Sun Xiao-Fei, Liu Dong-Geng, Su Yi-Shun, Lin Tong-Yu, Chen Xiao-Qin, He You-Jian
Department of Medical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
Ai Zheng. 2003 Dec;22(12):1343-5.
BACKGROUND & OBJECTIVE: Neuroblastoma is one of common solid tumors in children. The major treatment modality for neuroblastoma (NB) is chemotherapy combined with operation or irradiation. But the survival rate is still low for advanced patients. Further study is needed for improving cure rate of neuroblastoma. This study was designed to evaluate the efficacy of children with neuroblastoma treated in Cancer Center, Sun Yat-sen University, and to explore reasonable therapy strategy.
The clinical data of 30 children with NB aged from 7 months to 13 years were analyzed retrospectively. These patients were treated with chemotherapy plus operation or radiation. The stages were as follow: II, n=2; III, n=12; IV, n=15; IVS, n=1. Chemotherapy regimen was CAV (cyclophosphamide 750 mg/m(2) d1, vincristine 1.5 mg/m(2), d1, Adriamycin 50 mg/m(2) d1) alternated with EP (teniposide or etoposide 60 mg/m(2) d1-d5, cisplatin 20 mg/m(2) d1-d5). The resection would be done after 4 to 6 cycles of chemotherapy if possible. The chemotherapy or radiation would be done after resection. If operation was not available, the patients continued to receive the chemotherapy. The patients with stage IVS only received cyclophosphamide plus vincristine.
Among 30 patients, 2 cases achieved complete remission (CR 6.7%) by chemotherapy alone; 21 cases achieved partial remission (PR 70%); 6 cases showed no change (NC 20%); 1 cases showed progressive diseases (3.3%). Overall response rate (CR+PR) were 76.7% by chemotherapy alone. Of 21 PR patients, 9 cases could be resected;4 cases achieved CR after operation; 1 case achieved CR after radiation. The 2-year overall survival rate was 47.8% for all patients; 100% for Stage II/IVS, 34% for stage III, 22% for stage IV, respectively. Grade III/IV hematological toxicity occurred in 41.2% of the CAV regimen and 26.6% of the EP regimen.
Chemotherapy plus operation or radiation is the major treatment for neuroblastoma. CAV/EP alternative chemotherapy is the active regimen for NB. The toxicity is tolerable. Advance stage NB needs further study for improving the prognosis.
神经母细胞瘤是儿童常见的实体瘤之一。神经母细胞瘤（NB）的主要治疗方式是化疗联合手术或放疗。但晚期患者的生存率仍然较低。需要进一步研究以提高神经母细胞瘤的治愈率。本研究旨在评估中山大学肿瘤防治中心治疗的儿童神经母细胞瘤患者的疗效，并探索合理的治疗策略。
回顾性分析30例年龄从7个月至13岁的NB患儿的临床资料。这些患者接受化疗加手术或放疗。分期如下：Ⅱ期，n = 2；Ⅲ期，n = 12；Ⅳ期，n = 15；Ⅳs期，n = 1。化疗方案为CAV（环磷酰胺750mg/m² d1，长春新碱1.5mg/m²，d1，阿霉素50mg/m² d1）与EP（替尼泊苷或依托泊苷60mg/m² d1 - d5，顺铂20mg/m² d1 - d5）交替使用。如果可能，在化疗4至6个周期后进行手术切除。切除术后进行化疗或放疗。如果无法进行手术，患者继续接受化疗。Ⅳs期患者仅接受环磷酰胺加长春新碱治疗。
30例患者中，2例单纯化疗获得完全缓解（CR 6.7%）；21例获得部分缓解（PR 70%）；6例病情无变化（NC 20%）；1例病情进展（3.3%）。单纯化疗总的缓解率（CR + PR）为76.7%。21例PR患者中，9例可进行手术切除；4例术后获得CR；1例放疗后获得CR。所有患者的2年总生存率为47.8%；Ⅱ/Ⅳs期为100%，Ⅲ期为34%，Ⅳ期为22%。CAV方案中3/4级血液学毒性发生率为41.2%，EP方案为26.6%。
化疗加手术或放疗是神经母细胞瘤的主要治疗方法。CAV/EP交替化疗是NB的有效方案。毒性是可耐受的。晚期NB需要进一步研究以改善预后。
