Whole brain radiotherapy with concurrent temozolomide in multifocal and/or multicentric newly diagnosed glioblastoma复制标题

同期替莫唑胺全脑放疗治疗多灶性和/或多中心性新诊断胶质母细胞瘤

Glioblastoma (GBM) is the most common primary malignant brain tumour in adults, with 3.55 new cases per 100,000 persons per year, adjusted to the European Standard Population. Despite intensive therapeutic options, GBM is a lethal disease associated with a median overall survival (OS) of less than 24 months. GBM appears as contrast-enhanced space-occupying lesions on magnetic resonance imaging (MRI) with irregular boundaries. Central necrosis and perilesional oedema are common. In 2005, a randomized controlled trial showed that radiation therapy (RT) and temozolomide (TMZ) prolonged OS. Since then, this approach has become the standard treatment for healthy adult patients with newly diagnosed GBM. A recent systemic review and meta-analyses stated that the incidence of solitary glioma is 81%. Other older studies showed that 20% of GBM patients had multiple lesions, described as two entities: multifocal and multicentric (M/M) gliomas. Batzdorf and Malamud defined multifocal GBM as a tumour disseminated along established CNS pathways such as white matter fibre tracts, cerebrospinal fluid, or local invasion; and multicentric glioma as widely separated in location and/ or time. The incidences of multifocal and multicentric (M/M) gliomas were 25.4% and 2.4%, respectively. Recent studies showed that M/M GBM cohorts had significantly poor OS compared to unifocal GBM (6 versus 11 months). Thus, M/M GBMs present one of the worst prognoses of GBMs. The management of such an extended disease is therefore a challenge for neurosurgeons and radiation oncologists. Two first line therapeutic options for treating M/M GBM, after biopsy or partial resection, are currently being implemented: long-term TMZ and radiotherapy (Focal or Whole brain). There are no guidelines regarding the optimal management of M/M GBM.

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