يتناول هذا البروتوكول ورم النخاع الأرومي في الدماغ لدى المرضى المصنَّفين ضمن فئة عالية الخطورة بناءً على عبء الورم بعد الجراحة، أو مدى الانتشار النقيلي، أو الخصائص النسيجية والجزيئية المحددة.
DOI: 10.1016/S1470-2045(19)30669-2
High risk • Residual tumour >1·5 cm² • >M1 • Large cell/anaplastic histology • Group 4 molecular subgroup • SHH TP53mut
Vasogenic tumour oedema should be reduced by administration of corticosteroids before surgery (level III A).
If possible, surgery with definite tumour removal should be used to relieve the obstruction-causing hydrocephalus (level III A).
A gross total resection (GTR) with a residual volume of less than 1·5 cm² should be done in all patients to alleviate symptoms and to facilitate rapid diagnosis (level II A).
In cases where GTR is either not safe or not feasible, a maximal safe resection sparing eloquent areas and leaving residual tumour behind should be done (level II A).
Craniospinal irradiation is mandatory (level I A).
Adult patients with medulloblastoma should be treated with systemic therapy, in addition to resection and radiotherapy, irrespective of their risk category (level II A).
A postoperative MRI should be done within 48 h (level III A).
View source ↗