cns中枢神经系统肿瘤 NCCN 翻译Word格式文档下载.docx

cns中枢神经系统肿瘤 NCCN 翻译Word格式文档下载.docx

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这些研究证实的原则许多脑膜瘤生长非常缓慢,这决定在挑选出的无症状的病人不进行操作是合理的。

Asthegrowthrateisunpredictableinanyindividual,repeatbrainimagingismandatorytomonitoranincidentalasymptomaticmeningioma.

但是任何个体的生长速度是不可预知的，反复强制性进行脑成像来监测偶发的雾症状的脑膜瘤

Surgery

Thetreatmentofmeningiomasisdependentuponbothpatient-relatedfactors（age,performancestatus,medicalco-morbidities）andtreatment-relatedfactors（reasonsforsymptoms,resectabilityandgoalsofsurgery）.

脑膜瘤的治疗取决于与患者相关的因素（年龄、性能状况、医学联合发病率）和治疗相关的因素（症状原因,resectability可治愈性和外科手术的目标）。

Mostpatientsdiagnosedwithsurgically-accessiblesymptomaticmeningiomaundergosurgicalresectiontorelieveneurologicalsymptoms.

大多数病人被诊断为可手术的有症状的脑膜瘤经历手术切除缓解神经症状。

Completesurgicalresectionmaybecurativeandisthereforethetreatmentofchoice.

完成手术切除可能治愈的,所以是治疗的首选。

Boththetumorgradeandtheextentofresectionimpacttherateofrecurrence.

肿瘤分级和切除的范围影响复发的几率。

Inacohort同期组群of581patients,10-yearprogression-freesurvivalwas75%followingGTR（grosstotalresection）butdroppedto39%forpatientsreceivingsubtotalresection.203

在一个581个病人的同期组群中，接受完全切除的患者10年无进展生存率是75%，但接受次全切除的病人下降到39%。

Short-termrecurrencesreportedforgradeI,II,andIIImeningiomaswere1%to16%,20%to41%,and56%to63%,respectively.204-206

据报道短期的复发率在1、2、3级脑膜瘤分别是1%to16%,20%to41%,and56%to63%,

TheSimpsonclassificationschemethatevaluatesmeningiomasurgerybasedonextentofresectionofthetumoranditsduralattachment（gradesItoVindecreasingdegreeofcompleteness）correlateswithlocalrecurrencerates.207

辛普森分类方案,评估脑膜瘤手术基于肿瘤切除范围及硬脑膜的附件（1至V级在减少的完全程度）与局部复发率的关系

Firstproposedin1957,itisstillbeingwidelyusedbysurgeonstoday.

在1957年首次提出,今天它仍被外科医生广泛使用。

Radiationtherapy

放疗

SafeGTRissometimesnotfeasibleduetotumorlocation.

因为肿瘤位置安全的完整切除有时候是不可行的

Inthiscase,subtotalresectionfollowedbyadjuvantEBRT（externalbeamradiationtherapy）hasbeenshowntoresultinlong-termsurvivalcomparabletoGTR（86%vs.versus88%,respectively）,comparedtoonly51%withincompleteresectionalone.208

在这种情况下，次全切除,然后行辅助外放射治疗已被证明导致与完全切除相近的长期生存（分别是86%比88%）,而单纯的不完整切除只有51%。

Of92patientswithgradeItumors,Soyuerandcolleaguesfoundthatradiationfollowingsubtotalresectionreducedprogressioncomparedtoincompleteresectionalone,buthasnoeffectonoverallsurvival.209

92位1级肿瘤的患者，Soyuer和他的同事们发现,次全切除后放疗相比单纯不完全切除减少肿瘤进展,但不影响总的生存

BecausehighgrademeningiomashaveasignificantprobabilityofrecurrenceevenfollowingGTR,210postoperativehigh-doseEBRT（above54Gy）hasbecometheacceptedstandardofcareforthesetumorstoimprovelocalcontrol.211

因为高级别脑膜瘤甚至在完全切除后仍有很高的复发几率，手术后大剂量的外放射治疗（超过54GY）已经成为改善肿瘤局部控制率的公认的标准

Areviewof74patientsshowedthatadjuvantradiotherapyimprovessurvivalinpatientswithgradeIIImeningiomaandinthosewithgradeIIdiseasewithbraininvasion.212

一项74名患者的回顾研究显示辅助放疗改善了3级脑膜瘤患者的生存，这些患者存在2级的脑浸润病变

Theroleofpost-GTRradiotherapyinbenigncasesremainscontroversial.

