Recently, I was fortunate to have a pineapple meeting in the living room.Huashan Hospital Affiliated to Fudan UniversityProfessor Qin Zhiyong talked about brain glial Standardized treatment of tumor.. Sharing a selection of content today. Special thanks to volunteer Chu Beibei for helping organize the manuscript!
Professor Qin Zhiyong
Huashan Hospital Affiliated to Fudan University
Deputy Director of Neurosurgery
Vice-chairman of the Glioma Professional Committee of the Chinese Medical Doctor Association
Pineapple: What Types of Brain Tumors Are? Is a brain aneurysm a brain tumor?
Professor Qin: Brain tumor mainly refers to the general term of various intracranial tumors, and aneurysms are often referred to as vascular diseases rather than tumors. It’s like a balloon, it’s hollow. The tumor is equivalent to a pimple growing on a tree, and most of it is solid.
Brain tumors are also divided into benign and malignant tumors. The most common clinical tumors are benign tumors. Malignant tumors account for about 30%-40% of primary brain tumors, of which 70%-80% are gliomas. Meningiomas, pituitary tumors, and acoustic neuromas are all benign tumors.
Among brain malignant tumors, brain metastases are the most common, such as lung cancer, thyroid cancer, liver cancer, etc. After comprehensive treatment in recent years, these tumors metastasize to the brain with the prolongation of survival time. increased opportunities for ministry. Metastases mainly rely on comprehensive treatment, and there are not many patients who need surgery. The patients with metastases who really need surgery in brain surgery only account for about 2%-5% of the volume of neurosurgery in large general hospitals.
Pineapple: Can Glioma Surgery Be Cleaned?
Professor Qin: When many glioma patients hear that surgery is required, they will ask if the surgery can be done cleanly. In fact, strictly speaking, glioma surgery is difficult to clean.
For example, if there is a tumor in the lung, you can cut a larger area of surgery, or even remove the entire lobe of the lung, and the patient can still survive well with only one lung. However, brain tumors are not the same. Those involving important functional areas such as motor functional areas and language functional areas cannot be enlarged and removed. Even if it is not in an important functional area, the scope of resection can be expanded a little. For gliomas of grade two or above, the so-called total resection is only a complete resection on imaging, even if the tumor signs are no longer visible on postoperative magnetic resonance imaging. , in fact it still has some tumor cells in it.
I often make an analogy, brain glioma is like a handful of rice bran falling into a rice jar. If you want to take out the bran, the first handful is mainly bran, and the surrounding area is mainly bran. The rice only brought out a little. When you go to hold it for the second time, what comes out is mainly rice, and only a little bit of rice bran. At first glance, there is no chaff in the rice jar, but in fact there must still be some chaff in it. The same is true for tumors, because tumors grow invasively, and it is difficult to scoop out all the ink after it has been dropped into a water tank.
Therefore, total resection currently means that the tumor cannot be seen on imaging, and it can only be done to this extent. For some high-grade gliomas, even if the scope of resection is infinitely expanded, or even the cerebral hemisphere is removed, it may not be able to completely prevent recurrence.
However, there are indeed a small number of gliomas, such as first- and second-level gliomas that were discovered early. If they are located in a non-functioning lobe, the prognosis after extended resection is relatively good. . However, if it is discovered late, the tumor is relatively large, has been distributed in multiple lobes, or has developed into a high-grade disease, it will be very difficult to perform surgery, and it may not even be possible to perform imaging studies.
Pineapple: What is the standardised treatment for brain tumors?
Professor Qin: The treatment of glioma has been developed for more than 100 years. In the beginning, only a macroscopic excision could be performed, and later it was developed to a microscopic excision. . Now that the surgical technology is constantly improving, we can use electrophysiological monitoring during surgery to identify which are functional areas and which are non-functional areas, and remove as much as possible while preserving function.
Surgery has a principle that maximum resection and maximum function preservation require the best balance between the two.
After surgery for gliomas, most of the grades 2 or above require radiotherapy and chemotherapy according to the grade of the tumor. Only a few low-risk grade 2 gliomas that have been completely resected can be considered for observation.
So the standard treatment for glioma is generally surgery, radiotherapy and chemotherapy. However, for high-grade gliomas, such as glioblastoma grade 4, or astroglioma grade 4, as long as the brain tumor reaches grade 4, the treatment effect is really not ideal. There is also a method for this kind of tumor called electric field therapy, which is also a relatively new method.
Pineapple: How should I usually do a brain examination and screening?
