Resumen
Introducción: los gliomas difusos son tumores cerebrales altamente infiltrativos, con mal pronóstico y limitada respuesta terapéutica. La resección quirúrgica es fundamental, pero lograr un equilibrio entre la extensión de la resección (EOR) y la preservación de la función neurológica representa un desafío. Los avances en tecnologías intraoperatorias y perfil molecular han abierto nuevas posibilidades para un tratamiento individualizado.
Materiales y métodos: se realizó una revisión sistemática siguiendo las guías PRISMA. Se incluyeron estudios que evaluaban estrategias quirúrgicas como la resección subtotal (STR), la resección total macroscópica (GTR) y la resección supramáxima (SMR). También se analizaron biomarcadores moleculares como las mutaciones en IDH, la metilación del promotor de MGMT y las codeleciones 1p/19q.
Resultados: los gliomas con mutaciones en IDH mostraron una mayor supervivencia global y mejor respuesta a terapias adyuvantes. La metilación del promotor de MGMT se asoció con mayor supervivencia global en pacientes tratados con temozolomida. La resección supramáxima fue superior a la resección total macroscópica y a la resección subtotal en mejorar la supervivencia libre de progresión y la supervivencia global. Las cirugías guiadas por fluorescencia e imagen intraoperatoria redujeron el volumen tumoral residual, mejoraron la precisión de la resección y disminuyeron las complicaciones. No obstante, las resecciones agresivas se asociaron a un mayor riesgo de déficits neurológicos postoperatorios.
Discusión: la integración de innovaciones quirúrgicas con la caracterización molecular permite un manejo más preciso y eficaz de los gliomas. Aunque maximizar la extensión de la resección mejora el pronóstico oncológico, debe ponderarse con el riesgo funcional. Las herramientas tecnológicas pueden reducir esta tensión, especialmente en áreas elocuentes.
Conclusiones: las técnicas quirúrgicas avanzadas combinadas con estrategias guiadas por biomarcadores mejoran los desenlaces en pacientes con gliomas difusos. Los enfoques personalizados son esenciales para adaptar los tratamientos quirúrgicos y adyuvantes, mejorando la calidad de vida y prolongando la supervivencia.
Citas
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