儿童毛细胞型星形细胞瘤术后综合治疗研究进展

Research Progress in Postoperative Comprehensive Treatment of Pediatric Pilocytic Astrocytoma

摘要:

毛细胞型星形细胞瘤（Pilocytic Astrocytoma，PA）是最常见的儿童低级别脑肿瘤，常见于视神经、视交叉、下丘脑、脑干、小脑和大脑等部位。PA往往边界清楚、生长缓慢，属于WHO I级肿瘤，手术切除是治疗的首选方案。然而，由于视神经、视交叉、下丘脑、脑干等处神经功能的重要性，手术不一定能做到全切。目前临床对于儿童PA术后的治疗方案尚无定论，国内外对于儿童PA术后的主要治疗方式包括放疗、化疗、靶向治疗和随访观察。随着影像学和放射技术的进步，除了传统分次放疗，还包括适形放疗、立体定向放射治疗和质子治疗，旨在减轻放疗的毒副反应和提高放射治疗的疗效，但目前多数学者尚不推荐以放疗作为儿童PA术后的一线治疗选择。以长春新碱联合卡铂的化疗方案是进展性PA的首选，伊立替康-贝伐单抗可作为二线治疗用药。靶向治疗的发展如火如荼，以MEK抑制剂为首的靶向药物因其更少的毒副反应和良好的疗效而有望在未来成为儿童PA术后的一线用药，但目前尚缺乏高级别的临床证据。随访观察是儿童PA术后的选择之一，有学者提出儿童PA的分层治疗方案，推荐低风险层患者于术后随访观察。本文对儿童PA术后综合治疗进展作综述报道。

Abstract:

Pilocytic Astrocytoma (PA) is the most common low-level brain tumor in children, which is commonly found in optic nerve, optic chiasma, hypothalamus, brain stem, cerebellum and cerebrum. PA is often well-bounded, slow-growing and belongs to WHO I tumors, and surgical resection is the first choice for treatment. However, due to the importance of nerve functions of optic nerves, optic chiasma, hypothalamus, brain stem, total resection may not be possible. At present, there is no conclusion on the postoperative treatment of pediatric PA. The main treatment methods for postoperative pediatric PA patients include radiotherapy, chemotherapy, targeted therapy and follow-up observation. With the progress of imaging and radiation technology, in addition to traditional fractional radiotherapy, conformal radiotherapy, stereotactic radiotherapy and proton therapy are also included, aiming to reduce the toxic and side effects of radiotherapy and improve the efficacy of radiotherapy. However, most scholars currently do not recommend radiotherapy as the first-line treatment option for the patients after the surgery. Vincristine combined with carboplatin is the first-line treatment option for progressive PA. The combination of irinotecan and bevacizumab can be used as the second-line therapy. The development of target therapy is promising. Due to their less toxic side effects and excellent therapeutic effect, targeted therapy led by MEK inhibitors are expected to become the first-line drugs for the postoperative children suffered from PA in the future. However, there is still a lack of high-level clinical evidence. Follow-up observation is one of the postoperative options for children with PA. Some scholars have proposed hierarchical treatment for children with PA, and recommended postoperative follow-up observation for low-risk patients. This paper reviews the newly-published articles about the comprehensive treatment of the pediatric patients with PA.