nach oben

Der Nervenarzt

Erschienen in:

01.08.2014 | Leitthema

Interdisziplinäre Neuroonkologie

Teil 1: Diagnostik und operative Therapie primärer Gehirntumoren

verfasst von: G. Tabatabai, E. Hattingen, J. Schlegel, W. Stummer, Prof. Dr. U. Schlegel

Erschienen in: Der Nervenarzt | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die interdisziplinäre Neuroonkologie steht im Dienste von optimaler Diagnostik und Therapie primärer Gehirntumoren unter Einsatz der spezifischen Expertise der klinischen Neurofächer, flankiert von neuroonkologisch ausgerichteter Radioonkologie und Hämatoonkologie. Hochspezialisierte bildgebende Verfahren erlauben nicht selten die zuverlässige Vorhersage der Tumorentität und des Malignitätsgrads; sie sind unverzichtbar bei Operationsplanung und Therapie-Monitoring. Die Möglichkeiten einer immer ausgedehnteren und dabei (die neurologische Funktion) schonenden operativen Resektion intrakranieller Läsionen haben sich stürmisch entwickelt. Werkzeuge hierfür sind u. a. Neuronavigation, funktionelle Magnetresonanztomographie (fMRT), Traktographie, intraoperative Elektrostimulation und präzise intraoperative Darstellung der Tumorgrenzen mit unterschiedlichsten Verfahren. Wird das operativ gewonnene Gewebe untersucht, ergänzen umfassende molekulargenetische Analysen die klassische neuropathologische Diagnose und Klassifikation des Tumors. Ihre Ergebnisse bestimmen in Teilen bereits die Therapieplanung maligner Gliome. Zu den (für die Wirksamkeit einer Therapie) prädiktiven Faktoren gehören der kombinierte Verlust (die Kodeletion) von Chromosomenarmen 1p und 19q bei anaplastischen Gliomen und der Methylierungsstatus des O6-Methylguanin-DNA-Methyltransferase(MGMT)-Genpromotors bei Glioblastomen. Wenngleich dies sicher noch keine „individualisierte Tumortherapie“ ist, schafft die zunehmend detailliertere Charakterisierung der Molekularpathogenese eines individuellen Glioms die Voraussetzung dafür, therapeutisch gezielt in individuell gestörte intrazelluläre Signalwege einzugreifen. Dieser Beitrag informiert über den State of the Art der interdisziplinären Neuroonkologie. Der vorliegende Teil 1 behandelt die Diagnostik primärer Gehirntumoren; im Teil 2 wird die Therapie der primären Gehirntumoren beschrieben.

Hermann EJ, Hattingen E, Krauss JK et al (2008) Stereotactic biopsy in gliomas guided by 3-tesla 1H-chemical-shift imaging of choline. Stereotact Funct Neurosurg 86:300–307PubMedCrossRef

Hattingen E, Lanfermann H, Quick J et al (2009) 1H MR spectroscopic imaging with short and long echo time to discriminate glycine in glial tumours. MAGMA 22:33–41PubMedCrossRef

Kinoshita Y, Kajiwara H, Yokota A et al (1994) Proton magnetic resonance spectroscopy of brain tumors: an in vitro study. Neurosurgery 35:606–613PubMedCrossRef

Panigrahy A, Krieger MD, Gonzalez-Gomez I et al (2006) Quantitative short echo time 1H-MR spectroscopy of untreated pediatric brain tumors: preoperative diagnosis and characterization. AJNR Am J Neuroradiol 27:560–572PubMed

Senft C, Hattingen E, Pilatus U et al (2009) Diagnostic value of proton magnetic resonance spectroscopy in the noninvasive grading of solid gliomas: comparison of maximum and mean choline values. Neurosurgery 65:908–913PubMedCrossRef

Blasel S, Jurcoane A, Franz K et al (2010) Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas. Acta Neurochir (Wien) 152:1893–1899

Blasel S, Jurcoane A, Bähr O et al (2013) MR perfusion in and around the contrast-enhancement of primary CNS lymphomas. J Neurooncol 114:127–134PubMedCrossRef

Kim HS, Jahng GH, Ryu CW et al (2009) Added value and diagnostic performance of intratumoral susceptibility signals in the differential diagnosis of solitary enhancing brain lesions: preliminary study. Am J Neuroradiol 30:1574–1579PubMedCrossRef

Kuesel AC, Sutherland GR, Halliday W et al (1994) 1H MRS of high grade astrocytomas: mobile lipid accumulation in necrotic tissue. NMR Biomed 7:149–155PubMedCrossRef

10.

Dumrongpisutikul N, Intrapiromkul J, Yousem DM et al (2009) Distinguishing between germinomas and pineal cell tumors on MR imaging. AJNR Am J Neuroradiol 33:550–555CrossRef

11.

