他山之石可以攻玉

这段文字的目的是给我们大家看看，国外人是如何治疗胶质瘤的。我们可以看出，人家不是每个人都去做切除术的。但是要确诊，肯定都是做了组织取材，也就是说至少做了个活检，搞清楚了病变的性质。

所以当面对一个没有颅内压增高的病人，要弄清楚病理诊断，活检足够。不是每个人都需要大刀阔斧的切切切。上海东方医院神经外科魏社鹏

立体定性活检手术很小，风险也最小。所以不要害怕，更不要相信某些术士极力认为的活检增加了病变的扩散和转移。这显然是愚蠢的见解。

他山之石可以攻玉

年老胶质瘤病人的预后和治疗类型

Cancer. 2009 Aug 25

Prognosis and patterns of care in elderly patients with glioma 

Iwamoto FM, Reiner AS, Nayak L, Panageas KS, Elkin EB, Abrey LE.

Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York.
    作者对1994-2002年间65岁以上的低度恶性胶质瘤（星形细胞瘤和少枝胶质瘤）病人进行分析，发现总共1067例，其中891例星形细胞瘤，176例少枝胶质瘤。星形细胞瘤患者的平均生存期为9个月。间变的星形细胞瘤为4个月，少枝胶质瘤为57个月，间变少枝为9个月。几乎54%的病人在诊断时做了切除术。在诊断后6个月内，有66%的患者接受了放疗, 13%接受了化疗。在多因素分析中，年龄和肿瘤分级是指导切除，放疗和化疗最有意义的指标。同时作者还发现，间变肿瘤比低度的胶质瘤更容易接受手术，放疗和化疗。而少枝胶质瘤比星形细胞瘤更多的接受了化疗。

结论:织病理和肿瘤分级是年长的胶质瘤患者最有意义的预后因素。

BACKGROUND:: The current study was conducted to evaluate the patterns of care and survival of older adults with oligodendroglioma (OLI) and astrocytoma (AST) from a large population-based registry. METHODS:: The authors identified a cohort of OLI and AST patients aged >/=65 years from Surveillance, Epidemiology and End Results (SEER) cancer registry data linked with Medicare claims between 1994 and 2002. Patients with a diagnosis of glioblastoma were excluded. The impact of demographic characteristics and comorbidities on the probability of undergoing surgical resection, radiotherapy (RT), and chemotherapy within 6 months of diagnosis was assessed using multivariate logistic regression. RESULTS:: A total of 1067 patients (891 with AST and 176 with OLI) were included; the median survival was 9 months for patients with low-grade AST, 4 months for patients with anaplastic AST, 57 months for patients with low-grade OLI, and 9 months for patients with anaplastic OLI. Approximately 54% of patients underwent resection at the time of diagnosis; 66% received RT, and 13% received chemotherapy within 6 months of diagnosis. In a multivariate regression analysis, age and tumor grade were found to be the most significant predictors of resection, RT, or chemotherapy. Patients with anaplastic tumors were treated with resection, RT, and chemotherapy more often than patients with low-grade tumors, and OLI patients received chemotherapy more frequently than AST. CONCLUSIONS:: Data from the current study suggested that histologic diagnosis and tumor grade retained significant prognostic value in this elderly AST and OLI population. Furthermore, age and tumor grade were found to influence the probability of undergoing surgery, RT, and chemotherapy in this cohort. Cancer 2009. (c) 2009 American Cancer Society.