Professor Qin: The prevention and treatment of tumors is actually early detection, early diagnosis, and early treatment, and the word “early” must be highlighted. But at present, many unit physical examinations do not include brain examinations.
I thinkA brain examination is necessary. Now there are more tools for physical examination and the cost is reduced, so when there are no symptoms, I also recommend doing a plain MRI scan during the physical examination. It is not recommended to do plain CT scan because it is easy to miss brain tumors, especially brain tumors at the top, bottom of the skull, or near the edge of the bone, which are not easy to observe in plain scan, unless the tumor grows very large.
Direct enhanced CT is also not recommended, because it is necessary to use a potion before the examination. After all, it is a medicine that needs to be metabolized by the human body. There is no need for direct enhancement in the physical examination of healthy people. It is still recommended to do a plain scan first. If the plain scan is highly suspected of a brain tumor, then further enhanced MRI or enhanced CT is performed.
If you have symptoms, be sure to seek medical attention immediately. Intracranial tumors may have the following symptoms: First, headaches, are generally progressive, such as headaches today, better tomorrow, pain again after a period of time, and getting worse , this should be taken seriously, indicating that this thing may be growing and getting bigger.
The second is epilepsy. Children with high fever will also have limb convulsions, but if adults have limb convulsions and foaming at the mouth (the epilepsy in rural areas), Be sure to go to the hospital for examination, it may be possible to find out a brain problem. I met some patients in the outpatient clinic, some only had one or two minutes of seizures at a time, and some had seizures at night when they went to bed, and they were fine the next day. The tumor has grown.
In addition, if an adult develops weakness on one side of the limb, including poor performance of fine tasks, decreased vision, unsteady walking, apathy (previously active people become less responsive ) must remember to see a brain specialist.
Although it is not a symptom of glioma, I would also like to remind everyone that if one ear cannot hear clearly or has hearing loss, it may be a symptom of acoustic neuroma, a benign tumor. Pay attention to this too.
In addition, there is another point that is easily overlooked. If gay men have decreased sexual function, or lesbians are infertile or have irregular menstruation after marriage, they should also have a head examination. Craniopharyngioma or pituitary tumor.
Pineapple: I heard that playing with mobile phones can easily lead to brain tumors, especially gliomas. Is it true?
Professor Qin: There is no clear answer to this question, because there is no strong evidence to prove the connection, and the mainstream view is that mobile phones The radiation is non-ionizing radiation and does not cause gliomas.
But I read a review that started from the time when we used a brick machine (big brother), if you use a mobile phone to make calls every day for 1 hour for 10 years, it is not only a glue The incidence of brain tumors has increased significantly.
For example, if you smoke 20 cigarettes a day for 20 years, the incidence of lung cancer will be significantly higher than that of the control group. However, the correlation between making phone calls and brain tumors is far less strong than smoking and lung cancer. Therefore, the mainstream academic view is that normal use of mobile phones will not cause gliomas, and it is also safe to put them on the bedside table when sleeping. Don’t worry about this.
Pineapple: Can gliomas survive surgery? How does immunotherapy work?
Professor Qin: After being diagnosed with glioma by MRI, many patients will ask if it’s okay to do surgery without surgery, to do radiotherapy and chemotherapy directly, or to use immunotherapy?
We think that is not acceptable, because the diagnosis of MRI is not a pathological diagnosis. Although it can be basically determined to be a glioma, gliomas are also classified into grades 1, 2, 3, Level 4, each situation will be different.
Therefore, surgery is still required. After all or most of the tumor is removed, radiotherapy and chemotherapy are used to better control the tumor and improve the treatment effect. The tissue removed by surgery can also be used for pathological typing and genotyping, which is helpful for clarifying the follow-up treatment plan, so surgery is very important. If the tumor is deep and difficult to operate, at least a needle biopsy should be done to find out the pathology.
Some friends have heard that radiotherapy and chemotherapy are very toxic. If they want to use immunotherapy directly, it is not enough in the field of glioma. Radiotherapy and chemotherapy have to be done. Postoperative chemoradiotherapy for glioma can clearly improve overall survival.
The immunotherapy of glioma is a very important direction, but so far, immunotherapy has not been written in the guidelines of glioma like surgery, radiotherapy and chemotherapy. As part of standard treatment, there are no immunologic drugs specifically for glioma as guidelines recommend, and only some clinical trials can participate.
Currently, many clinical trials of glioma immunotherapy have shown effects in Phase I and Phase II, but Phase III trials have not shown very good results, so the current immunotherapy may only be effective for some patients. Useful for specific patients.