Neurological Surgery 脳神経外科41巻7号

2013年07月発行

総説

Grade Ⅱ神経膠腫のエビデンスと治療

著者： 成田善孝¹

所属機関： ¹国立がん研究センター脳脊髄腫瘍科

ページ範囲：P.565 - P.581

Ⅰ．はじめに

　WHO grade Ⅱ神経膠腫（World Health Organization grade Ⅱ glioma）に分類されるびまん性星細胞腫（diffuse astrocytoma：DA）・乏突起膠腫（oligodendroglioma：OL）・乏突起星細胞腫（oligoastrocytoma：OA）は，WHO grade Ⅲの退形成性星細胞腫（anaplastic astrocytoma：AA）やgrade Ⅳの膠芽腫（glioblastoma：GBM）に比べると，生存期間が長いため，“良性の”神経膠腫と説明されることがある．しかし，脳腫瘍全国集計調査報告Vol.12（1984-2000）¹²⁾によると，DAおよびOLの5年生存率は68.3%・87.8%である．全国がん（成人病）センター協議会（全がん協）による共同調査によると，全がん協加盟施設の部位別の全症例（ステージⅠ～Ⅳの集計）の5年生存率は，乳がん（87.3%），結腸がん（74.6%），胃がん（71.8%），肺がん（37.8%），膵臓がん（7.8%）であり⁷⁴⁾，DAは未だ予後不良の悪性腫瘍（がん）であることが実感される．WHO grade Ⅱ神経膠腫は長い時間をかけてgrade Ⅲ，grade Ⅳ神経膠腫へ悪性転化（malignant transformation）し，患者を死にいたらしめる“悪性腫瘍”である．低悪性度神経膠腫（low grade glioma：LGG）という言葉が用いられるときには，grade Ⅱのみならずgrade Ⅰの毛様細胞性星細胞腫も含まれていることがあるので，古い臨床試験の成績の解釈においては注意が必要である．本稿では，WHO grade Ⅱ神経膠腫についてのエビデンスとその治療について述べる．

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