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胶质母细胞瘤(gliobalstoma,GBM)作为最常见的神经系统原发恶性肿瘤,其中位发病年龄为64岁[1]。目前对老年患者的年龄定义不尽相同,大部分的研究将老年的年龄界定为70岁以上,也有研究界定为65岁或60岁[2]。目前统计数据表明GBM的中位生存期已达到14个月,5年生存率接近10%[3]。然而老年GBM的治疗效果仍不理想。分析原因,除了年龄因素外,老年GBM患者还存在体能评分相对较低且多伴有其他系统合并症等预后不利因素。因此,在老年GBM患者耐受程度的基础上制定合适的治疗方案是提高老年GBM患者疗效的关键。我们将对近年来老年GBM的分子病理特征以及临床方面的研究进展进行综述。
老年胶质母细胞瘤的治疗进展
Progress on glioblastoma treatment for the elderly
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摘要: 虽然目前在最大限度的安全切除的基础上辅助Stupp方案治疗已经成为大多数指南推荐的成年胶质母细胞瘤(GBM)的标准一线治疗方案,但是该方案中并未包含老年患者(>70岁)。因此,对于占GBM发病人数近50%的老年患者来说,目前仍缺乏统一的标准治疗方案。究其原因可能是老年患者大多体能评分不佳,其他系统合并症较多,以及家庭社会等因素导致老年GBM患者往往不能接受规范化治疗,从而造成总体预后较差。近年来随着对老年GBM患者关注度的逐渐提高,已经有越来越多的相关研究开展。笔者通过对老年GBM的分子病理特征以及最新相关临床研究结果进行综述,为临床选择最佳的个体化治疗方案提供循证医学依据。Abstract: Although maximal safe surgery and adjuvant Stupp protocols are the first line treatment of glioblastoma (GBM) recommended by several guidelines, patients >70 years old are excluded from this protocol. No identical treatment exists for elderly patients who account for nearly 50% of all cases. Elderly patients do not receive standard treatment because of certain reasons, including low physical fitness score, multiple comorbidities, and social and family factors. Hence, the prognosis of the elderly is poor. Many clinical trials have emerged to analyze GBM in elderly patients. This review describes the molecular features and new clinical trials of elderly GBM to provide medical evidence for the individualized treatment of elderly patients.
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Key words:
- Glioblastoma /
- Aged /
- Therapy /
- Molecular features
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