文 指导老师：陆雪官 Advances in the clinical postoperative chemoradiotherapy of Glioblastoma multiforme ABSTRACT Glioma is the most common intracranial primary tumor, the World Health Organization (WHO) classified it into I-IV grades according to the pathological characteristic,and Glioblastoma multiforme (GBM) is about 50% of glioma. GBM is the most common pathological type of all ,but has a highest death rate ,because the operation is particularly difficult resul from the highly invasive of the tumor cell, it always mix with the normal tissue and difficult to be separated. Passed epidemiological studies had enough evidences to prove that the extent of resection, the patients age, physiclal status et al are prognostic factors of GBM. Recent years，studies of some molecular markers of GBM is more and more, some molecular prognostic factors are considered to impact the prognosis of GBM, and even probable to guide the individualized treatment. The treatment with radiotherapy with combined and adjuvant chemotherapy following operation is the standard treatment of GBM, and is more effective to improve overall survival. In recent years, some new molecular targeted drugs have provided a glimmer of hope to improve the survival of malignant glioma. At the same time，these treatments of chemotherapy combined with radiotherapy and targeted therapy lead to higher rate of pseudoprogression and Pseud