中国儿童高级别胶质瘤诊疗指南(2024版)

中国儿童高级别胶质瘤诊疗指南(2024版)评价(gradingofrecommendationsassessment,d证据等级 低未来研究很有可能对现有疗效评估有重要影响，改变评估结果可信度的可能性较大 极低任何疗效的评估都很不确定推荐强度弱利弊不确定或者利弊相当ma”“Chemotherapy”“CT”“Diffuseintrinsicpontineg”“Molecularpathology”“Responseassessment”“Immunotherapy”“Surgery”“Management”“MRI”“PET-CT”“PHGG”“Radio-therapy”“Targetedtherapy”“T同头颅MRI稳定或改善停用激素或仅用生理替代剂量；停用减小≥25%,持续8周不适用稳定或改善减小≥50%,持续8周同头颅MRI稳定或改善不适用临床情况恶化(除外其他因素)不适用同头颅MRI不适用不适用表3不同病理学类型儿童高级别胶质瘤的分(级)弥漫性中线胶质瘤，弥漫性大脑半球胶质瘤，弥漫性儿童型高级别444IDH野生型，H3.3IDH野生型，NTRK家IHC、qPCR、Sanger测序、IHC、qPCR、Sanger测序、FISH、qPCR、Sanger测序、位于大脑半球，瘤细胞常为Olig2、ATRX、查微卫星不稳定性和是否为胚系突变，以除外遗传相关综合征年人IDH突变，不伴有1p/IHC、F19q联合缺失测序、NGS、DNAMC2*,3IDH突变并1p/19q联IHC、FISH、qP多形性黄色星形细胞瘤2*,3IDH野生型，BRAF突4IDH野生型，BRAF突失，PDGFRA扩增推荐意见10:对于带“NOS”或“NEC”后缀的“描述性诊断”,病理学诊断赋予分级时存期(overallsurvival,0S)和无进展生存期(progressionfreesu1.化学治疗：对于年龄≥3岁的儿童，放疗联合替莫唑胺和洛莫司汀辅助治推荐意见22:术后48周内开始放疗联合同步替莫唑胺治疗，及辅助替莫唑胺(单药或联观缓解率(objectiveresponserate,ORR)达52.8%~65.9%,并与持久缓解和良好的生存预变异的原发性CNS肿瘤的儿童和青年患者，ORR为5的发生，其特征为突变负荷高于偶发脑肿瘤或其他实体瘤中的典型突变负荷[81],发生超突推荐意见26:超突变肿瘤患儿可应用纳武利尤单抗、帕博利珠单抗等免疫检查点抑制剂汀等)姑息性化疗[68,83,87-88]。虽然贝伐珠单抗在新诊断的PHGG治疗中未能增加获益，col,2020,22(1):116-127.DOI:10.1093/neuonc/noz142.[2]NunnaRS,KhalidS,Behbahaniandoutcomes[J].ChildsNervSyst,2021,37(1):185-193.DO[3]LamS,LinY,MelkonianS.Anatrichigh-gradespinalcordastrocytoeurosurg,2012,48(5):299-305.10.1159/000353135.[4]GajjarA,MahajanA,Abdelbacancers,version2.2023,NCCNClinicalPracticeGuidelinesinOnctlComprCancNetw,2022,20(12):1339-1362.DOI:10.6004/jnccn.2022.0062.vNeurol,2022,18(9):515-529.DOI:10.1038/s41582-022-00679-w.ico-pathologicalprofile,therapeutsurvival[J].Neurochirurgie,2019,65(2-3):63-68.DOI:10.1016/j.neuchi.2019.03.(3):541-549.DOI:10.1007/s11060[8]ErkerC,TamraziB,PoussaintTY,ethigh-gradeglioma:recommendationsfromtheResponseAssessmentinPediatricNeuro-Oncology(RAPNO)WorkingGroup[J].LancetOncol,2020,21(6):e317-e3I:10.1016/S1470-2045(20)3ntrinsicpontineglioma:recommendationsfromtheRespricNeuro-Oncology(RAPNO)WorkingGroup[J].LancetOncol,2020,21(6):e6.DOI:10.1016/S1470-2045(20)30166-2edictiveofpostoperativeventriculoperitonealshuntinposteriorfossatumors[J].PediatrNeurol,2023,144:119-125.DOI:10.1016/j.pediatrneurol.2023.04.023.[11]ChatwinHV,CruzCruzJ,Greenowardsubtype-specificmultimodaltherapy[J].FEBSDOI:10.1111/febs.15739.[12]ValviS,ManoharanN,MateosMK,etal.ManagementoealandChildren'sHaematology/OncologyGrouppositi2024,220(10):533-538.DOI:10.5694/mja2.52295.[13]McNamaraC,MankadK,ThustS,etalofthecentralnervoussystem:areviewfortheneuroradiologist[J].Neuroradiology,2022,64(10):1919-1950.DOI:10.1007/s00234-022-03008-6.