完全切除之后的放射治疗的角色良性情况下存在争议

Technicaladvanceshaveenabledstereotacticadministrationofradiotherapybylinearaccelerator（LINAC）,LeksellGammaKnifeorCyberkniferadiosurgery.

技术进步使立体定向放射治疗实施由直线加速器（直线加速器）,立体定向伽玛刀或射波刀放射外科。

Theuseofstereotacticradiotherapy（eithersinglefractionorfractionated）inthemanagementofmeningiomascontinuestoevolve.AdvocateshavesuggestedthistherapyinlieuofEBRTforsmall（<

35mm）recurrentorpartiallyresectedtumors.

使用立体定向放射治疗（无论是单部分或分组）在脑膜瘤的治疗中得以持续发展。

这一疗法的倡导者建议代替外放射治疗对于小（<

35毫米）复发或部分切除的肿瘤。

Inaddition,ithasbeenusedasprimarytherapyinsurgicallyinaccessibletumors（i.e.baseofskullmeningiomas）orinpatientsdeemedpoorsurgicalcandidatesbecauseofadvancedageormedicalco-morbidities.

此外,作为无法手术的肿瘤的主要治疗（例如头盖骨为基础脑膜瘤）或在病人认为因为高龄老人和医疗共病难以手术。

Astudyofabout200patientscomparedsurgerywithSRSasprimarytreatmentforsmallmeningiomas.213

一项关于200例患者手术相比与SRS作为主要治疗小脑膜瘤

TheSRSarmhadsimilar7-yearprogression-freesurvivalcomparedtoGTRandsuperiorsurvivaloverincompleteresection.

SRS组相比完全切除具有相似的7年雾进展生存，相比不完全切除有较高生存

Inanotherstudy,Kondziolkaandcolleaguesfollowedacohortof972meningiomapatientsmanagedbySRSover18years.214

在另一项研究中,Kondziolka及其同事追踪了一组972名SRS治疗的脑膜瘤患者超过18年。

Halfofthepatientshaveundergoneprevioussurgery.

一半的病人之前接受过手术。

SRSprovidedexcellenttumorcontrol（93%）inpatientswithgradeItumors.

SRS为一级肿瘤患者提供了卓越的肿瘤控制（93%）。

ForgradeIIandIIImeningiomas,tumorcontrolwas50%and17%,respectively.

对于等级II和III脑膜瘤,肿瘤控制分别是50%和17%。

Theseresultssuggestthatstereotacticradiationiseffectiveasprimaryandsalvagetreatmentformeningiomassmallerthan3.5cm.

这些结果表明,立体定向放射治疗对于小于3.5厘米脑膜瘤的初始及抢救性治疗是有效的。

Systemictherapy

全身治疗

Notwithstandinglimiteddata,hydroxyureahasbeenmodestlysuccessfulinpatientswithrecurrentmeningiomas.215

虽然数据有限,羟基脲都类治疗复发性脑膜瘤患者是成功的。

Targetedtherapiesthathaveshownpartialefficacyinrefractorymeningiomasaresomatostatinanaloguesandalphainterferon.

靶向治疗已经表明在难治性脑膜瘤中有部分效果的是生长抑素类似物和α干扰素。

NCCNRecommendations推荐

Initialtreatment初始治疗

MeningiomasaretypicallydiagnosedbyCTorMRIimaging.

脑膜瘤通常由CT或MRI成像诊断。

Biopsyoroctreotidescanmaybeconsideredforconfirmation.

活检或奥曲肽扫描可以被当成证据。

Fortreatmentplanning,multidisciplinarypanelconsultationisencouraged.

为制定治疗计划、多学科小组会诊是被鼓励的。

Patientsarestratifiedbythepresenceorabsenceofsymptomsandthetumorsize.

