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OBJECTIVE To analyze the hotspots， progress and frontiers of the therapy of recurrent high-grade gliomas， and to provide a reference for the research in this field. METHODS The relevant literature were retrieved from the Web of Science and CNKI during Jan. 1st， 2005-Mar. 14th， 2022. CiteSpace 6.1.R3 software was used to quantitatively analyze the countries， authors， institutions and keywords of the included literature to form visual network maps and generate data. RESULTS A total of 1 019 English papers and 308 Chinese papers were included. The number of international publications kept growing and the number of domestic publications remained stable. Institutions and authors cooperated extensively. The United States featured a large centrality （0.38） and the largest number of publications （442）， with major research institutions such as the University of California San Francisco， University Texas MD Anderson Cancer Center， Dana-Farber Cancer Institute， and important researchers such as Wen， Cloughesy， Reardon， and so on. Domestic research groups were relatively fixed and closed. Internationally， the mechanism of tumorigenesis and drug resistance were the focus of basic research， while there was less basic research in China. Radiotherapy， chemotherapy， targeted therapy and combination therapy were studied the most internationally. Immunotherapy and photodynamic therapy were emerging therapies in recent years. In China， temozolomide and radiotherapy were the main research directions. CONCLUSIONS International attention and investment in the treatment of recurrent high-grade glioma are increasing. The United States has a high influence in this field. Currently， radiotherapy， traditional chemotherapeutic agents and bevacizumab are still the main treatment for recurrent high-grade glioma. Novel therapeutic approaches， including immunotherapy and photodynamic therapy， warrant more attempts and research.
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INTRODUCTION- Gliomas are the tumor of glial cells found in Central nervous System. High Grade Gliomas are rare in pediatric age group. Definitive diagnosis is made by histopathological examination. A 2 ½ year old male admitted with the complaint of abnormal tonic-clonic body movements along with headache, nausea, vomiting and fever. CT scan showed a poorly circumscribed hypodense lesion involving fronto- parietal region. Surgery was performed and specimen sent for histopathological examination. Histopathological examination showed features of high grade glioma like microvascular proliferation, necrosis and haemorrhage. Cerebral tumors are the most common childhood neoplastic tumors. Gliomas are generally classified into low grade glioma and high grade glioma. High Grade glioma is rare in pediatric age group. Most commonly they present in supra tentorial compartment. The most common cerebral cortex involved are frontal lobe followed by parietal and temporal. Clinical signs and symptoms of High grade gliomas are seizure, headache, nausea, vomiting and visual disturbances. CT scan showed a poorly circumscribed hypodense lesion involving left fronto- parietal region mainly. Definitive diagnosis of high grade glioma is by histopathological examination. Histopathological examination showed hypercellular heterogeneous tumor lying on a fibrillary background. Areas of microvascular proliferation along with necrosis and haemorrhage are also seen. Surgical resection followed by chemotherapy and local radiotherapy are the present recommendation. High grade gliomas are rare pediatric tumor associated with poor outcome. Surgery was performed due to neurological worsening, which was unsuccessful and patient died. Diagnosis was confirmed on histopathological examination. Poor prognosis and high morbidity even after evolution of treatment, demands further research to improve the prognosis and reduce morbidities
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Pediatric-type of diffuse high-grade gliomas (HGG) are classified as a distinct group in the current fifth edition of WHO classification. This group of high-grade tumors is no more called as glioblastoma (GBM), which has been reserved for adult isocitrate dehydrogenase (IDH)-wild type HGG. These tumors are uncommon as compared to embryonal tumors and low-grade gliomas (LGG). Pediatric-type of diffuse HGG biologically differs from their adult counterparts in that they are therapeutically less sensitive to alkylating chemotherapies. They comprise a heterogeneous group of molecularly defined tumors – predominantly histone gene altered, less common receptor tyrosine kinase (RTK)-mediated, and syndrome-associated. This review provides an overview of these uncommon tumors and discusses the diagnostic approach of this heterogeneous group of tumors.
