青少年期髓母细胞瘤：关于毒性和治疗的特定群体：一项加拿大儿科脑肿瘤联盟研究

Medulloblastoma in the second decade of life: a specific group with respect to toxicity and management: a Canadian Pediatric Brain Tumor Consortium Study.

作者信息

Tabori Uri, Sung Lillian, Hukin Juliette, Laperriere Normand, Crooks Bruce, Carret Anne-Sophie, Silva Mariana, Odame Isaac, Mpofu Chris, Strother Douglas, Wilson Beverly, Samson Yvan, Bouffet Eric

机构信息

Pediatric Brain Tumor Program, The Hospital for Sick Children, Toronto, Ontario, Canada.

出版信息

Cancer. 2005 May 1;103(9):1874-80. doi: 10.1002/cncr.21003.

DOI:10.1002/cncr.21003

PMID:15770645

Abstract

BACKGROUND

Most reported data of chemoradiotherapy protocols for the treatment of medulloblastoma describe children who were treated in the first decade of life. To consider the feasibility of this approach in adolescents, the authors studied their clinical course with specific emphasis on toxicity, tolerability, and prognosis.

METHODS

In this retrospective study, the authors examined the toxicity profiles and outcomes of children age 10-20 years with medulloblastoma who were treated at centers throughout Canada between 1986 and 2003. Detailed toxicity data from 2 chemotherapy protocols were collected for teenagers and were compared with data from a group of control patients age 5-10 years.

RESULTS

In total, 72 teenagers were analyzed. Grade >/= 2 ototoxicity and neurotoxicity occurred in 45% and 71% of chemotherapy-treated patients, respectively. Grade 3-4 hematotoxicty occurred in 95% of patients. Toxicity resulted in delay of treatment for 73% of patients and dose modification in 75% of patients, including protocol discontinuation in 25% of patients. Weight loss > 10% was encountered in 73% of patients and required intervention in 45% of patients. Teenagers had significantly more hematotoxicity and neurotoxicity compared with controls on both chemotherapeutic protocols. Ototoxicity was similar in both age groups. Toxicity resulted in significantly more treatment delays and dose modifications in teenager patients compared with controls. The 5-year overall and event-free survival rates (+/- standard deviation) were 78% +/- 6% and 70% +/- 6%, respectively. The mean time (+/- standard deviation) to disease recurrence was 3.2 +/- 2.2 years.

CONCLUSIONS

The increased toxicity rate and high incidence of treatment modifications in this study suggested that current pediatric protocols may require modifications for teenagers with medulloblastoma. The results highlighted several issues that should be addressed in future prospective trials.

摘要

背景

大多数报道的髓母细胞瘤放化疗方案的数据描述的是在生命的第一个十年接受治疗的儿童。为了探讨这种方法在青少年中的可行性，作者研究了他们的临床病程，特别强调了毒性、耐受性和预后。

方法

在这项回顾性研究中，作者检查了1986年至2003年期间在加拿大各中心接受治疗的10至20岁髓母细胞瘤儿童的毒性特征和结局。收集了来自2种化疗方案的青少年详细毒性数据，并与一组5至10岁对照患者的数据进行比较。

结果

总共分析了72名青少年。接受化疗的患者中，≥2级耳毒性和神经毒性的发生率分别为45%和71%。95%的患者发生3 - 4级血液毒性。毒性导致73%的患者治疗延迟，75%的患者剂量调整，其中25%的患者终止方案。73%的患者体重减轻>10%，45%的患者需要干预。在两种化疗方案中，青少年的血液毒性和神经毒性均显著高于对照组。两个年龄组的耳毒性相似。与对照组相比，毒性导致青少年患者的治疗延迟和剂量调整显著更多。5年总生存率和无事件生存率（±标准差）分别为78%±6%和70%±6%。疾病复发的平均时间（±标准差）为3.2±2.2年。