Neurological Surgery 脳神経外科47巻2号

2019年02月発行

特別寄稿 脳神経外科コントロバーシー2019

（7）グレード2神経膠腫に対する治療方針—手術・放射線治療・化学療法

著者： 新田雅之¹ 村垣善浩¹

所属機関： ¹東京女子医科大学脳神経外科

ページ範囲：P.147 - P.158

Ⅰ．はじめに
　低悪性度神経膠腫は20〜40代に多く発生し，脳内に浸潤性に進展する腫瘍であり，Nakamuraらの統計報告と脳腫瘍全国集計調査（脳腫瘍全国統計）から推測すると，発生頻度は100万人に6.3人程度と非常に稀である^2,47)．前世紀までは，「良性グリオーマ」と呼ばれ，主に「経過観察」が行われていたが，最近では手術で可能な限り腫瘍を摘出する，という方針が一般的になっている．しかしながら，手術でどこまで摘出すべきか，術後の放射線療法，化学療法は必要なのか，どのタイミングでどのような治療を行うべきなのか，他に有効な治療はないのかなど，いまだ標準治療は確立されていない．また，2016年に改訂されたWorld Health Organization（WHO）脳腫瘍分類において神経膠腫診断に遺伝子診断が必須となり，今後は遺伝子診断に基づいた治療方針が確立されていくと考えられる．本稿では，WHOグレード2神経膠腫の治療戦略に関して，これまでの経緯，現状および今後の展望を述べる．

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