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ABSTRACT Introduction: Some gene mutations in high grade glioma patients have many implications in prognosis and treatment response. Objectives: To describe the characteristics and associations of IDH, TP53 gene mutations and MGMT methylation status with some characteristics and treatment response in patients with high grade glioma. Methods: A descriptive, prospective, uncontrolled study was conducted, in 52 patients with high-grade glioma. Research variables include age, sex, Karnofsky score, the rate of IDH, P53 mutation, MGMT methylation; the relationship between genes mutation with some characteristics and response to treatment according to the RECIST classification. Results: For IDH gene mutation, grade III patients (23.1%) have a higher positive rate than grade IV (11.5 %); for P53 gene mutation, grade III patients (55.6 %) have a higher positive rate than grade IV (44.1 %); the rate of MGMT promoter methylation occurred in the study group of patients with the rate of 42.3 %. There is a relationship between IDH gene mutation with pathological results and malignancy in studied patients. Patients with the mutant expression of the IDH gene, p53, MGMT methylation status had better RECIST responses than patients without these expressions. Conclusion: High-grade glioma mainly occurs in men, over 40 years old. The presence of mutations in IDH, P53 genes, and MGMT methylation status was a beneficial factor for treatment response as assessed by RECIST.
RESUMEN Introducción: Algunas mutaciones genéticas en pacientes con glioma de alto grado tienen implicaciones en el pronóstico y respuesta al tratamiento. Objetivos: Describir las características y asociaciones de IDH, mutaciones del gen TP53 y estado de metilación de MGMT con algunas características y respuesta al tratamiento en pacientes con glioma de alto grado. Métodos: Se realizó un estudio descriptivo, prospectivo no controlado, en 52 pacientes con glioma de alto grado. Las variables investigadas fueron: edad, sexo, puntuación de Karnofsky, tasa de IDH, mutación P53, estado de metilación de MGMT, relación entre la mutación de genes con algunas características y la respuesta al tratamiento según la clasificación RECIST. Resultados: Mutación del gen IDH: los pacientes grado III (23,1 %) tienen una tasa positiva más alta que los grado IV (11,5 %). Mutación del gen P53: los grado III (55,6 %) tienen una tasa positiva más alta que los grado IV (44,1 %). La tasa de metilación del promotor de MGMT se produjo con una tasa del 42,3 %. Existe relación entre la mutación del gen IDH con los resultados patológicos y la malignidad. Los pacientes con la expresión mutante del gen IDH, p53, estado de metilación de MGMT tuvieron mejores respuestas RECIST. Conclusión: El glioma de alto grado se presenta principalmente en hombres, mayores de 40 años. La presencia de mutaciones en los genes IDH, P53 y el estado de metilación de MGMT fue un factor beneficioso para la respuesta al tratamiento según lo evaluado por RECIST.
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Objective:To compare the efficacy and side effects between simultaneous and sequential integrated boost intensity-modulated radiotherapy after operation for high-grade glioma.Methods:We retrospectively analyzed 142 patients with high-grade glioma who underwent postoperative radiotherapy from January 2010 to December 2017. All patients were divided into the simultaneous and sequential integrated boost intensity-modulated radiotherapy groups. Concurrent temozolomide chemotherapy was delivered during radiotherapy in two groups. The follow-up outcomes were statistically compared between two groups.Results:For the whole group, the median overall survival (OS) was 24 months, the median progression-free survival (PFS) was 17 months, and the median disease-free survival (DFS) was 25 months. In the simultaneous and sequential integrated boost intensity-modulated radiotherapy groups, the median OS were 27.2 and 21.0 months ( P=0.950), the median PFS were 21.2 and 15.0 months ( P=0.21), and the median DFS were 28.0 and 18.0 months ( P=0.171), and the disease control rates were 92.86% and 85.17%( P=0.541), respectively. There was no statistical difference in OS, PFS, DFS, short-term efficacy and side effects between two groups. However, the conformity index in the simultaneous integrated boost intensity-modulated radiotherapy group was better than that in the sequential integrated boost intensity-modulated radiotherapy group ( P=0.032). Conclusions:Postoperative simultaneous and sequential integrated boost intensity-modulated radiotherapy yield no statistical differences in the survival, short-term efficacy and side effects in the treatment of high-grade glioma. However, the conformity index in the simultaneous integrated boost intensity-modulated radiotherapy group is significantly better, which can be recommended for postoperative radiotherapy of high-grade glioma.
