Childhood tumor

Surgical treatment

Surgical resection of tumors can quickly and directly solve the space occupying effect of tumors, such as high intracranial pressure symptoms, and reduce the use of glucocorticoids; Being able to clearly understand the nature of the tumor during surgery can increase the effectiveness of radiotherapy after surgical resection of the tumor; After tumor resection, it can reduce the likelihood of tumor recurrence into higher-level tumors; It is important to obtain tumor specimens through surgical resection, and we can obtain tumor pathological grading and related molecular indicators (1p/19q, MGMT, IDH1/2, etc.), which can guide the selection of postoperative radiotherapy and chemotherapy treatment plans. Glioma patients who cannot undergo complete resection choose surgical treatment.

There are several main purposes for choosing surgical treatment for glioma patients who cannot undergo complete resection.

Through surgery, a clear pathological diagnosis can be made. Preoperative imaging examination only provides a rough diagnosis of the grade and malignancy of the tumor based on experience, while intraoperative biopsy can provide clear grading and classification of the tumor. Clarifying the pathological classification of tumors is crucial for subsequent treatment and predicting patient prognosis.

Secondly, current research has shown that even if some gliomas cannot achieve complete resection, if the degree of resection of gliomas reaches more than 90%, it also plays a significant role in prolonging the survival of patients.

For tumor resection in the functional area, experts in hospitals use electrophysiological monitoring surgery and intraoperative awakening anesthesia technology to effectively protect multiple functions of patients, such as movement, language, spatial cognition, and digital cognition. Although some gliomas cannot be completely removed, performing partial resection, especially in more than 70% of cases, is very helpful in prolonging survival.

Cost issues and length of hospital stay

Glioma: around 50000 to 70000 yuan, hospitalization for about 3 weeks

Radiation therapy

What is radiation therapy

Radiation therapy is a treatment method that provides uniform and accurate irradiation to a certain tumor tissue while the dose to surrounding normal tissues is very small. Radical radiotherapy is the main task of glioma radiotherapy. Although we have made significant progress in the field of basic research on gliomas and have a hundred years of clinical treatment history, the overall treatment effect, especially the efficacy of malignant gliomas, is still unsatisfactory. Surgery, radiotherapy, and chemotherapy combined therapy are still the choice for glioma. Radiation therapy, as one of the indispensable treatment methods for gliomas, has long been recognized for its therapeutic effect.

The sensitivity of various types of gliomas to radiation therapy varies. It is generally believed that tumors with poor differentiation are higher than those with good differentiation. Medulloblastoma is most sensitive to radiation therapy, followed by ependymoblastoma. Glioblastoma multiforme is only moderately sensitive, while astrocytoma, oligodendroglioma, and pineal cell carcinoma are even worse. For medulloblastoma and ependymoma, as they are prone to spread with cerebrospinal fluid, full spinal irradiation should be included.

Preparation before radiotherapy

(1) Actively improve the general condition of patients. Especially correcting anemia, controlling blood sugar, balancing electrolytes, can help enhance the effectiveness of radiotherapy and reduce reactions. Subcutaneous effusion, subdural (external) effusion, and intracranial hematoma are not absolute contraindications for radiotherapy, but postoperative complications need to be addressed for radiotherapy

Preparation before radiotherapy

(1) Actively improve the general condition of patients. Especially correcting anemia, controlling blood sugar, balancing electrolytes, can help enhance the effectiveness of radiotherapy and reduce reactions. Subcutaneous effusion, subdural (external) effusion, and intracranial hematoma are not absolute contraindications for radiotherapy, but the impact of these postoperative complications on radiotherapy needs to be evaluated. At the same time, great attention should be paid to the adjustment of the patient's mental state. Fear and pressure towards disease and treatment may lead to rapid deterioration of the body's condition. Therefore, strengthening psychological counseling and enhancing patient confidence is one of the indispensable preparations before radiotherapy.

(2) Improve pre radiotherapy examinations. Postoperative MR or CT is necessary, as the position of the tumor may shift before and after surgery. Clinical treatment targets (CTVs) can be determined by comparing imaging data such as preoperative and postoperative MR and CT.

(3) Determine treatment plans based on existing clinical data. Including treatment objectives (curative radiotherapy or palliative radiotherapy), selecting appropriate treatment methods (single external irradiation or combination therapy with chemotherapy, internal irradiation, etc.). For low-grade malignant gliomas, in radiotherapy, in addition to considering tumor control probability (TCP), it is more important to consider the probability of normal tissue complications (NTCP). TCP depends on various factors such as tumor sensitivity to radiation and tumor size. Compared to malignant gliomas, low-grade gliomas are more sensitive to radiotherapy. Radiation therapy should not cause unacceptable radiation damage to the patient while controlling the tumor, as a prerequisite and requirement for radiation therapy, with the goal of curative radiation therapy. Malignant gliomas, especially gel tumors, have poor radiation resistance and short survival time. Radical radiotherapy is often difficult to achieve and should be treated differently depending on the specific conditions of the patient. For patients with large residual tumor after surgery, who generally have poor conditions and many other adverse prognostic factors, it is estimated that if it is difficult to have a long survival time, there is no need to extend the treatment time too long. Palliative radiotherapy, 3Gy, can be used × 10f or 2.5Gy × 20f, in order to improve the quality of life without increasing patient suffering, extend the survival period appropriately, and give patients more time to return to society and family.

Selection of timing for radiotherapy

According to histological sources, gliomas include: astrocytoma, oligodendroglioma, oligodendroglioma, ependymoma, and glioblastoma; According to the degree of malignancy, it is divided into low-grade gliomas (astrocytomas) and high-grade gliomas (anaplastic and glioblastoma). Previous retrospective and prospective studies have confirmed the positive effect of immediate postoperative radiotherapy in the treatment of high-grade gliomas. It can significantly improve the survival time of patients and is an independent factor affecting the prognosis of high-grade gliomas. The combination of surgery and radiation therapy can increase the 5-year survival rate of anaplastic astrocytoma and prolong the survival time of glioblastoma multiforme. Therefore, surgery combined with immediate postoperative radiotherapy is currently an effective method for treating high-grade gliomas.

The growth of low-grade gliomas is relatively slow, and previous research on the timing of postoperative radiotherapy has not yielded a consistent answer. Most retrospective studies have shown that the median survival time and 5-year survival rate of patients with immediate postoperative radiotherapy for low-grade gliomas are significantly higher than those with delayed surgery