摘要
儿童胶质瘤是儿童最常见的中枢神经系统肿瘤,近年来其诊疗策略因分子生物学进展而发生根本性变革。2021年WHO分类首次将儿童胶质瘤独立分型,强调其与成人在基因驱动、表观遗传及肿瘤微环境方面的显著差异。本文系统综述了儿童胶质瘤在分子分型、手术治疗、靶向治疗及免疫治疗等方面的最新突破。分子分型方面,BRAF、H3K27M、IDH等关键突变不仅指导预后分层,也为靶向治疗提供依据;手术方面,神经导航与术中监测技术显著提升了丘脑与脑干肿瘤的全切率与安全性;靶向药物如托沃拉非尼、Vorasidenib等逐步覆盖低龄患儿并有效延迟放疗;免疫治疗中GPC2-CAR T等新型策略展现出良好前景。然而,药物递送障碍、耐药机制及罕见亚型研究仍是未来重点。多学科协作与精准医疗正不断改善患儿生存与生活质量。
Pediatric glioma,the most common central nervous system tumor in children,has undergone transformative changes in diagnosis and treatment due to advances in molecular biology.The 2021 WHO classification now recognizes pediatric gliomas as distinct entities,highlighting differences in driver mutations,epigenetics,and tumor microenvironment compared to adults.This review summarizes recent progress in molecular subtyping,surgical management,targeted therapy,and immunotherapy.Molecular profiling of BRAF,H3K27M,IDH,and other alterations enables prognostic stratification and guides targeted interventions.Surgical innovations,including advanced imaging and intraoperative monitoring,have improved resection rates and safety for thalamic and brainstem tumors.Targeted agents such as tovorafenib and vorasidenib are expanding treatment options for young children and delaying radiation.Emerging immunotherapies,including GPC2-CAR T cells,show promising efficacy.However,challenges such drug delivery barriers,resistance mechanisms,and research on rare subtypes remain.Multidisciplinary collaboration and precision medicine are steadily enhancing survival and quality of life for young patients.
作者
张所军
舒凯
ZHANG Suojun;SHU Kai(Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《临床外科杂志》
2025年第11期1133-1136,共4页
Journal of Clinical Surgery
关键词
儿童胶质瘤
分子分型
精准治疗
pediatric glioma
molecular subtyping
precision therapy