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Glioma is a primary brain tumor with high incidence rate. High-grade gliomas (HGG) are those with the highest degree of malignancy and the lowest degree of survival. Surgical resection and postoperative adjuvant chemoradiotherapy are often used in clinical treatment, so accurate segmentation of tumor-related areas is of great significance for the treatment of patients. In order to improve the segmentation accuracy of HGG, this paper proposes a multi-modal glioma semantic segmentation network with multi-scale feature extraction and multi-attention fusion mechanism. The main contributions are, (1) Multi-scale residual structures were used to extract features from multi-modal gliomas magnetic resonance imaging (MRI); (2) Two types of attention modules were used for features aggregating in channel and spatial; (3) In order to improve the segmentation performance of the whole network, the branch classifier was constructed using ensemble learning strategy to adjust and correct the classification results of the backbone classifier. The experimental results showed that the Dice coefficient values of the proposed segmentation method in this article were 0.909 7, 0.877 3 and 0.839 6 for whole tumor, tumor core and enhanced tumor respectively, and the segmentation results had good boundary continuity in the three-dimensional direction. Therefore, the proposed semantic segmentation network has good segmentation performance for high-grade gliomas lesions.
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Humans , Attention , Glioma/diagnostic imaging , Magnetic Resonance Imaging/methods , SemanticsABSTRACT
ABSTRACT Background: Cancer patients in general and glioblastoma patients, in particular, have an increased risk of developing complications from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and reaching a balance between the risk of exposure to infection and the clinical benefit of their treatment is ideal. The aggressive behavior of this group of tumors justifies the need for a multidisciplinary team to assist in clinical decisions during the current pandemic. Brazil is now ranked #2 in the number of cases and deaths from COVID-19 pandemic, and existing disparities in the treatment of neuro-oncology patients in Brazil will challenge the clinical and surgical decisions of this population, possibly affecting global survival. Objective: To search the literature about the management of glioblastomas during COVID-19 pandemic to guide surgical and clinical decisions in this population of patients in Brazil. Methods: We performed a systematic search on the PubMed electronic database targeting consensus statements concerning glioblastoma approaches during COVID-19 pandemic up to July 18, 2020. Results: When approaching glioblastoma during the COVID-19 pandemic, important parameters that help in the decision-making process are age, performance status, tumor molecular profile, and patient consent. Younger patients should follow the standard protocol after maximal safe resection, mainly those with MGMT methylated tumors. Aged and underperforming patients should be carefully evaluated, and probably a monotherapy scheme is to be considered. Centers are advised to engage in telemedicine and to elaborate means to reduce local infection. Conclusion: Approaching glioblastoma during the COVID-19 pandemic will be challenging worldwide, but particularly in Brazil, where a significant inequality of healthcare exists.
