Kalifa C, Valteau D, Pizer B, Vassal G, Grill J, Hartmann O
Département de Pédiatrie Institut Gustave Roussy, 39 Rue Camille Desmoulins, F-94805 Villejuif Cédex, France.
Childs Nerv Syst. 1999 Oct;15(10):498-505. doi: 10.1007/s003810050538.
New therapeutic strategies are required to improve the prognosis of malignant brain tumours in children, in terms of survival and quality of life. During the last 10 years, high-dose chemotherapy (HDCT) with autologous haematopoietic stem cell rescue has been studied in different types of paediatric brain tumours. The most frequently used combined regimens were busulfan-thiotepa and etoposide-thiotepa along with carboplatin or BCNU. High response rates have been reported in medulloblastoma and germ cell tumours, and HDCT has been further developed as salvage therapy or for consolidation in these diseases. Interesting objective tumour responses have been obtained in supratentorial high-grade glioma, but HDCT has not so far been effective either in ependymoma or in diffuse pontine brain stem tumours. This article reviews the rationale for HDCT in brain tumours and the current clinical results obtained in each tumour type. The place of HDCT in the therapeutic strategy for paediatric brain tumours, especially in young children, is discussed.
为了改善儿童恶性脑肿瘤在生存和生活质量方面的预后，需要新的治疗策略。在过去十年中，对不同类型的儿童脑肿瘤开展了伴有自体造血干细胞救援的大剂量化疗（HDCT）研究。最常用的联合方案是白消安-噻替派以及依托泊苷-噻替派，同时联合卡铂或卡莫司汀。据报道，在髓母细胞瘤和生殖细胞瘤中反应率较高，HDCT已进一步发展为这些疾病的挽救治疗或巩固治疗。在幕上高级别胶质瘤中也获得了令人感兴趣的客观肿瘤反应，但迄今为止，HDCT在室管膜瘤或弥漫性脑桥脑干肿瘤中均未取得疗效。本文综述了HDCT用于脑肿瘤治疗的理论依据以及在每种肿瘤类型中获得的当前临床结果。讨论了HDCT在儿童脑肿瘤，尤其是幼儿脑肿瘤治疗策略中的地位。
