Zhen Zi-Jun, Sun Xiao-Fei, Xia Yi, Wang Zhi-Hui, Ling Jia-Yu
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China.
Ai Zheng. 2006 Dec;25(12):1550-2.
BACKGROUND & OBJECTIVE: About 30% of neuroblastoma patients have poor response to first-line chemotherapy or progress during chemotherapy. Although advanced neuroblastoma patients could achieve complete remission after combined treatment, most of them relapsed finally. This study was to evaluate the efficacy of ifosphamide and carboplatin as a salvage chemotherapy regimen on recurrent or refractory neuroblastoma.
Nine refractory neuroblastoma patients and 23 recurrent neuroblastoma patients were treated with ifosphamide (1.5 g/m(2) daily for 5 days) and carboplatin (400 mg/m(2) on day 1). Mesna was applied at a dosage of 20% of ifosfamide 3 times at 4-hour intervals after termination of the ifosfamide infusion. Chemotherapy was administered every 2-3 weeks.
None of the 32 patients achieved complete remission; 19 (59.4%) achieved partial remission. The median remission time was 4.2 months (1-28 months). After chemotherapy, 8 patients received operation to resect tumors. Main adverse events included grade III-IV neutropenia (44.7%), grade III-IV thrombocytopenia (53.1%), neutropenia accompanied with infection (18.8%), grade I liver dysfunction (12.5%), and hemorrhagic cystitis (9.4%). All adverse events were reversible.
Recurrent and refractory neuroblastoma responds well to chemotherapy regimen of ifosphamide plus carboplatin. The toxicities are tolerable. But the long-term prognosis is poor. More effective strategies are needed to improve its long-term survival.
约30%的神经母细胞瘤患者对一线化疗反应不佳或在化疗期间病情进展。尽管晚期神经母细胞瘤患者在联合治疗后可实现完全缓解，但大多数最终仍会复发。本研究旨在评估异环磷酰胺和卡铂作为挽救性化疗方案对复发性或难治性神经母细胞瘤的疗效。
9例难治性神经母细胞瘤患者和23例复发性神经母细胞瘤患者接受异环磷酰胺（每日1.5 g/m²，共5天）和卡铂（第1天400 mg/m²）治疗。在异环磷酰胺输注结束后，美司钠以异环磷酰胺剂量的20%，每隔4小时给药3次。每2 - 3周进行一次化疗。
32例患者均未实现完全缓解；19例（59.4%）实现部分缓解。中位缓解时间为4.2个月（1 - 28个月）。化疗后，8例患者接受了手术切除肿瘤。主要不良事件包括III - IV级中性粒细胞减少（44.7%）、III - IV级血小板减少（53.1%）、中性粒细胞减少伴感染（18.8%）、I级肝功能不全（12.5%）和出血性膀胱炎（9.4%）。所有不良事件均为可逆性。
复发性和难治性神经母细胞瘤对异环磷酰胺加卡铂的化疗方案反应良好。毒性是可耐受的。但长期预后较差。需要更有效的策略来提高其长期生存率。