RESUMO Introdução: Pacientes com câncer, em geral, e particularmente pacientes com glioblastoma estão sob elevado risco de desenvolver síndrome respiratória aguda grave devido à infecção pelo SARS-CoV-2, e alcançar um equilíbrio entre risco de exposição à infecção e benefício clínico do tratamento seria o ideal. O comportamento agressivo desse grupo de tumores justifica a necessidade de equipe multidisciplinar para auxiliar nas decisões clínicas durante a pandemia vigente. O Brasil ocupa hoje o segundo lugar em número de casos e óbitos pela COVID-19, e as atuais disparidades no tratamento de pacientes neuro-oncológicos desafiarão as decisões clínicas e cirúrgicas dessa população, possivelmente afetando a sobrevida global. Objetivo: Guiar decisões clínicas e cirúrgicas relacionadas ao manejo de glioblastoma durante a pandemia pelo COVID-19 no Brasil por meio de pesquisa em literatura. Métodos: Busca sistemática no banco de dados eletrônico da PubMed por estudos ou consensos quanto à abordagem de glioblastoma durante a pandemia por COVID-19 até 18/07/2020. Resultado: Ao abordar o glioblastoma durante a pandemia pela COVID-19, parâmetros importantes que auxiliam no processo de tomada de decisão são idade, desempenho, perfil molecular tumoral e consentimento do paciente. Pacientes jovens devem seguir protocolo padrão após máxima ressecção cirúrgica, principalmente aqueles com metilação do promotor MGMT. Idosos e pacientes debilitados devem ser cuidadosamente avaliados, e monoterapia deve ser provavelmente considerada. Centros de saúde são orientados a utilizar-se da telemedicina e de meios para reduzir infecção local. Conclusão: A abordagem do glioblastoma durante a pandemia por COVID-19 será mundialmente desafiadora, mas particularmente no Brasil, onde ainda existe significativa inequidade no cuidado com a saúde.
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Humans , Aged , Glioblastoma/etiology , Glioblastoma/epidemiology , COVID-19 , Brazil/epidemiology , Pandemics , SARS-CoV-2ABSTRACT
Objective:To investigate the effect of long non-coding RNA (LncRNA) LY6E-DT on temozolomide (TMZ) resistance in high grade glioma cells (HGG) cells and its mechanism.Methods:Bioinformatics screened the LncRNA correlated to the expression of O6-methylguanine-DNA methyltransferase (MGMT) in HGG tissue, and excavated potentially related microRNA (miRNA) . HGG cell U251 was cultured and randomly divided into control group, resistance group and interference group. Resistance group and interference group were treated with 0.2-16.0 μg·ml -1 TMZ gradient incremental induction, and isosmotic PBS was used to treat control group cells. Control group and resistance group were transfected with control vector, while the interference group was transfected with shRNA interference vector targeting LY6E-DT by lentivirus. The semi-inhibitory concentration (IC 50) of TMZ in each group was detected by CCK-8 experiment, the expression levels of LY6E-DT, miR-125a-5p and MGMT mRNA in each group were detected by real-time fluorescent quantitative PCR (RT-qPCR) , and the expression levels of MGMT protein were detected by Western blot. The effect of miR-125a-5p on MGMT and LY6E-DT was detected by luciferase reporter gene method. Results:LY6E-DT expression was positively correlated with MGMT (Pearson correlation coefficient = 0.32, P<0.001) , and it was found that LY6E-DT expression was significantly lower in HGG tissues, but it was not conducive to the prognosis of HGG patients; In the control group, resistance group and interference group, the expressions of LY6E-DT were 1.000±0.047, 3.704±0.402 and 0.743±0.064; the expressions of miR-125a-5p were 1.000±0.049, 0.351±0.031 and 0.934±0.050; the expressions of MGMT mRNA were 1.000±0.017, 5.205±0.462 and 3.183±0.667; the expressions of MGMT protein are 0.108±0.012, 0.891±0.063 and 0.375±0.038; TMZ IC 50 are 6.79±0.71, 30.52±3.69 and 15.64±2.25 μg·ml -1. Compared with the control group, LY6E-DT, MGMT and TMZ IC50 in the resistance group were significantly higher, while LY6E-DT expression in the interference group was significantly lower, MGMT and TMZ IC 50 were significantly higher ( P<0.05) ; Compared with the resistance group, the expression of LY6E-DT, MGMT mRNA and protein and TMZ IC 50 decreased significantly in the interference group ( P<0.05) . miR-125a-5p significantly inhibited luciferase expression of MGMT 3'UTR ( P<0.01) , while LY6E-DT significantly restored the expression level ( P<0.01) . Conclusion:LY6E-DT can promote MGMT expression and TMZ resistance in HGG cells, which is related to the inhibition of miR-125a-5p expression.
