Bleyer Archie, Choi Mehee, Wang Samuel J, Fuller Clifton D, Raney R Beverly
Cancer Treatment Center, St. Charles Medical Center, 2500 N.E. Neff Road, Bend, OR 97701, USA.
Pediatr Blood Cancer. 2009 Dec 15;53(7):1205-10. doi: 10.1002/pbc.22164.
To assess the rate of spinal cord toxicity in adolescents resulting from chemoradiotherapy of parameningeal sarcoma.
Of 152 patients with parameningeal sarcoma treated per the Intergroup Rhabdomyosarcoma Study Group protocol from 1977 through 1989, eight developed paralyzing ascending myelitis after intrathecal chemotherapy with cytosine arabinoside, methotrexate, and hydrocortisone administered during and after radiation therapy to volumes that included part of the spinal cord. The eight cases include three not previously published.
Of eight patients who developed CNS toxicity after intrathecal chemotherapy and radiotherapy for parameningeal rhabdomyosarcoma, all but one were between 13 and 18 years of age when treated. This severe toxicity occurred in one quarter of 28 adolescents treated with the regimen in comparison with one of 123 children 12 years of age or less (P < 0.0001), a rate that was as much as 30 times higher in the adolescents. Lengthening of the spinal cord during the pubertal growth spurt may account for the apparent increased vulnerability.
Chemoradiotoxicity-associated spinal cord injury appears to be more likely to occur in adolescents than in younger or older ages. This observation appears to reverse a conventional wisdom in which the central nervous system is thought to become more resistant to the neurotoxic effects of chemoradiotherapy as it matures.
评估脑膜旁肉瘤放化疗对青少年脊髓造成毒性的发生率。
1977年至1989年期间，按照横纹肌肉瘤协作组方案治疗的152例脑膜旁肉瘤患者中，8例在放疗期间及放疗后接受鞘内注射阿糖胞苷、甲氨蝶呤和氢化可的松化疗后发生了麻痹性上升性脊髓炎，放疗范围包括部分脊髓。这8例中有3例此前未发表。
8例脑膜旁横纹肌肉瘤患者在鞘内化疗和放疗后出现中枢神经系统毒性，除1例患者外，其余患者治疗时年龄均在13至18岁之间。接受该方案治疗的28例青少年中有四分之一出现了这种严重毒性，而12岁及以下的123例儿童中仅有1例出现这种情况（P < 0.0001），青少年的发生率比儿童高出多达30倍。青春期生长突增期间脊髓的延长可能是导致易感性明显增加的原因。
放化疗毒性相关的脊髓损伤在青少年中似乎比在年龄较小或较大的人群中更易发生。这一观察结果似乎与传统观念相反，传统观念认为中枢神经系统随着成熟会对放化疗的神经毒性作用更具抵抗力。
