Biassoni V, Casanova M, Spreafico F, Gandola L, Massimino M
Department of Pediatric, Istituto Nazionale per lo Studio e la Cura dei Tumori, 20133, Milan, Italy.
J Neurooncol. 2006 Nov;80(2):195-201. doi: 10.1007/s11060-006-9176-3. Epub 2006 May 3.
Childhood malignant gliomas are rare and their clinical behavior is almost as aggressive as in adults: they resist treatment, progress rapidly and often spread. Therapeutic strategies at relapse deserve an experimental approach, since none of the conventional-dose treatments have demonstrated a clear superiority over the others and no randomized trials have proved that high-dose chemotherapy is better than conventional treatment. Vinorelbine is a semi-synthetic vinca alkaloid with an in vitro and in vivo experimentally proven broad spectrum of activity, including against malignant brain glioma. We report our experience with a 19-year-old girl with glioblastoma multiforme (GBM) of the deep temporal region recurring 6 months after completing an intensive treatment that included preradiation chemotherapy (chemotherapy as a preradiation "sandwich" phase) with a myeloablative course of thiotepa, tumor bed radiotherapy and postradiation maintenance chemotherapy. The GBM proved fully responsive to intravenous vinorelbine, with a subsequent progression-free interval lasting more than 24 months. This case report suggests that vinorelbine is effective against high-grade pediatric glioma and, since this evidence has only one precedent in the literature (and given the generally poor prognosis for this tumor), even this single success seems worth reporting.
儿童恶性胶质瘤较为罕见，其临床行为几乎与成人一样具有侵袭性：它们抗拒治疗，进展迅速且常发生扩散。复发时的治疗策略值得采用实验性方法，因为常规剂量治疗中没有一种显示出比其他方法具有明显优势，且没有随机试验证明高剂量化疗优于传统治疗。长春瑞滨是一种半合成长春花生物碱，其体外和体内实验证明具有广泛的活性谱，包括对恶性脑胶质瘤的活性。我们报告了一名19岁女孩的病例，她患有颞叶深部多形性胶质母细胞瘤（GBM），在完成强化治疗6个月后复发，强化治疗包括放疗前化疗（化疗作为放疗前的“三明治”阶段），使用噻替派进行清髓疗程、肿瘤床放疗及放疗后维持化疗。该GBM对静脉注射长春瑞滨完全反应良好，随后无进展生存期超过24个月。本病例报告表明长春瑞滨对高级别儿童胶质瘤有效，并且由于该证据在文献中仅有一个先例（且鉴于该肿瘤总体预后较差），即使这一单一成功案例似乎也值得报告。
