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DOI: 10.1055/s-0038-1631196
Therapie maligner Gliome
Aktuelle KonzepteManagement of malignant gliomaCurrent conceptsPublication History
Publication Date:
03 February 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034915/201101/lookinside/thumbnails/10-1055-s-0038-1631196_de-1.jpg)
Zusammenfassung
In der Behandlung maligner Gliome hat sich in den letzten Jahren viel getan, therapeutischer Nihilismus ist nicht mehr angesagt. Die Standardtherapie besteht aus Operation, gefolgt von kombinierter Radiochemotherapie und Chemotherapie bei WHO-Grad-IV-Gliomen, bei WHO-Grad-III-Tumoren kommen Strahlentherapie oder Chemotherapie bei der Erstdiagnose zum Einsatz. Eine besondere Situation stellt sich bei älteren Patienten, die eine schlechtere Prognose und Ansprechen auf die Therapie zeigen. Beim Rezidiv maligner Gliome sollte individuell entschieden werden, es stehen zunehmend mehr Therapiealternativen zur Verfügung. Auch die symptomatische und supportive Therapie sollten nicht vernachlässigt werden und, gleich in welchem Krankheitsstadium, antiepileptische Medikation, Ödembehandlung und Thrombosenprophylaxe bzw. -therapie überdacht und optimiert werden.
Summary
Therapy of malignant glioma has changed and developed further in the last years. Standard therapy consists of operation with consecutively radiochemotherapy and chemotherapy in WHO grade IV glioma, and either radiotherapy or chemotherapy in grade III glioma. Older patients, who have a worse prognosis, should be considered separately. In case of recurrent disease, further therapy should be discussed individually with more and more therapeutically options. Symptomatic and supportive treatment must not be neglected and should be always reconsidered and optimized.
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Literatur
- 1 Altschuler E, Moosa H, Selker RG, Vertosick Jr FT. The risk and efficacy of anticoagulant therapy in the treatment of thromboembolic complications in patients with primary malignant brain tumors. Neurosurgery 1990; 27 (01) 74-76.
- 2 Batchelor TT. et al. Phase II study of cediranib, an oral pan-vascular endothelial growth factor receptor tyrosine kinase inhibitor, in patients with recurrent glioblastoma. J Clin Oncol 2010; 28 (17) 2817-23.
- 3 Brandes AA. et al. Temozolomide 3 weeks on and 1 week off as first-line therapy for recurrent glioblastoma: phase II study from gruppo italiano cooperativo di neuro-oncologia (GICNO). Br J Cancer 2006; 95: 1155-1160.
- 4 Choucair AK, Silver P, Levin VA. Risk of intracranial hemorrhage in glioma patients receiving anticoagulant therapy for venous thromboembolism. J Neurosurg 1987; 66 (03) 357-8.
- 5 De Witt Hamer PC. Small molecule kinase inhibitors in glioblastoma: a systematic review of clinical studies. Neuro-Oncol 2010; 12 (03) 304-316.
- 6 Friedman HS. et al. Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol 2009; 27 (28) 4733-40.
- 7 Happold C. et al. ACNU-based chemotherapy for recurrent glioma in the temozolomide era. J Neurooncol 2009; 92 (01) 45-48.
- 8 Hegi ME. et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005; 352: 997-1003.
- 9 Keime-Guibert F. et al. Radiotherapy for glioblastoma in the elderly. N Engl J Med 2007; 356 (15) 1527-35.
- 10 Kreisl TN. et al. Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol 2009; 27 (05) 740-5.
- 11 Laperriere N, Zuraw L, Cairncross G. Cancer Care Ontario Practice Guidelines Initiative Neuro-Oncology Disease Site Group. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002; 64 (03) 259-73.
- 12 Louis DN. et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007; 114 (02) 97-109.
- 13 Malmstrom A. et al. Glioblastoma (GBM) in elderly patients: A randomized phase III trial comparing survival in patients treated with 6-week radiotherapy (RT) versus hypofractionated RT over 2 weeks versus temozolomide single-agent chemotherapy (TMZ). J Clin Oncol 2010, ASCO Annual Meeting Proceedings (Post-Meeting Edition). 28 18s, LBA2002.
- 14 Marras LC, Geerts WH, Perry JR. The risk of venous thromboembolism is increased throughout the course of malignant glioma: an evidence-based review. Cancer 2000; 89 (03) 640-6.
- 15 Perry JR. et al. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol 2010; 28 (12) 2051-7.
- 16 Reardon DA. et al. Randomized phase II study of cilengitide, an integrin-targeting arginine-glycine-aspartic acid peptide, in recurrent glioblastoma multiforme. J Clin Oncol 2008; 26 (34) 5610-7.
- 17 Schmidt F, Faul C, Dichgans J, Weller M. Low molecular weight heparin for deep vein thrombosis in glioma patients. J Neurol 2002; 249 (10) 1409-12.
- 18 Stummer W. et al. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006; 7 (05) 392-401.
- 19 Stupp R. et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352: 987-996.
- 20 Stupp R. et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009; 10 (05) 459-66.
- 21 Weller M. et al. Combined 1p/19q loss in oligodendroglial tumors: predictive or prognostic biomarker?. Clin Cancer Res 2007; 13 (23) 6933-6937.
- 22 Wick A. et al. Efficacy and tolerability of temozolomide in an alternating weekly regimen in patients with recurrent glioma. J Clin Oncol 2007; 25: 3357-3361.
- 23 Wick W, Küker W. Brain edema in neurooncology: radiological assessment and management. Onkologie 2004; 27 (03) 261-6.
- 24 Wick W. et al. NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol 2009; 27 (35) 5 874-80.
- 25 Wick W. et al. NOA-08 randomized phase III trial of 1-week-on/1-week-off temozolomide versus involved-field radiotherapy in elderly (older than age 65) patients with newly diagnosed anaplastic astrocytoma or glioblastoma (Methusalem). J Clin Oncol 2010, ASCO Annual Meeting Proceedings (Post-Meeting Edition). 28 18s, LBA2001.