| Objectives Glioma is a common malignant tumor in the brain.There are different viewpoints about the postoperative chemotherapy of low-grade gliomas with relatively low malignancy.In the January 2018 National Comprehensive Cancer Network(NCCN)guidelines for the treatment of central nervous system tumors,the opinion is that postoperative radiotherapy and chemotherapy for low-grade gliomas requires a combination of risk factors and a personalized combination of therapies.At the same time,we advocate the accurate treatment of GLIOMAS,is to combine with the molecular pathological classification of individual treatment is to improve the molecular pathological classification is the basis for accurate treatment.To investigate the effects of IDH1 / 2,1P / 19 q,MGMT promoter methylation and VEGF on different grades of Gliomas,so as to provide data for postoperative treatment This study was designed to investigate the adverse effects of early chemotherapy in the high risk group of LOW GRADE GLIOMAS(Age & GT;40 years,subtotal tumor resection,preoperative neurological deficits,IDH wild type).Methods Total of 30 patients with GLIOMAS,including 17 males and 13 females,aged 30 to 60 years,were enrolled in this study.The pathological types were diffuse astrocytoma and oligodendrocyte tumors in the 2016 WHO central nervous system.1 Test Preparation,admission routine examination ECG,chest film,blood routine,coagulation series,electrolytes,liver function and renal function,etc..After the initial diagnosis of gliomas,the brain MRI(including plain scan + enhancement,Dwi,DTI,Mrs,ASL and other functional imaging)was performed.After preoperative preparation,intracranial tumor resection was performed under general anesthesia at selected time.All the operations were performed by Zhang Hongyi,director of our department.The tumors were totally resected in the largest scope under the microscope.All the tumor tissues were examined by histopathology and molecular pathology,which were reviewed by two chief physicians of Pathology Department of our hospital.The molecular pathology tests were performed by Beijing meta-code Genetic Testing Company and also reviewed by two senior laboratory physicians.The detection items were IDH1 / 2 Mutation,1P / 19 q deletion,MGMT promoter methylation,VEGF.48 hours after operation,the patients who were diagnosed as Brain Glioma were re-examined by plain scan and enhanced MRI.2 Data Collection: General Information of patients was recorded,including sex,age,weight and KPS score of each group.Patients with clinical signs and symptoms of tumor-related dysfunction(including headache,epilepsy,motor,speech or sensory impairment,impaired visual function,changes in emotion,consciousness,etc.)were recorded.The preoperative and postoperative imaging features,tumor location,tumor maximum diameter and postoperative residual were recorded.The molecular pathology of patients with different histopathologic grades was recorded.The patients were divided into low grade group(grade I,II group,Group A),High Grade Group(Group III,IV,Group B)according to different histopathological grading,the Molecular Pathology(IDH1 / 2 Mutation,1P / 19 q deletion,MGMT promoter methylation,VEGF)was recorded at different risk factors.The low-grade Group was divided into high-risk Group and low-risk group according to the molecular pathological results and high-risk factors.The patients in high-risk Group(Group C)and high-grade group were treated with temozolomide(75mg / kg / M2,for 5 days)at the 7th day after operation.3 Statistical analysis of data: Statistical Analysis of data using SPSS statistical software.The measurement data were measured by mean standard deviation(xs)and group paired t test.Chi-square test and exact probability method for counting data and rates.P < 0.05 indicated that the difference was statistically significant.Results 1 the KPS score in Group A was significantly higher than that in group B(p < 0.05).The proportion of frontal lobe and temporal lobe was higher than that of frontotemporal lobe,parietal lobe and Cerebellum(p < 0.05).The proportion of frontotemporal lobe was higher than that of parietal lobe and cerebellum(p < 0.05).2 compared with clinical stratification and molecular pathological indexes,the patients with preoperative functional loss were significantly higher than those without functional loss(p < 0.01).The level of Idh Mutation,1P / 9q deletion and VEGF negative in Group B was lower than that in group a(p < 0.05).3 The promoter methylation of 1P / 19 q and MGMT and the expression of VEGF were different in different factors of clinical stratification.4 in the high-risk Group of low-grade Glioma,the incidence of adverse reactions of temozolomide was lower than that of high-risk group(p < 0.05).Conclusions 1 according to the characteristics of IDH1 / 2,1P / 19 q,MGMT promoter methylation and VEGF in the molecular pathology of Gliomas,the lower grade gliomas have better molecular pathological types in general,so that the patients can be more accurately stratified.2 low-grade gliomas were grouped according to High Risk Factors(Age & GT;40 years,subtotal tumor resection,preoperative neurological deficits,IDH wild type),it is helpful to provide more individualized and precise treatment for low-grade gliomas.The adverse reactions of early chemotherapy in low-grade Gliomas were lower than those in high-grade gliomas.Figure5;Table10;Reference 80... |
PDF Full Text Request