胶质瘤手术how-much课件.pptx

1、Glioma Resection,How Much is Enough?Zhiyong QinDepartment of neurosugery,huashan hospital流行病学流行病学中国第三次死因回顾（2008）脑血管病，22.45%恶性肿瘤，22.32%国外 41010万。发病率：脑瘤为第九或第十 死亡率 65 yearsAge 65 yearsMGMT+MGMT-RT RT/TMZTMZTMZRT Cancer Lett.2016.7Question？How much glioma resection was enough?Total remove or subtotal or

2、 biopsy?EOR(or Molecular subtype)vs OS or PFS?Algorithm for the integrated diagnosis of glioblastomaNAN 2015;41:694720Algorithm for the integrated diagnosis of astrocytomas and oligodendrogliomas NAN 2015;41:694720 Volumetric EOR studies in high-grade glioma,n=1023Neurosurgery 62:753766,2008 Non-vol

3、umetric studies of EOR in high-grade glioma,n=4992Neurosurgery 62:753766,2008Negative nonvolumetric high-grade glioma studiesN=1585Volumetric EOR studies in low-grade glioma,n=462Neurosurgery 62:753766,2008Positive low grade non-volumetric studies,n=982Neurosurgery 62:753766,2008 OSforExtent of Rese

4、ction in GBMJ Neurosurg 115:38,2011500 GBMs OSforextent of resection in GBMJ Neurosurg 115:38,20111229GBMafterdifferentdegreesofresectionJ Neurosurg Volume124April2016Systematic Review GBMJAMA Oncol.2016.1373Systematic Review GBMJAMA Oncol.2016.1373Systematic Review GBMSystematic Review GBMKey Point

5、sConclusionKaplan-Meier plot of 5-year survival by AA and GBM patientsWorld Neurosurg.(2016)90:186-193.Kaplan-Meier plot of survival by AA and GBM patients according to patient ageWorld Neurosurg.(2016)90:186-193.Kaplan-Meier plot of survival by AA and GBM patients according to TMZ eraWorld Neurosur

6、g.(2016)90:186-193.KaplanMeier estimates of IDH wild malignant astrocytoma Neuro-Oncology 16(1),8191,2014KaplanMeier estimates of IDH mutant malignant astrocytoma Neuro-Oncology 16(1),8191,2014Impact of gross total resection in patients with WHO grade III glioma J Neurooncol(2016)129:505514，n124Low

7、grade gliomaLow grade glioma treatment strategy Low grade glioma If surgery resulted in EOR 90%,patients with astrocytoma will require second-look surgery,whereas patients with oligodendroglioma or oligoastrocytoma,which are sensitive to chemotherapy,will be treated with chemotherapy.Personal Medici

8、ne in future Histopathology Molecular pathology Deep sequrencing Clinical trail to certify Detecting 2-HG in glioblastoma with IDH1 R132G mutation（案例）Time course and work flow and Negative ion mode DESI mass spectra 2-HG signal in neuronavigation Significance use the Advanced Multimodality Image Gui

9、ded Operating Suite at Brigham and Womens Hospital to demonstrate that desorption electrospray ionization MS could be usedto detect residual tumor that would have been left behind in the patient.The approach paves the way for the clinical testing of MS-based intraoperative monitoring of tumor metabo

10、lites,an advance that could revolutionize the care of surgical oncology patients.Coevolution of Peer-Reviewed Literature and Clinical Practice in HGG ResectionWorld Neurosurg.(2016)96:237-241.Gross total resection rate by 4-year intervalWorld Neurosurg.(2016)96:237-241.World Neurosurg.(2016)96:237-241.Gross total resection rate by 4-year interval.5