解放军医学杂志2011，Vol.36Issue(6)：657-659,662,4.
综合治疗儿童髓母细胞瘤33例临床分析
Combined radiotherapy and chemotherapy for pediatric medulloblastoma: a clinical study of 33 cases
郑伟 1聂青 1康静波 1杨平 1张丽萍 1李方明1
作者信息
- 1. 100048,北京,海军总医院放射肿瘤科
- 折叠
摘要
Abstract
Objective To retrospectively review the clinical characteristics of medulloblastoma, discuss the optimized treatment regimen, and analyze the prognostic influential factors. Methods Thirty-three children with pathologically certified medulloblastoma (aged 3-14 years with average of 6.5 years), admitted from Aug. 2004 to Dec. 2007, received radiotherapy within 3 weeks post surgery.Ratiotherapy consisted of 28～36Gy whole craniospinal radiation and a supplementary radiation aimed at tumors by three-dimensional conformal radiotherapy (3D-CRT) for a total dose of 50～54Gy (conventional fraction dose of 1.8-2.OGy). A part of patients received hyperfractionation radiotherapy (1.0Gy/f, 2f/d) for alleviating the tardive adverse events. Meanwhile, a synchronized chemotherapy,consisting of lomustine + vincristine + cisplatin, or isophosphamide + carboplatin + etoposide, was administered after the completion of whole craniospinal radiation, and 3-5 courses of sequential chemotherapy were given after the overall radiotherapy was finished. According to the metastasis, and the residual tumor and its size, the 33 patients were divided into 2 groups as follows : low-risk group (n=24) : no metastases, total or sub-total excision of tumors (residual tumors ≤1.5cm3) ; high-risk group ( n=9) : either metastases or residual tumor ＞1.5cm3. The 3-year surival rates of two groups were then compared. Results The combined radiotherapy and chemotherapy was effective to 10 of the 11 patients (90.9％) with residual tumors. Out of the 33 patients, 31 obtained complete remission (93.9％), and 2 patients showed partial remission or stable status (3.0％, respectively) . The median survival time of 33 patients was 51 months, 3-year disease free survival (DFS) was 75.8％, and 3-year overall survival (OS) was 78.8％, including 33.3％ in high-risk group and 95.8％ in low-risk group (P＜0.01). The major side effects occurred in haematological system and digestive system, such as an incidence of 21.2％(7133) with grade Ⅲ - Ⅳ bone marrow suppression, 87.9％(29/33) with nausea, and 66.7％(22/33) with nausea and vomiting.Conclusions It is not difficult to make a definite diagnosis of pediatric medulloblastoma. Combined radiotherapy and chemotherapy following surgery, which is primarily recommended therapy, will give favorable effects with a low risk of complicating severe adverse events. The eradication of the tumor plays a pivotal role in influencing the prognosis of patients.关键词
髓母细胞瘤/放射治疗剂量/预后Key words
medulloblastoma/ radiotherapy dosage/ antineoplastic combined chemotherapy protocols / prognosis分类
医药卫生引用本文复制引用
郑伟,聂青,康静波,杨平,张丽萍,李方明..综合治疗儿童髓母细胞瘤33例临床分析[J].解放军医学杂志,2011,36(6):657-659,662,4.
