在神经外科瘤学中针对性和免疫学药物的术期管理
Maged T Ghoche1,2, Kenji Miki1,2, Fanen Yuan1,2
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Neurosurgery
|February 2, 2026
概括
在神经外科手术前后管理现代癌症疗法至关重要. 本综述为定时向和生物制剂提供了一个框架,以最大限度地降低诸如伤口愈合不良和感染等风险.
科学领域:
- 神经外科瘤学 神经外科瘤学
- 药理学 药理学是指药理学的学科.
- 在瘤学瘤学.
背景情况:
- 系统疗法在癌症治疗中的使用越来越多,这给神经外科手术带来了独特的挑战.
- 许多瘤药物可以损害伤口愈合,血液静止和免疫功能,增加外科手术期间的风险.
- 有限的基于证据的指导存在于神经外科干预周围管理这些药物.
研究的目的:
- 开发一个全面和可操作的框架,用于神经外科瘤学中针对性和生物疗法的术前管理.
- 为神经外科医生提供基于证据的推药物定时,以减轻手术风险.
主要方法:
- 临床试验,FDA安全数据,元分析和社会指导方针的系统审查.
- 基于药理动力学,作用机制和与手术结果相关的不良影响对药物类别的评估.
- 根据风险级别对建议进行分层分类,以证据和专家共识为基础.
主要成果:
- 抗VEGF单克隆抗体和mTOR抑制剂具有最高的伤口愈合风险,需要延长手术前持有 (分别为≥4周和≥1周) 和2-4周的术后延迟.
- VEGF受体-TKIs和BTK抑制剂增加出血风险,需要短暂停留 (长达1周),并在手术后3-7天恢复.
- CDK4/6抑制剂,JAK抑制剂和生物免疫调节剂增加了感染风险,需要短暂的中断 (2-7天) 和术后1-2周的恢复.
结论:
- 现代的全身疗法需要在神经外科瘤学中更新的术后管理策略.
- 药物定时和风险减轻的务实框架对于平衡手术安全和瘤控制至关重要.
- 实施这些原则可以减少并发症,标准化护理,并改善神经外科瘤患者的治疗结果.
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