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Background: Patients with high grade gliomas have poor survival even with aggressive multimodality approach. The aim of our study is to evaluate the predicting factors affecting the survival outcome in patients with high grade gliomas (HGG). Materials and methods: 46 patients diagnosed to have high grade gliomas (HGG) treated in our Radiotherapy department during the period of March 2014 to March 2017 were analyzed in this single centre retrospective study. All patients underwent maximal safe surgery followed by postoperative radiotherapy with or without temozolamide chemotherapy. Data regarding the patient age, gender, performance status, histology, grade of the tumor, tumor location, extent of surgery, radiotherapy, and chemotherapy details were collected and analyzed. The differences in clinical characteristics and treatment variables were analyzed by chi square test and overall survival analysis using Kaplan Mayer method. The Cox proportional hazards regression model was used to determine statistically significant variables related to survival. Results: The median survival of patients with HGG in this study was 9 months. The median survival of patients with grade III and IV glioma was 19 and 4 months respectively. In univariate analysis histology, grade, laterality were identified to have prognostic significance. The result of multivariate analysis showed that performance status, grade, histology, extent of surgery is significant for survival. S. Jeeva, V. Vanitha, K. Chandralekha, M. Sornam, Balasubramanium, P. Vidya. Predictive factors for survival and outcome in patients with high grade gliomas: A single centre retrospective study. IAIM, 2019; 6(3): 24-31. Page 25 Conclusion: Our study showed that histology, grade, extent of surgery is the significant factors in assessing the prognosis of patients with HGG. The survival of HGG was poor in spite of combined modality treatment.
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Radiotherapy is one of the most important treatments of high-grade gliomas (HGG).Currently,there has been no consensus on the standards for the delineation of the gross tumor volume (GTV) based on the simulated computed tomography (CT) scanning and conventional magnetic resonance imaging (MRI).As the radiological technology advances,researchers have found that the application of multimodal MRI including 1 H magnetic resonance spectroscopy (1 H-MRS),blood oxygenation level dependent functional MRI (BOLD-fMRI),diffusion-weighted MRI (DWI) and diffusion tensor imaging (DTI) can evaluate the range of HGG invasion and locate the surrounding vital tissues,thereby serving as a supplement for the delineation of target volume and protection of organs at risk.Moreover,multimodal MRI can be utilized to evaluate the clinical efficacy of radiotherapy,detect the radiation-induced injury and differentiate the progressive disease from pseudoprogression.In this article,the application of multimodal MRI in the postoperative radiotherapy for patients with high-grade glioma was reviewed.
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High grade gliomas are always the research focus in the field of neurosurgery due to their poor prognosis despite the current standard therapeutic regimen of surgical resection followed by radiation therapy and chemotherapy. Alkylating agent temozolomide has been established as the standard chemotherapy while its resistance inevitable during treatment. This phenomenon seriously influences the prognosis of patients suffering from high grade gliomas. This review aims to elucidate temozolomide chemoresistance mechanisms through three chapters including O6-methylguanine-DNA methyltransferase (MGMT) methylation, mismatch repair mutation and epigenetic regulation consisting of p21, chromatin and histone, Y-box binding protein-1 and microRNAs.
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Germline mutations in cancer causing genes result in high risk of developing cancer throughout life. These cancer predisposition syndromes (CPS) are especially prevalent in childhood brain tumors and impact both the patient's and other family members' survival. Knowledge of specific CPS may alter the management of the cancer, offer novel targeted therapies which may improve survival for these patients, and enables early detection of other malignancies. This review focuses on the role of CPS in pediatric high grade gliomas (PHGG), the deadliest group of childhood brain tumors. Genetic aspects and clinical features are depicted, allowing clinicians to identify and diagnose these syndromes. Challenges in the management of PHGG in the context of each CPS and the promise of innovative options of treatment and surveillance guidelines are discussed with the hope of improving outcome for individuals with these devastating syndromes.