[14]LazowMA,FullerC,DeWireM,etal.Accuracy[J].NeuroOncol,2022,24(5):821-833.DOI:10.1093/neuonc/noab245.[15]AuffretL,AjlilY,Tauziède-EspariatA,etal.Anewstomolecularcharacterisation[J].ActaNeuropathol,7/s00401-023-02651-4.omasbymagneticresonanceimaging:asystematicreviewaneuroradiology,2022,64(7):1311-1319.DOI:10.1007/s00234-022-02947-4.ndimplicationsofw-gradegliomas,andcircumscribedastrocyticgliomas[J].JMagnReso2023,58(3):690-708.DOI:10.1002/jmri.28740.hespectrumofdiffusegliomas[J].Radiology,2022,304(3):494-508.DOI:10.1148/radiol.213063.[19]BaderA,HeranM,DunhamC,etal.Radiologicaloblastomaanddesmoplasticspitalexperience[J].JNeurosurgPediatr,2015,16(2):119-125.DOI:10.3171/2023.DOI:10.1093/neuonc/nox087.[21]NikamRM,YueX,KaurG,etal.Advancedneuroimagingapproachetricbraintumors[J].Cancers(Basel),2022,14(14):3401.DOI:10.3390/cancers1ationofpediatricmalignancies[J].JNuclMed,2015,56(2):274-286.DOI:10.2967/jnumed.114.146290.[23]PiccardoA,AlbertNL,BorgwardtL,etal.JointEANM/SIOPE/RAPNOpracticeguidelines/SNMMIprocedurest1MedMolImaging,2022,49(11):3852-3869.DOI:10.1007/s00259-022-05817-6.diatriclow-gradeglioma:recommendationsfromtheResponseAssessmetricNeuro-Oncology(RAPNO)WorkingGroup[J].LancetOncol,2020,21(6):e305-e316.DOI:10.1016/S1470-204[25]YuX,LiS,MaiW,etaeanalyses[J].EurRadiol,2024(2024-06-21)[2024-07-09]./10.1007/s00330-024-10855-9.[26]VajapeyamS,BrownD,BillupsC,etaltricbraintumorconsortium[J].AJNRAmJNeuroradiol,2020,41(4):718-724.DOI:1251.DOI:10.1093/ne[J].NeuroOncol,2023,25(1):199-210.DOI:10.1093/neuonc/noac132.6(3):112-120.DOI:10.1007/s10014ledoutcomeanalysisofmolecularlyannotatedpediatredependymoma[J].NeurooncolAdv,2023,5(1):vdad057tumorsacrossallCNScompartments,histopatholoCancerCell,2015,27(5):728-743.DOI:10.1016/j.ccell.2015.04.002.[32]LouisDN,WesselingP,AldapeK,etal.cIMPACT-anddiagnosticprinciplerecommendDOI:10.1111/bpa.12832./NTRK/METdriveagroupofinfantilehemisph0(1):4343.DOI:10.1038/s41467-019-12187-5.centralnervoussystemtumours[J].Nature,2018,555(7697):469-474.DOI:38/nature26000.ndistinguishingIDH-wildtypeglioblastomaomnext-generationsequencinganalysisof479c-01-12)[2024-07-09]./doi/10.11blishedonlineaheadofprint].[36]ReinhardtA,StichelD,SchrimpfD,etal.Anaplasticastro-cytomawithpiloidfeatures,anovelmolecularclassofIDHwildtypegliomawithrecurrentM73-291.DOI:10.1007/s00401-018-1837-8.urrNeurolNeurosciRep,2021,21(11):64.DOI:10.1007/s11910-021-01149-4[38]Priesterbach-AckleyLP,BoldtHB,PetersenJK,etasticsusingaDNAmethylation-baseNeuropatholApplNeurobiol,2020,46(5):478-492.DOI:10.1111/nan.12610.[39]JaunmuktaneZ,CapperD,Jones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