Paulino Arnold C, Nguyen Thanh X, Barker Jerry L
Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA.
Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):177-83. doi: 10.1016/s0360-3016(03)00502-9.
To determine the incidence and prognosis of children who develop brain metastasis.
The medical and tumor registry records of 611 children treated at the University of Iowa Hospitals and Clinics between 1965 and 2000 for a sarcoma, neuroblastoma, or Wilms' tumor were reviewed.
Thirty children (4.9%) were found to have brain metastasis. Brain metastasis occurred in 9 of 113 (8%) neuroblastoma, 7 of 104 (6.7%) rhabdomyosarcoma, 6 of 105 (5.7%) Ewing's sarcoma, 5 of 106 (4.7%) osteosarcoma, 2 of 83 (2.4%) nonrhabdomyosarcoma soft-tissue sarcoma, and 1 of 100 (1%) Wilms' tumor patients. There were 22 male and 8 female patients, with a median age of 14 years at the time of diagnosis of brain metastasis (range 8 months-20 years). Four patients were diagnosed at autopsy, whereas five had brain metastasis at initial diagnosis. For the 25 children who did not have brain metastasis at initial presentation, the median interval from initial diagnosis to development of brain metastasis was 5 months (range 1-43 months). Twenty-nine (97%) had concurrent or prior history of distant metastasis. Eighteen (60%) had solitary brain metastasis. Treatment for the 26 non-autopsy-diagnosed children included surgery (S), followed by postoperative radiotherapy (RT) and chemotherapy (CT) in 2, S and postoperative RT in 1, RT and CT in 16, S alone in 2, CT alone in 2, RT alone in 1, and no treatment in 2. Median survival was 4 months after diagnosis of brain metastasis, with a 1-year survival rate of 11.5%. On multivariate analysis, only the use of RT was found to positively influence freedom from neurologic progression (p = 0.005).
Brain metastasis is uncommon in children with a diagnosis of sarcoma, neuroblastoma, or Wilms' tumor and is often accompanied by concurrent distant disease. Children treated with RT for brain metastasis had a better freedom from neurologic progression rate than those who did not receive radiotherapy.
确定发生脑转移的儿童的发病率和预后。
回顾了1965年至2000年间在爱荷华大学医院及诊所接受治疗的611例患有肉瘤、神经母细胞瘤或肾母细胞瘤的儿童的医疗和肿瘤登记记录。
发现30例儿童（4.9%）发生脑转移。脑转移发生在113例神经母细胞瘤中的9例（8%）、104例横纹肌肉瘤中的7例（6.7%）、105例尤因肉瘤中的6例（5.7%）、106例骨肉瘤中的5例（4.7%）、83例非横纹肌肉瘤软组织肉瘤中的2例（2.4%）以及100例肾母细胞瘤患者中的1例（1%）。有22例男性和8例女性患者，脑转移诊断时的中位年龄为14岁（范围8个月至20岁）。4例患者在尸检时被诊断，而5例在初始诊断时即有脑转移。对于25例初始表现时没有脑转移的儿童，从初始诊断到发生脑转移的中位间隔时间为5个月（范围1至43个月）。29例（97%）有远处转移的并发或既往史。18例（60%）有孤立性脑转移。26例非尸检诊断的儿童的治疗包括手术（S），其中2例术后接受放疗（RT）和化疗（CT），1例接受S和术后RT，16例接受RT和CT，2例仅接受S，2例仅接受CT，1例仅接受RT，2例未接受治疗。脑转移诊断后的中位生存期为4个月，1年生存率为11.5%。多因素分析显示，仅放疗的使用被发现对无神经功能进展有积极影响（p = 0.005）。
脑转移在诊断为肉瘤、神经母细胞瘤或肾母细胞瘤的儿童中并不常见，且常伴有并发的远处疾病。接受放疗治疗脑转移的儿童无神经功能进展率高于未接受放疗的儿童。