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Humans , Brain Neoplasms , Germ-Line Mutation , Glioma , Hope , Li-Fraumeni Syndrome , Neurofibromatosis 1ABSTRACT
Objective To explore the value of cMRI and MRS in diagnosis and differential diagnosis of single brain metastases and localized high grade gliomas.Methods The cMRI (T1WI,T2WI and contrast-enhanced MRI)and MRS data of 23 cases with single brain metastases and in 28 cases with high grade gliomas confirmed by pathology were collected and analyzed retrospectively.Results cMRI:①There were no significant differences of T1WI,T2WI and constrast-enhanced MRI between single brain metastases and high-grade gliomas.②Enhanced images of single brain metastases and localized high-grade gliomas showed that there was a significant difference in the peritumoral edema area:the nodular or ring enhancement were found in single brain metastases,the outer outline of ring enhancement was smooth,and there was no enhancement at the peripheral edema area;Irregular patchy or ring enhancement were found in localized high-grade glioma tumor,both of the outer and inner edges of the ring enhancement rough,a little patchy enhancement at the peripheral edema area were found in 1 6 patients,and there was no enhancement of the edema area in the other 1 2 patients.MRS:①There were no significant differences of the tumor parenchyma in the peaks of NAA,Cr,Cho and central Lac between single brain metastases and localized high grade gliomas.②A significant difference of the peripheral edema area were observed between them.The peaks of NAA,Cr,Cho at the edema area in all single brain metastases patients were normal.But in all high-grade glioma patients,the NAA and Cr peaks were decreased,while the Cho peaks were increased.Conclusion The morphological manifestations of single brain metastases are similar to localized high grade gliomas.An obvious difference of cMRI and MRS lines exists in the peritumoral edema area between them,which could be used for differential diagnosis.
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High grade gliomas are always the research focus in the field of neurosurgery due to their poor prognosis despite the current standard therapeutic regimen of surgical resection followed by radiation therapy and chemotherapy.Alkylating agent temozolomide has been established as the standard chemotherapy while its resistance inevitable during treatment.This phenomenon seriously influences the prognosis of patients suffering from high grade gliomas.This review aims to elucidate temozolomide chemoresistance mechanisms through three chapters including O6-methylguanine-DNA methyltransferase (MGMT) methylation,mismatch repair mutation and epigenetic regulation consisting of p21,chromatin and histone,Y-box binding protein-1 and microRNAs.
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Objective:To analyze the curative effect and prognostic factors for comprehensive therapy in patients with high-grade glioma.Methods:Patients with high-grade glioma (WHO grade Ⅲ,grade Ⅳ) were chosen from July 2008 to May 2016 in the Hunan Cancer Hospital,and a retrospective analysis was performed in 64 patients with complete follow-up data.Results:The follow-up time was 3-111 (median 29.5) months,the median overall survival time was 36.00 (95％ CI 22.85 to 49.16) months,the median progression-free survival time (PFS) was 21.00 (95％ CI 9.72 to 32.28) months,The 1-year,2-year,3-year and 5-year survival rates of high-grade glioma patients were 87.50％,56.25％,40.63％ and 17.19％,respectively.The univariate analysis of Log-Rank test and the Cox regression model analysis showed that the prognostic factors related to the prognosis of high-grade glioma patients were pathological grade,resection degree,and concurrent chemo-radiotherapy (P＜0.05).Conclusion:The overall survival time,progression-free survival time and the 5-year survival rate of patients with high-grade glioma after comprehensive treatment is partially improved.The factors relevant to the prognosis of patients with high-grade glioma are pathological grade,resection degree,and concurrent chemo-radiotherapy,indicating that the glioma patients (WHO grade Ⅲ) received total resection of the tumor and concurrent chemo-radiotherapy have better clinical effect.