Pillai S, Singhal A, Byrne AT et al (2011) Diffusion-weighted imaging and pathological correlation in pediatric medulloblastomas-“They are not always restricted!“. Childs Nerv Syst 27:1407–1411PubMedCrossRef

12.

Scott JN, Brasher PM, Sevick RJ et al (2002) How often are nonenhancing supratentorial gliomas malignant? A population study. Neurology 59:947–949PubMedCrossRef

13.

Brandes AA, Tosoni A, Franceschi E et al (2009) Recurrence pattern after temozolomide concomitant with and adjuvant to radiotherapy in newly diagnosed patients with glioblastoma: correlation with MGMT promoter methylation status. J Clin Oncol 27:1275–1279PubMedCrossRef

14.

Wen PY, Macdonald DR, Reardon DA et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972PubMedCrossRef

15.

Hu LS, Baxter LC, Smith KA et al (2009) Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements. Am J Neuroradiol 30:552–558PubMedCrossRef

16.

Kong DS, Kim ST, Kim EH et al (2011) Diagnostic dilemma of pseudoprogression in the treatment of newly diagnosed glioblastomas: the role of assessing relative cerebral blood flow volume and oxygen-6-methylguanine-DNA methyltransferase promoter methylation status. Am J Neuroradiol 32:382–387PubMedCrossRef

17.

Sugahara T, Korogi Y, Tomiguchi S et al (2000) Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue. Am J Neuroradiol 21:901–909PubMed

18.

Hattingen E, Jurcoane A, Bähr O et al (2011) Bevacizumab impairs oxidative energy metabolism and shows antitumoral effects in recurrent glioblastomas: a 31P/1H MRSI and quantitative magnetic resonance imaging study. Neuro Oncol 13:1349–1363PubMedCentralPubMedCrossRef

19.

Togao O, Yoshiura T, Keupp J et al (2014) Amide proton transfer imaging of adult diffuse gliomas: correlation with histopathological grades. Neuro Oncol 16:441–448PubMedCrossRef

20.

Tóth V, Förschler A, Hirsch NM et al (2013) MR-based hypoxia measures in human glioma. J Neurooncol 115:197–207PubMedCrossRef

21.

Pope WB, Prins RM, Albert Thomas M et al (2012) Non-invasive detection of 2-hydroxyglutarate and other metabolites in IDH1 mutant glioma patients using magnetic resonance spectroscopy. J Neurooncol 107:197–205PubMedCentralPubMedCrossRef

22.

Sahm F, Capper D, Jeibmann A et al (2012) Addressing diffuse glioma as a systemic brain disease with single-cell analysis. Arch Neurol 69:523–526PubMedCrossRef

23.

Mandonnet E, Delattre JY, Tanguy ML et al (2003) Continuous growth of mean tumor diameter in a subset of grade II gliomas. Ann Neurol 53:524–528PubMedCrossRef

24.

Keles GE, Lamborn KR, Berger MS (2001) Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735–745PubMedCrossRef

25.

McGirt MJ, Chaichana KL, Attenello FJ et al (2008) Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 63:700–707PubMedCrossRef

26.

Smith JS, Chang EF, Lamborn KR et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345PubMedCrossRef

27.

Jakola AS, Myrmel KS, Kloster R et al (2012) Comparison of a strategy favoring early surgical resection vs. a strategy favoring watchful waiting in low-grade gliomas. JAMA 308:1881–1888PubMedCrossRef

28.

Duffau H (2013) A new philosophy in surgery for diffuse low-grade glioma (DLGG): oncological and functional outcomes. Neurochirurgie 59:2–8PubMedCrossRef

29.

Yordanova YN, Moritz-Gasser S, Duffau H (2011) Awake surgery for WHO grade II gliomas within „noneloquent“ areas in the left dominant hemisphere: toward a „supratotal“ resection. J Neurosurg 115:232–239PubMedCrossRef

30.

Woodworth G, McGirt MJ, Samdani A et al (2005) Accuracy of frameless and frame-based image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy and open resection specimen. Neurol Res 27:358–362PubMedCrossRef

31.

Jackson RJ, Fuller GN, Abi-Said D et al (2001) Limitations of stereotactic biopsy in the initial management of gliomas. Neuro Oncol 3:193–200PubMedCentralPubMed

32.

Muragaki Y, Chernov M, Maruyama T et al (2008) Low-grade glioma on stereotactic biopsy: how often is the diagnosis accurate? Minim Invasive Neurosurg 5:275–279CrossRef

33.

Floeth FW, Pauleit D, Sabel M et al (2007) Prognostic value of O-(2-18F-fluoroethyl)-L-tyrosine PET and MRI in low-grade glioma. J Nucl Med 48:519–527PubMedCrossRef

34.

