The treatment of neuro-oncology has always been a complex and delicate field. With the continuous advancement of medicine, we have ushered in new treatment concepts and technologies that bring more hope to patients with neurological tumors. In this issue of "Physician Daily", Professor Tao Rongjie, a neuro-oncology major from Shandong Cancer Hospital, was invited to give readers an in-depth interpretation of the latest developments in the diagnosis and treatment of neuro-tumors.
"Modern medicine has shown several important aspects in the treatment of neuro-tumors," he said. First of all, molecular diagnostics has led us into the era of precision medicine, which provides precision treatment options for each patient through in-depth analysis of tumor molecular characteristics. Secondly, the rise of integrated diagnosis, comprehensive consideration of multiple information, to make the treatment more comprehensive and scientific; Finally, the combination of standardized and individualized treatment strategies not only ensures the safety of treatment, but also takes into account the individual differences of patients. This series of advances not only improves the accuracy of diagnosis and the effectiveness of treatment, but also reflects the respect of modern medicine for the individual differences of patients and the continuous optimization of treatment effects. ”
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Innovation in diagnostic concepts: Molecular diagnostics leads a new era of precision medicine
In the field of medicine, the concept of diagnosis of neuro-oncology is undergoing a profound revolution. According to Professor Tao, the traditional pathological diagnosis method mainly relies on the observation of cell morphology under a high-powered microscope and the percentage of malignant cells to judge the degree of malignancy of the tumor. However, this approach is sketchy in some cases and does not meet the needs of increasingly precise medical care. Before 2015, pathologists mainly relied on nuclear metachromaty, nuclear mitotic images, angiogenesis, necrosis, etc., as well as proliferation index to assess the degree of malignancy of tumors. However, in some cases, it is difficult for these methods to accurately determine the type of tumor and prognosis.
In recent years, with the rapid development of molecular biology, the diagnosis of neurological tumors has also ushered in a major breakthrough. Since 2015, with the continuous supplementation and improvement of molecular biology, the diagnosis of neurological tumors has become more refined and accurate. Among them, different types of tumors such as adult glioma, pediatric glioma, and senile glioma, as well as the distinction between low-grade and high-grade glioma, have all benefited from the introduction of genetic testing technology.
According to the latest guidance of the 5th edition of the WHO classification of central nervous system tumors in 2021, molecular diagnostics has become an integral part of the diagnosis of neurological tumors. Through genetic testing, doctors can more accurately determine the pathological grade and prognosis of tumors. This revolution provides a more accurate diagnosis and treatment plan for patients with neurological tumors.
It is worth mentioning that the introduction of molecular diagnosis not only improves the accuracy of diagnosis, but also provides strong support for the personalized treatment of patients. For example, in clinical practice, when low-grade gliomas are shown on pathology reports, and when molecular genetic testing reveals multiple gene mutations and driver genes, doctors need to re-evaluate the biological behavior and prognosis of the tumor. This can help to develop a more targeted treatment plan for patients, improving treatment outcomes and quality of life.
He believes that the introduction of molecular diagnostic technology is a big leap forward in the field of neuro-oncology diagnosis. It not only improves the accuracy and reliability of diagnosis, but also opens up new possibilities for personalized treatment for patients. With the continuous progress of science and technology, we have reason to believe that the diagnosis of neuro-tumor will be more accurate, efficient and personalized in the future.
"Integrated diagnosis" is of great importance in the diagnosis and treatment of neurological tumors
In recent years, "integrated diagnosis" is gradually becoming a key part of the diagnosis and treatment of neurological tumors, which is not only a medical concept, but also a new treatment strategy, providing patients with a more accurate and individualized treatment plan.
Professor Tao introduced that the value of integrated diagnosis is highlighted when encountering complex and difficult neurotumor cases, especially when traditional pathological diagnosis cannot solve clinical problems. However, integrated diagnostics is not a single detection method, but a multidisciplinary and cross-disciplinary collaborative process. In this process, bioinformatics experts translate complex genetic data into a "language" that doctors can understand, while biologists interpret the effects of these genetic mutations on tumor growth, metastasis, and possible prognosis. At the same time, pharmacologists provide patients with the most appropriate treatment drug suggestions based on the latest drug research progress at home and abroad.
This model of integrated diagnosis is actually a high-level multidisciplinary care (MDT) team collaboration – MTB refers to a committee of clinical oncologists, pathologists, molecular biologists, bioinformatics specialists, geneticists, and pharmacology experts to interpret and discuss multidisciplinary based on the patient's clinical information and tumor genomic variants. It includes not only surgeons, radiation therapists and chemotherapy specialists, but also biologists, internal medicine specialists and pharmacologists. Together, they discuss and develop an individualized treatment plan for each patient.
It is worth mentioning that integrated diagnostics also introduces advanced technologies such as in vitro culture of organoids, which allows doctors to simulate the growth of tumors in a laboratory environment, further improving the targeting and effectiveness of treatment. Professor Tao believes that integrated diagnosis plays an increasingly important role in the diagnosis and treatment of neurological tumors. It not only provides more accurate diagnostic results, but also allows patients to develop personalized treatment plans, thereby improving treatment outcomes and prolonging patient survival. We have reason to believe that integrated diagnosis will become an important direction in the future treatment of neuro-oncology.