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Objective To evaluate the effect of MRS-assisted stereotactic radiosurgery (SRS) for small recurrent high grade glioma (HGG).Methods A total of 54 patients with recurrent HGG were selected,the tumor diameter was less than 3 cm,the patients were divided into the conventional MRI group of 26 cases,and MRI+MRS group of 28 cases.The target region of the conventional MRI group was defined as the enhanced and short T1,long T2 area;MRI+MRS group was defined as the region of Cho/NAAindex (CNI) ≥1.6 in the surrounding short T1,long T2 and enhanced area.All the patients were followed up at least 12 months,analysed their therapeutic effect.Results Compared with the conventional MRI group,MRS+MRI group margin dose increased (19.46 Gy vs.13.58 Gy),the average diameter of target were smaller (2.6 cm vs.3.0 cm),progression-free survival was longer (6.8 months vs.5.6 months),the 1-year survival rate was higher (78.6％ vs.50.0％),and the occurrence rate of brain edema was lower (5 vs.17),the difference was statistically significant (P＜0.05).Conclusion MRI+-MRS assisted SRS helps to accurately identify the scope of HGG,its short term effect was superior.
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Germline mutations in cancer causing genes result in high risk of developing cancer throughout life. These cancer predisposition syndromes (CPS) are especially prevalent in childhood brain tumors and impact both the patient's and other family members' survival. Knowledge of specific CPS may alter the management of the cancer, offer novel targeted therapies which may improve survival for these patients, and enables early detection of other malignancies. This review focuses on the role of CPS in pediatric high grade gliomas (PHGG), the deadliest group of childhood brain tumors. Genetic aspects and clinical features are depicted, allowing clinicians to identify and diagnose these syndromes. Challenges in the management of PHGG in the context of each CPS and the promise of innovative options of treatment and surveillance guidelines are discussed with the hope of improving outcome for individuals with these devastating syndromes.
Subject(s)
Humans , Brain Neoplasms , Germ-Line Mutation , Glioma , Hope , Li-Fraumeni Syndrome , Neurofibromatosis 1ABSTRACT
High-grade gliomas (HGG) are a group of malignant tumours with high recurrence rate, rapid progression, poor prognosis and short median survival. Patients suffer with severe symptoms after operation, which seriously affect the quality of life of patients. Palliative care is an important nursing measure to improve the quality of life of patients with malignant tumors. This paper reviews the current situation and research progress of palliative care in patients with advanced glioma at home and abroad, and provides the evidence and guidance for medical staff to carry out palliative care of patients with high grade glioma.
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Brain glioma is the most common primary nervous system tumors,in which high-grade glioma grows rapidly,often infiltrates growth,and easy recurrence after treatment. Its mortality and morbidity are still high. Surgical resection is the preferred treatment for high-grade glioma. Postoperative radiotherapy is one of the-important adjuvant therapy. At present,tumor radiotherapy was guided the sketch of the target area by MRI ima-ges,but MRI imaging has limitations. With the development and application of a variety of radioactive tracers,PET reflects the extent of tumor infiltration through the metabolic changes of tumor tissue,and also helps to identify ra-dioactive necrosis and tumor recurrence. The combination of PET/MRI has a good prospect in the radiotherapy of high-grade glioma.
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Objective To discuss the value of dynamic contrast-enhanced MRI (DCE-MRI)in differential diagnosis of high-grade gliomas (HGG)and metastasis.Methods 27 cases of HGG and 46 cases of metastasis were enrolled.All patients took contrast MRI and DCE-MRI before operation.Using the pharmacokinetic model of Extended Tofts Linear to quantitative analyze the data,volume transfer constant (Ktrans ),extracellular extravascular volume fraction (Ve )and blood plasma fraction (Vp )of the lesion's solid components and perilesional edam were obtained.Ktrans value,Ve value and Vp value were compared to judge whether there were significant differences between the two kinds of tumors.Results The values of the Ktrans ,Ve and Vp in parenchyma of HGG and metastasis were not statistically significant (P >0.05).The values of Ktrans and Ve in peritumoral edema of HGG were significantly higher than that of metastasis (P <0.05);Vp values in the peritumoral edema of HGG were lower than that of metastasis,but the difference was not statistically significant (P >0.05). Conclusion DCE-MRI can effectively distinguish HGG from metastasis through quantitative analysis of the perilesional edema.