Mostasymptomaticpatientswithsmalltumors（<

30mm）arebestmanagedbyobservation.

Ifneurologicimpairmentisimminent,surgery（ifaccessible）orradiotherapy（EBRTorSRS）isfeasible.

Asymptomatictumors30mmorlargershouldbesurgicallyresectedorobserved.

Symptomaticdiseaserequiresactivetreatmentbysurgerywheneverpossible.

Non-surgicalcandidatesshouldundergoradiation.

Regardlessoftumorsizeandsymptomstatus,allpatientswithsurgicallyresectedgradeIIImeningioma（evenafterGTR）shouldreceiveadjuvantradiationtoenhancelocalcontrol.

Followingsubtotalresection,radiationshouldbeconsideredforsmall,asymptomaticgradeIItumorsandforlargegradeIandIItumors.

SRSmaybeusedinlieuofconventionalradiationasadjuvantorprimarytherapyinasymptomaticcases.

Follow-upandrecurrence

Intheabsenceofdata,panelistshavevaryingopinionsonthebestsurveillanceschemeandcliniciansshouldfollowpatientsbasedonindividualclinicalconditions.

Generally,malignantorrecurrentmeningiomasarefollowedmorecloselythangradesIandIItumors.

AtypicalscheduleforlowgradetumorsisMRIevery3monthsinyear1,thenevery6to12monthsforanother5years.

Lessfrequentimagingisrequiredbeyond5-10years.

Upondetectionofrecurrence,thelesionshouldberesectedwheneverpossible,followedbyradiation.

Non-surgicalcandidatesshouldreceiveradiation.

Chemotherapyisreservedforpatientswithanunresectablerecurrencerefractorytoradiotherapy.

BrainMetastases脑转移

Metastasestothebrainarethemostcommonintracranial[,intr?

'

kreini?

l]tumorsinadultsandoccurtentimesmorefrequentlythandoprimarybraintumors.

Metastasestothebrainarethemostcommonintracranial颅内的[,intr?

l]tumorsinadults成人andoccur存在tentimes十倍morefrequently频繁thandoprimarybraintumors.

脑转移是最常见的成人颅内肿瘤，频率（发病率）是原发脑肿瘤的十倍。

Morerecentpopulation-baseddatareportedthatabout8%to10%ofcancerpatientsareinflictedbysymptomaticmetastatictumorsinthebrain.

Morerecent较新的population-baseddatareportedthatabout8%to10%ofcancerpatientsareinflictedvt.造成；

使遭受（损伤、痛苦等）；

给予（打击等）bysymptomaticmetastatictumorsinthebrain.

最近的以人群为基础的数据报道,大约8%至10%的癌症患者都存在有症状的脑转移瘤。

Amuchhigherincidenceuponautopsy尸检hasbeenreported.

据报道经过尸体解剖发生率要高得多。

Asaresultofadvancesinthediagnosisandtreatment,mostpatientsimprovewithtreatmentanddonotdieofthesemetastaticlesions.

因为诊断和治疗发展,大多数病人通过治疗好转,不会死于这些转移病灶。

Primarylungcancersarethemostcommonsource,accountingforhalfofintracranial[,intr?

l]metastases,althoughmelanoma黑色素瘤hasbeendocumentedtohavethehighestpredilection偏爱tospreadtothebrain.

原发性肺癌是最常见的来源,占一半的颅内转移,尽管黑色素瘤被证明是最偏爱扩散到大脑。

DiagnosisofCNSinvolvement损伤isbecomingmorecommoninpatientswithbreastcancerastherapyformetastaticdiseaseisimproving.220

因为转移性疾病治疗的改进，乳腺癌患者中枢神经系统损伤的诊断日趋常见。

Almost80%brainmetastasesoccurinthecerebralhemispheres,anadditional15%occurinthecerebellum,and5%occurinthebrainstem.221

几乎80%的脑转移发生在大脑半球,额外的15%发生在小脑,5%发生在脑干

Theselesionstypicallyfollowapatternofhematogenousspreadtothegray-whitejunctionwheretherelativelynarrowcaliberoft