Современные концепции эпидемиологии, молекулярная классификация, хирургическое лечение, прогностические факторы и будущие направления: всесторонний обзор глиом
DOI:
https://doi.org/10.63666/ejsmr.1694-9013.4.I.2026.101Ключевые слова:
глиома, астроцитома, глиобластома, объем резекции, хирургическая резекцияАннотация
Введение: Глиомы являются наиболее распространенными первичными злокачественными опухолями головного мозга у взрослых, составляя более 80% всех злокачественных новообразований центральной нервной системы. Их гетерогенная биология, вариабельное клиническое поведение и устойчивость к мультимодальной терапии обуславливают постоянно неблагоприятный прогноз, особенно для высокозлокачественных вариантов, таких как глиобластома (ГБМ).
Цель: Данный всесторонний обзор обобщает современные данные об эпидемиологии, молекулярной классификации, хирургическом лечении, прогностических факторах и новых терапевтических стратегиях лечения глиом в нейроонкологической хирургии.
Методы: Был проведен систематический нарративный обзор рецензируемой литературы, опубликованной преимущественно в период с 2015 по 2026 год, с использованием баз данных PubMed/MEDLINE, EMBASE и Cochrane Library. Поисковые запросы включали «глиома», «глиобластома», «объем резекции», «мутация IDH», «классификация ВОЗ» и связанные термины. Приоритет отдавался метаанализам, рандомизированным контролируемым исследованиям, проспективным когортным исследованиям и высококачественным ретроспективным сериям.
Результаты: Классификация ВОЗ 2021 года коренным образом реструктурировала таксономию глиом, основывая диагностику на молекулярных маркерах, включая статус мутации IDH, коделецию 1p/19q, метилирование промотора MGMT и изменение H3K27. Максимально безопасная хирургическая резекция остается краеугольным камнем лечения. Интраоперационные вспомогательные методы — флуоресценция 5-аминолевулиновой кислоты (5-ALA), интраоперационная МРТ (iMRI) и краниотомия в сознании — существенно увеличивают частоту полного удаления опухоли. Химиолучевая терапия на основе темозоломида по протоколу Ступпа остается стандартом лечения глиобластомы; однако иммунотерапия и таргетные молекулярные препараты демонстрируют многообещающие результаты на ранних стадиях клинических испытаний.
Заключение: Достижения в молекулярной диагностике, хирургических технологиях и мультимодальной онкологической терапии постепенно улучшают результаты лечения пациентов с глиомой. В дальнейшем необходимо уделить внимание рецидивам опухоли, проникновению через гематоэнцефалический барьер, иммунодепрессивной микросреде и качеству жизни, связанному со здоровьем.
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