超越边缘:评估在胶质母细胞瘤治疗中进行边缘上切除术的必要性和时机

D. Chaulagain, V. Smolanka, A. Smolanka, T. Havryliv
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摘要

胶质母细胞瘤被世界卫生组织列为 IV 级星形细胞瘤,仍然是一种侵袭性很强的癌症,需要采取包括手术、放疗和化疗在内的综合策略。传统上,全切除术主要针对 T1 加权磁共振图像上显示的对比度增强区域。然而,目前的研究表明,一种更积极的方法是重点切除肿瘤周围的区域,即边缘上切除术。这种创新策略试图超越传统的界限,为患者的生存提供了可能的优势。然而,它也引起了人们对切除对重要功能至关重要的脑组织的担忧。胶质母细胞瘤的预后极差,中位生存期仅为10个月,这凸显了对新型治疗方法的迫切需要。这项研究的目的是评估边缘超出对比度增强范围的切除术对某些胶质母细胞瘤患者生存期的影响。之前收集的病例中记录的潜在优势与个性化手术决策的理念相一致,这种理念对尽可能切除造影剂增强的肿瘤的主流方法提出了质疑。然而,对潜在的神经系统风险应进行全面评估。本研究的目的是通过研究特定患者群体在积极切除肿瘤和保护神经功能之间的谨慎权衡,为改善胶质母细胞瘤的治疗提供重要见解。
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Beyond the margins: evaluating the necessity and timing of supramarginal resection in glioblastoma management
Glioblastoma, classified as a grade IV astrocytoma by the World Health Organization, continues to be a very aggressive cancer that requires a comprehensive strategy comprising surgery, radiation, and chemotherapy. Traditionally, gross total resection has primarily targeted the contrast-enhanced regions shown on T1-weighted magnetic resonance images. However, current studies suggest a more aggressive approach that focuses on removing the areas around the tumor, called supramarginal resection. This innovative strategy seeks to go beyond traditional bounda-ries, offering possible advantages for survival. However, it also raises worries over the removal of brain tissue that is crucial for important functions. The extremely poor prognosis of glioblastoma, characterized by a median survival of 10 months, highlights the pressing need for novel approaches to treatment. The aim of the study is to evaluate the influence of resection with a margin that extends much beyond the contrast enhancement on the survival of certain glioblastoma patients. The potential advantages documented in previous collections of cases are consistent with the notion of personalized surgical decision-making, which questions the prevailing approach of achieving the greatest possible removal of the tumor that is enhanced by contrast. Nevertheless, the potential neurological risks should be thoroughly evaluated. The objective of this study is to provide significant insights into improving the management of glioblastoma by examining the careful trade-off between aggressive tumor removal and preserving neurological function in specific groups of patients.
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