Ewelt C, Floeth FW, Felsberg J et al (2011) Finding the anaplastic focus in diffuse gliomas: the value of Gd-DTPA enhanced MRI, FET-PET, and intraoperative, ALA-derived tissue fluorescence. Clin Neurol Neurosurg 113:541–547PubMedCrossRef

35.

McGirt MJ, Chaichana KL, Gathinji M et al (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 110:156–162PubMedCrossRef

36.

Lacroix M, Abi-Said D, Fourney DR et al (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190–198PubMedCrossRef

37.

Vuorinen V, Hinkka S, Farkkila M et al (2003) Debulking or biopsy of malignant glioma in elderly people – a randomised study. Acta Neurochir (Wien) 145:5–10

38.

Stummer W, Pichlmeier U, Meinel T et al (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401PubMedCrossRef

39.

Senft C, Bink A, Franz K et al (2011) Intraoperative MRI guidance and extent of resection in glioma surgery: randomised, controlled trial. Lancet Oncol 12:997–1003PubMedCrossRef

40.

Stummer W, Meinel T, Ewelt C et al (2012) Prospective cohort study of radiotherapy with concomitant and adjuvant temozolomide chemotherapy for glioblastoma patients with no or minimal residual enhancing tumor load after surgery. J Neurooncol 108:89–97PubMedCentralPubMedCrossRef

41.

Kreth FW, Thon N, Simon M et al (2013) Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy. Ann Oncol 24:3117–3123PubMedCrossRef

42.

Stummer W, Bent MJ van den, Westphal M (2011) Cytoreductive surgery of glioblastoma as the key to successful adjuvant therapies: new arguments in an old discussion. Acta Neurochir (Wien) 153:1211–1218

43.

McGirt MJ, Mukherjee D, Chaichana KL et al (2009) Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery 65:463–469PubMedCrossRef

44.

Stummer W, Nestler U, Stockhammer F et al (2011) Favorable outcome in the elderly cohort treated by concomitant temozolomide radiochemotherapy in a multicentric phase II safety study of 5-ALA. J Neurooncol 103:361–370PubMedCrossRef

45.

Ojemann G, Ojemann J, Lettich E et al (2008) Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 108:411–421PubMedCrossRef

46.

Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358:18–27PubMedCrossRef

47.

Farrel DF, Burbank N, Lettich E et al (2007) Individual variation in human motor-sensory (rolandic) cortex. J Clin Neurophysiol 24:286–293CrossRef

48.

Shinoura N, Suzuki Y, Yamada R et al (2009) Precentral knob corresponds to the primary motor and premotor area. Can J Neurol Sci 36:227–233PubMed

49.

Weiss C, Nettekoven C, Rehme AK et al (2012) Mapping the hand, foot and face representations in the primary motor cortex – retest reliability of neuronavigated TMS versus functional MRI. Neuroimage 66:531–542CrossRef

50.

Giussani C, Roux FE, Ojemann J et al (2010) Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies. Neurosurgery 66:113–120PubMedCrossRef

51.

Nimsky C, Kuhnt D, Ganslandt O et al (2011) Multimodal navigation integrated with imaging. Acta Neurochir Suppl 109:207–214PubMedCrossRef

52.

Nabavi A, Black PM, Gering DT et al (2001) Serial intraoperative magnetic resonance imaging of brain shift. Neurosurgery 48:787–797PubMed

53.

Frey D, Strack V, Wiener E, Jussen D et al (2012) A new approach for corticospinal tract reconstruction based on navigated transcranial stimulation and standardized fractional anisotropy values. Neuroimage 62:1600–1609PubMedCrossRef

54.

Wu JS, Zhou LF, Tang WJ et al (2007) Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: a prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery 61:935–948PubMedCrossRef

55.

Zolal A, Hejcl A, Vachata P et al (2012) The use of diffusion tensor images of the corticospinal tract in intrinsic brain tumor surgery: a comparison with direct subcortical stimulation. Neurosurgery 71:331–340PubMedCrossRef

56.

Duffau H, Lopes M, Arthuis F et al (2005) Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry 76:845–851PubMedCentralPubMedCrossRef

57.

Seidel K, Beck J, Stieglitz L et al (2013) The warning-sign hierarchy between quantitative subcortical motor mapping and continuous motor evoked potential monitoring during resection of supratentorial brain tumors. J Neurosurg 118:287–296PubMedCrossRef

58.

Ilmberger J, Ruge M, Kreth FW et al (2008) Intraoperative mapping of language functions: a longitudinal neurolinguistic analysis. J Neurosurg 109:583–592PubMedCrossRef

59.

De Witt Hamer PC, Robles SG, Zwindermann AH et al (2012) Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 30:2559–2565CrossRef

60.

Fernández Coello A, Moritz-Gasser S, Martino J et al (2013) Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks. J Neurosurg 119:1380–1394CrossRef

61.

