儿童毛细胞型星形细胞瘤术后综合治疗研究进展  

Research advances in postoperative comprehensive treatment of pediatric pilocytic astrocytoma

作　　者：梁擎天 王翦[1] LIANG Qingtian;WANG Jian(Department of Neurosurgery and Neuro-Oncology,State Key Laboratory of Oncology in South China,Collaboration Innovation Center for Cancer Medicine,Sun Yat-Sen University Cancer Center,Guangzhou,Guangdong 510060,China)

机构地区：[1]中山大学肿瘤防治中心神经外科/神经肿瘤科、华南肿瘤学国家重点实验室、肿瘤医学协同创新中心,广东广州510060

出　　处：《国际神经病学神经外科学杂志》2024年第1期51-58,共8页Journal of International Neurology and Neurosurgery

摘　　要：毛细胞型星形细胞瘤(PA)是最常见的儿童低级别脑肿瘤,常见于视神经、视交叉、下丘脑、脑干、小脑和大脑等部位。PA往往边界清楚、生长缓慢,属于WHO I级肿瘤,手术切除是治疗的首选方案。然而,由于视神经、视交叉、下丘脑或脑干等处神经功能的重要性,手术不一定能做到全切。目前临床对于儿童PA术后的治疗方案尚无定论,国内外对于儿童PA术后的主要治疗方式包括放疗、化疗、靶向治疗和随访观察。随着影像学和放射技术的进步,除了传统分次放疗,还包括适形放疗、立体定向放射治疗和质子治疗。但目前多数学者尚不推荐将放疗作为儿童PA术后的一线治疗选择。以长春新碱联合卡铂的化疗方案是进展性PA的首选,伊立替康-贝伐单抗可作为二线治疗用药。靶向治疗的发展如火如荼,以丝裂原活化蛋白激酶(MEK)抑制剂为首的靶向药物因其更少的毒副反应和良好的疗效而有望在未来成为儿童PA术后的一线用药,但目前尚缺乏高级别的临床证据。随访观察是儿童PA术后的选择之一,有学者提出儿童PA的分层治疗方案,推荐低风险层患者于术后随访观察。该文对儿童PA术后综合治疗进展作综述报道。Pilocytic astrocytoma(PA)is the most common low-grade brain tumor in children and is commonly observed in the optic nerve,optic chiasma,hypothalamus,brain stem,cerebellum,and cerebrum.PA often has clear boundaries and slow growth and belongs to WHO I tumors,and surgical resection is the preferred regimen for treatment.However,due to the importance of nerve functions of the optic nerves,optic chiasma,hypothalamus,and brain stem,total resection may not be possible.At present,no conclusion has been reached on the postoperative treatment of pediatric PA,and the main postoperative treatment methods for pediatric PA include radiotherapy,chemotherapy,targeted therapy,and follow-up observation.With the advances in imaging and radiation techniques,in addition to traditional fractionated radiotherapy,the treatment methods also include conformal radiotherapy,stereotactic radiotherapy,and proton therapy,aiming to reduce the toxic and side effects of radiotherapy and improve the efficacy of radiotherapy,but most scholars currently do not recommend radiotherapy as the first-line treatment for pediatric PA after surgery.The chemoradiotherapy regimen of vincristine combined with carboplatin is the preferred regimen for progressive PA,and the combination of irinotecan and bevacizumab can be used as the second-line therapy.There has been a rapid growth in the development of target therapy,and targeted drugs represented by mitogen-activated protein kinase inhibitors are expected to become the first-line drugs for the postoperative treatment of pediatric PA due to a fewer toxic and side effects and a better clinical effect,but there is still a lack of high-level clinical evidence.Follow-up observation is one of the options for children with PA after surgery,and some scholars have proposed hierarchical treatment regimens for children with PA and recommended postoperative follow-up observation for low-risk patients.This article reviews the advances in the postoperative comprehensive treatment of pediatric PA.

关 键 词：儿童脑肿瘤 毛细胞型星形细胞瘤 放疗 化疗 综合治疗 

分 类 号：R739.41[医药卫生—肿瘤]