Neurological Surgery 脳神経外科34巻7号

2006年07月発行

総説

脳腫瘍に対する血管新生抑制療法

著者： 高野晋吾¹ 松村明¹

所属機関： ¹筑波大学大学院人間総合科学研究科臨床医学系脳神経外科

ページ範囲：P.657 - P.678

Ⅰ．は じ め に

　血管新生抑制療法は固形腫瘍に対する新しい治療として，Folkmanが1971年に“Tumor angiogenesis：Therapeutic implications”という標題でNew England Journal of Medicineに提唱してから，最近になりようやく臨床での有効性が報告され，特に既存の化学療法あるいは放射線療法との併用療法による臨床試験が飛躍的に多く行われている．これらの臨床試験にもとづき，大腸がんでは術後のファーストラインの治療として用いられ，血管新生抑制の方法の展開とともに腫瘍に対する新しい治療法としてさらに有望である．

　脳腫瘍のうちグリオーマは難治性であり，1）新生血管が豊富であること，2）WHO grade Ⅳはgrade Ⅲに比べて明らかに生存率が悪く，grade Ⅳの組織学的特徴である壊死，glomeruloid vesselはgrade Ⅲではみられない．壊死は種々の血管新生因子を誘発する組織の低酸素領域を顕し，他の悪性腫瘍にもみられないglomeruloid vesselはさまざまな血管新生因子，血管新生関連因子が働いた結果であること，3）血管新生抑制はグリオーマの浸潤にも関係する基底膜の破壊抑制にもつながることから血管新生抑制療法のよい標的と考えられている^14,39,62,89)．ここでは，グリオーマにおける血管新生のメカニズムおよび血管新生抑制療法のこれまでの経緯，現状とこれからの展望を述べる．

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