2014ESMO临床实践指南：高级别神经胶质瘤的诊断,治疗和随访

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1、AnnalsofOncologyAdvanceAccesspublishedApril29,2014clinicalpracticeguidelinesAnnalsofOncology00:1–9,2014doi:10.1093/annonc/mdu050High-gradeglioma:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-up†R.Stupp1,M.Brada2,M.J.vandenBent3,J.-C.Tonn4&G.Pen

2、theroudakis5onbehalfofthe ESMOGuidelinesWorkingGroup*1DepartmentofOncologyandCancerCentre,UniversityHospitalZurich,Zurich,Switzerland;2DepartmentofMolecularandClinicalCancerMedicine,Universityof Liverpool,ClatterbridgeCancerCentre,Wirral,UK;3DepartmentofNeuro-

3、Oncology,ErasmusMCCancerCenter,Rotterdam,Netherlands;4DepartmentofNeurosurgery, Ludwig-Maximilians-University,Munich,Germany;5DepartmentofMedicalOncology,MedicalSchool,UniversityofIoannina,Ioannina,GreeceincidenceandepidemiologyTheyearlyincidenceofmalignantgli

4、omais∼3–5/100000withaslightpredominanceinmales.Malignantgliomamaydevelopatallages,withthepeakincidencebeinginthefifthandsixthdecadesoflife[1–3].Exposuretoionisingirradiationhasbeenassociatedwithincreasedriskofdevelopmentofglioma,whileassociationwiththeuseofcell

5、phonescouldnotbeconfirmedinepidemiologicalstudies.Rarehereditarysyndromescarryanincreasedriskforglioma:Cowden-,Turcot-,Lynch-,Li-Fraumenisyndromeandneurofibromatosistype1.diagnosisandpathologyThecommonlyusedWorldHealthOrganization(WHO)clas-sificationdistinguishes

6、tumoursaccordingtotheirpresumedcelloforigin(astrocytesoroligodendrocytes),andgradesthemfromgradeI–IV[4].GradeItumoursoccurmainlyinchildhood,andgradeII(orlow-grade)gliomaareslow-growingtumoursbutwillalmostinvariablytransformovertimetoamoremalignantphenotype.Gra

7、deIIItumours(alsocommonlyreferredtoasanaplasticglioma)compriseanaplasticastrocy-toma,mixedanaplasticoligoastrocytomaandanaplasticoligodendroglioma,whileglioblastoma(GBM)representsWHOgradeIV.Tissuediagnosisismandatory,andusuallyobtainedbystereotacticbiopsyoraft

8、ertumourresection.GBMadditionaltoolsfordiagnosisandtreatmentguidance(seebelow),andareofincreasingimportanceindailypractice.Adequatetissuecollectionandpreservation(e.g.sufficientmate