Standardization and individualization: a new strategy for the treatment of intracranial malignancies
The treatment of intracranial malignancies has historically been a major challenge in the medical field. Professor Tao emphasized the importance of standardizing diagnosis and treatment in parallel with individualized diagnosis and treatment. He noted that surgery is still the preferred treatment for intracranial malignancies. On the premise of ensuring function, as much tumor tissue should be removed as much as possible. This principle is also clearly reflected in the latest updated authoritative guidance.
Secondly, radiotherapy also plays an important role in the treatment process. At present, except for children under 3 years of age, who rarely receive radiotherapy due to problems such as cognitive impairment and memory impairment, all patients basically need radiotherapy. Radiotherapy can effectively control the growth and spread of tumors according to their pathological properties.
Third, in terms of chemotherapy, although the progress of drugs for malignant glioma has been relatively slow in recent years, experts are still exploring new treatment options. At present, the commonly used chemotherapy drug in China is temozolomide, and foreign combination drug regimens also provide us with new ideas. It is worth mentioning that the resumption of production of setepa and teniposide injection (VM-26) provides a new treatment option for patients with relapsed and advanced stages, and the drug can penetrate the blood-brain barrier and has significant efficacy against malignant glioma.
In addition to traditional treatments such as surgery, radiotherapy, and chemotherapy, electric field therapy and anti-vascular therapy are also gradually emerging as new treatment strategies. Antivascular therapy, in particular, has achieved remarkable results in the treatment of recurrent glioblastoma. At the same time, the application of drugs such as bevacizumab and regorafenib has brought new hope to such patients.
Prof. Tao also shared their innovative experience in clinical practice. He proposed that the early use of bevacizumab in combination with small molecule TKI drugs such as anlotinib, apatinib and surufatinib can effectively improve the therapeutic effect. After three years of practice, he found that this combination therapy regimen can significantly prolong the survival of patients. In summary, the treatment of intracranial malignancies needs to consider a variety of methods and individualize treatment according to the specific situation of the patient.
The concept of comprehensive treatment is deeply rooted in the hearts of the people, and accurate diagnosis and individualized treatment are the key
With the continuous progress of medicine, the concept of comprehensive treatment of neurological tumors has been deeply rooted in the hearts of the people. Professor Tao pointed out that whether it is a malignant glioma or a refractory glioma, the key to its treatment lies in the words "diagnosis" and "treatment". In terms of diagnosis, although molecular diagnostics can achieve accurate diagnosis, it can help doctors understand the characteristics of tumors more accurately, so as to provide strong support for subsequent treatment. However, there are some difficulties in the diagnostic process.
For example, when a tumor recurs or metastasizes, new genetic mutations may emerge, which requires dynamic diagnostics to capture these changes in a timely manner. In addition, for tumors located in important sites, such as the brainstem and thalamus, it is difficult to take biopsies, and many patients' families will refuse to do so, which brings a lot of challenges to diagnosis.
In terms of treatment, Professor Tao emphasized the fundamental role of surgery. Removal of as much tumor tissue as possible is key to surgery, especially in the treatment of low-grade gliomas in children, and if complete resection can be achieved, subsequent treatments may no longer be necessary. In addition to surgery, standardized radiotherapy is also an important part of comprehensive treatment. Whether low-grade and high-grade gliomas require concurrent radiotherapy and how to determine the dose of radiotherapy need to be fully evaluated by doctors according to the specific situation of the patient.
In addition, with the continuous launch of new drugs and the application of new technologies, chemotherapy and immunotherapy are also playing an increasingly important role in the comprehensive treatment of neurological tumors. He said that new chemotherapy drugs, nanotechnology, fat-soluble technology, etc. provide more possibilities for treatment, and immunotherapy is also expected to make greater breakthroughs in the future development.
Professor Tao summarized the two guidelines for comprehensive treatment of neuro-oncology: precise diagnosis and individualized treatment. Only by accurately diagnosing the characteristics of the tumor can the most suitable treatment plan for the patient be formulated; At the same time, taking into account the specific situation and needs of each patient, individualized treatment is also the key to improving the treatment effect.
Deputy leader of the 6th China Glioma Collaboration Group
Vice Chairman of the Oncology Neurology Committee of the Chinese Anti-Cancer Association
Vice Chairman of the First Neuro-Oncology Professional Committee of China Association of Non-public Hospitals
He is a member of the Standing Committee of the First Glioma Professional Committee of the Chinese Anti-Cancer Association
He is a member of the Standing Committee of the 2nd Neuro-Oncology Committee of the Chinese Society of Clinical Oncology
He is a member of the 1st Glioma Professional Committee of the Chinese Medical Doctor Association
He is a member of the 1st to 5th Neuro-Oncology Committee of the Chinese Anti-Cancer Association
Chairman of the first Brain Metastases Committee of the Glioma Professional Committee of the Chinese Anti-Cancer Association
Vice Chairman of the 1st and 2nd Drug and Biological Therapy Committee of the Glioma Professional Committee of the Chinese Medical Doctor Association
Chairman of the 1st and 2nd Neuro-Oncology Professional Committee of Shandong Anti-Cancer Association
Honorary Chairman of the 3rd Neuro-Oncology Professional Committee of Shandong Anti-Cancer Association
Consultant of the first professional committee of glioma combined therapy of Shandong Medical Association
Chairman of the Fifth Council of Shandong Laser Medical Association