Louis DN, Ohgaki H, Wiestler OD et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109 (Berl)PubMedCentralPubMedCrossRef

62.

Kleihues P, Cavenee WK (2000) Pathology and genetics of tumours of the nervous system. IARC Press, Lyon

63.

Killela PJ, Pirozzi CJ, Healy P et al (2014) Mutations in IDH1, IDH2, and in the TERT promoter define clinically distinct subgroups of adult malignant gliomas. Oncotarget 5:1515–1525PubMedCentralPubMed

64.

Dang L, White DW, Gross S et al (2009) Cancer-associated IDH1 mutations produce 2-hydroxyglutarate. Nature 462:739–744PubMedCentralPubMedCrossRef

65.

Turcan S, Rohle D, Goenka A et al (2012) IDH1 mutation is sufficient to establish the glioma hypermethylator phenotype. Nature 483:479–483PubMedCentralPubMedCrossRef

66.

Jenkins RB, Blair H, Ballman KV et al (2006) A t(1;19)(q10;p10) mediates the combined deletions of 1p and 19q and predicts a better prognosis of patients with oligodendroglioma. Cancer Res 66:9852–9861PubMedCrossRef

67.

Bettegowda C, Agrawal N, Jiao Y et al (2011) Mutations in CIC and FUBP1 contribute to human oligodendroglioma. Science 333:1453–1455PubMedCentralPubMedCrossRef

68.

Weller M, Stupp R, Reifenberger G et al (2010) MGMT promoter methylation in malignant gliomas: ready for personalized medicine? Nat Rev Neurol 6:39–51PubMedCrossRef

69.

Ohgaki H, Dessen P, Jourde B et al (2004) Genetic pathways to glioblastoma: a population-based study. Cancer Res 64:6892–6899PubMedCrossRef

70.

Jiao Y, Killela PJ, Reitman ZJ et al (2012) Frequent ATRX, CIC, FUBP1 and IDH1 mutations refine the classification of malignant gliomas. Oncotarget 3:709–722PubMedCentralPubMed

71.

Weller M, Kaulich K, Hentschel B et al (2014) Assessment and prognostic significance of the epidermal growth factor receptor vIII mutation in glioblastoma patients treated with concurrent and adjuvant temozolomide radiochemotherapy. Int J Cancer 134:2437–2447PubMedCrossRef

72.

Mellinghoff IK, Wang MY, Vivanco I et al (2005) Molecular determinants of the response of glioblastomas to EGFR kinase inhibitors. N Engl J Med 353:2012–2024PubMedCrossRef

73.

Weller M, Pfister SM, Wick W et al (2013) Molecular neuro-oncology in clinical practice: a new horizon. Lancet Oncol 14:e370–e379PubMedCrossRef

74.

The Cancer Genome Atlas (2008) Comprehensive genomic characterization defines human glioblastoma genes and core pathways. Nature 455:1061–1068CrossRef

75.

Nicholas MK, Lukas RV, Chmura S et al (2011) Molecular heterogeneity in glioblastoma: therapeutic opportunities and challenges. Semin Oncol 38:243–253PubMedCrossRef

76.

Vartanian A, Singh SK, Agnihotri S et al (2014) GBM’s multifaceted landscape: highlighting regional and microenvironmental heterogeneity. Neuro Oncol. DOI 10.1093/neuonc/nou035

77.

Chen R, Nishimura MC, Bumbaca SM et al (2010) A hierarchy of self-renewing tumor-initiating cell types in glioblastoma. Cancer Cell 17:362–375PubMedCrossRef

Titel: Interdisziplinäre Neuroonkologie
Teil 1: Diagnostik und operative Therapie primärer Gehirntumoren
verfasst von: G. Tabatabai
E. Hattingen
J. Schlegel
W. Stummer
Prof. Dr. U. Schlegel
Publikationsdatum: 01.08.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Der Nervenarzt / Ausgabe 8/2014
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI: https://doi.org/10.1007/s00115-014-4041-7

Neu in den Fachgebieten Neurologie und Psychiatrie

25.04.2024 | Hypotonie | Nachrichten

Springer Medizin

Interdisziplinäre Neuroonkologie

Teil 1: Diagnostik und operative Therapie primärer Gehirntumoren

Zusammenfassung

Neu in den Fachgebieten Neurologie und Psychiatrie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2014

Neues auf dem Gebiet der Epilepsien

Ausbildungscurriculum zur FEES

Epidemiologie der Multiplen Sklerose in Deutschland

Mitteilungen der Schlaganfallgesellschaft 8/2014

Neuigkeiten und Perspektiven der Neurointensivmedizin

FEES für neurogene Dysphagien

Neu in den Fachgebieten Neurologie und Psychiatrie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Weniger postpartale Depressionen nach Esketamin-Einmalgabe