Broniscer Alberto, Laningham Fred H, Kocak Mehmet, Krasin Matthew J, Fouladi Maryam, Merchant Thomas E, Kun Larry E, Boyett James M, Gajjar Amar
Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105, USA.
Cancer. 2006 Mar 15;106(6):1364-71. doi: 10.1002/cncr.21749.
Children with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG.
All available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10-year interval (1992-2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow-up, all patients had died of tumor progression.
The authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25% of patients at the time of diagnosis. The 6-month and 12-month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5% +/- 5.5% and 24.4% +/- 6.5%, respectively. The same estimates for symptomatic cases were 8.9% +/- 4% and 17.8% +/- 6%, respectively. All cases of IH at the time of diagnosis and 78% of symptomatic cases that developed after diagnosis were located in necrotic areas.
Although IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20% of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event.
弥漫性脑干胶质瘤（BSG）患儿通常采用新的治疗方法，因为放射治疗（RT）对其疗效不佳。尽管最近使用新型生物制剂的临床试验记录了几例BSG患儿发生瘤内出血（IH），但据作者所知，对此现象了解甚少。在本研究中，作者评估了BSG患儿IH的特征并估计了其累积发生率。
回顾了在10年期间（1992 - 2002年）在研究机构接受治疗的48例新诊断的BSG连续患者的所有可用脑部影像学研究和医疗记录。治疗包括RT和各种传统化疗方案；这些患者均未接受生物制剂治疗。在最后一次随访时，所有患者均死于肿瘤进展。
作者回顾了319项影像学研究（251次磁共振成像扫描和68次计算机断层扫描）。诊断时6.25%的患者存在IH。无论有无相关症状，IH的6个月和12个月累积发生率估计分别为15.5%±5.5%和24.4%±6.5%。有症状病例的相同估计分别为8.9%±4%和17.8%±6%。诊断时所有IH病例以及诊断后发生的78%有症状病例位于坏死区域。
尽管诊断时IH并不常见，但BSG诊断后近20%的患儿可能发生有症状的IH。接受各种化疗方案治疗的患者中IH的一致发生及其与坏死区域的关联表明肿瘤生物学在这一事件中起重要作用。
