Gliomas

Gliomas are primary tumors that develop from the parenchyma of the brain. Symptoms and diagnosis - as with other brain tumors.

Treatment for gliomas is surgical, radiological, for some tumors chemotherapeutic.

Excision rarely leads to a cure.

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Symptoms of the gliomas

Symptoms of the disease and signs depend on localization.

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Forms

Gliomas include astrocytomas, oligodendrogliomas, medulloblastomas and ependymomas. Many gliomas diffuse and unevenly infiltrate the brain tissue.

For all astrocytes, a universal grading system (WHO) is used according to the histological criterion of the "degree of malignancy". Degree 1 (astrocytoma): there should be no sign of anaplasia. Degree 2 (astrocytoma): 1 sign of anaplasia, more often - nuclear atypia. Degree 3 (anaplastic astrocytoma): 2 signs, more often - nuclear atypia and mitosis. Degree 4 (glioblastoma): 3-4 signs - nuclear atypia, mitosis, proliferation of vascular endothelium and / or necrosis.

Astrocytomas are the most common gliomas. In order of increasing degree of malignancy, they are classified as 1st and 2nd degree (low gradation astrocytomas: piloid and diffuse), grade 3 (anaplastic astrocytomas) and grade 4 (glioblastomas, including the most malignant glioblastoma multiforme). Astrocytomas 1-3 tend to develop in younger individuals and can degenerate into secondary glioblastomas. Glioblastomas consist of chromosomal-heterogeneous cells. Primary glioblastomas develop  de novo  usually in middle or old age. The genetic characteristics of primary and secondary glioblastomas can vary with the development of the tumor.

Oligodendrogliomas are the most benign tumors. They affect, mainly, the cerebral cortex, especially the frontal lobes.

Medulloblastomas develop mainly in children and young adults, usually in the area of the IV ventricle. Ependymomas are rare, mainly in children, usually in the area of the IV ventricle. Medulloblastomas and ependymomas predispose to occlusal hydrocephalus.

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Diagnostics of the gliomas

 Diagnosis is the same as for other brain tumors.

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Treatment of the gliomas

Anaplastic astrocytomas and glioblastomas are treated surgically, radiotherapy and chemotherapy to reduce the mass of the tumor. The excision of as large a mass of the tumor is not fraught with danger, prolongs survival and improves neurological functions. After the operation, radiotherapy is indicated in a course dose of 60 Gy per tumor in the form of conformal radiation therapy aimed at the tumor and sparing normal brain tissue. Chemotherapy is carried out with nitrosoureas (for example, carmustine, lomustine) alone or in combination. Instead of combined chemotherapy, you can give temozolomide 5 days a month at 150 mg / m orally 1 time / day in the first month and 200 mg / m in the following months.

In the process of chemotherapy, you need to take a general blood test at least 24 or 48 hours before each session. Consider using new methods (for example, chemotherapy capsules, stereotactic radiosurgery, new chemotherapeutic agents, gene or immune therapy). After complex treatment, the survival rate for anaplastic astrocytomas or glioblastomas is 1 year in 50% of cases, 2 years in 25%, and 5-15% in 10-15%. Favorable prognostic factors: age less than 45 years, histology of anaplastic astrocytoma, and not multiform glioblastoma, complete or almost complete excision of the tumor and the fact of improvement of the neurologic function after the operation.

Astrocytomas of low grade are excised as possible, then irradiated. The moment of the beginning of radiotherapy is the subject of discussion: early treatment is more effective, but also fraught with earlier neurotoxicity. Five-year survival can be achieved in 40-50% of cases.

Oligodendrogliomas are treated promptly and radologically, as do astrocytomas with low malignancy. Sometimes they use chemotherapy. Five-year survival can be achieved in 50-60% of cases.

Medulloblastoma is treated with whole brain radiation at a dose of approximately 35 Gy, the posterior cranial fossa is 15 Gy, and the spinal cord is 35 Gy per course. Chemotherapy is prescribed as an auxiliary treatment and with relapses. Assign the derivatives of nitrosoureas, procarbazine, vincristine alone and in combination, intrathecal administration of methotrexate, combined polychemotherapy (for example, according to the MOPP protocol: mechlorethamine, vincristine, procarbazine and prednisolone), cisplatin and carboplatin, but none of the schemes gives a stable effect. Five-year survival can be achieved in 50% of cases, and 10-year survival in 40%.

Ependymomas are usually treated promptly, excising the tumor and restoring the pathway of CSF outflow, followed by radiotherapy.

In histologically benign ependymomas, radiation therapy is directed to the tumor itself, with malignant tumors and incomplete removal of the tumor during the operation, the entire brain is irradiated. With signs of seeding, both the brain and spinal cord are irradiated. The degree of completeness of tumor excision determines survival. After treatment, 5-year survival can be achieved in 50% of cases, and with complete removal of the tumor - in more than 70% of cases.