Feng Chen, Tang Suo-Qin, Wang Jian-Wen, Liu Ying, Yang Guang
Department of Pediatrics, People's Liberation Army General Hospital, Beijing 100853, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2009 Nov;11(11):885-7.
To evaluate the effects and the toxicity of the protocol of CDV combined with CiE as pre-operative chemotherapy in childhood stage IV neuroblastoma.
The clinical data of 27 children aged from 1.2 to 8 years with neuroblastoma in stage IV was retrospectively studied. The primary sites of the diseases were abdomen (n = 21), posterior mediastinum (n = 4) and pelvic cavity (n = 2). Twenty three patients had bone marrow metastasis. Twelve patients had bone metastasis. All patients were treated with the CDV protocol (cyclophosphamide + doxorubicin + vincristine) for 3 cycles and the CiE protocol (cisplatin + etoposide) for 2 cycles. Neuroblastoma therapeutic response evaluation criterion and common terminology criteria for adverse events of National Cancer Institute were used to evaluate effects and chemotherapy related toxicity.
All patients received the pre-operative chemotherapy. The overall response rate was 82%. After chemotherapy, 24 patients received operations. Total resection of primary tumor was found in 14 patients (58%) and part resection in 10 patients (42%). The most common chemotherapy related toxicity was bone marrow suppression: grade IV suppression of neutrophils (n = 27), reduction in hemoglobin (III grade, n = 7; IV grade, n = 20) and reduction in platelet (III grade, n = 2; IV grade, n = 25). Infection was found in all patients and was controlled with antibiotics. I or II grade lesions of digestive, liver and kidney were found and could be recovered after therapy. Grade I neurotoxicity occurred in 2 patients (7%). The heart function damage was not found in any of patients.
The protocol of CDV combined with CiE as pre-operative chemotherapy might be effective in children with stage IV neuroblastoma.
评估环磷酰胺、阿霉素、长春新碱（CDV）联合顺铂、依托泊苷（CiE）方案作为术前化疗方案对儿童Ⅳ期神经母细胞瘤的疗效及毒性。
回顾性分析27例年龄在1.2至8岁的Ⅳ期神经母细胞瘤患儿的临床资料。疾病的原发部位为腹部（n = 21）、后纵隔（n = 4）和盆腔（n = 2）。23例患者有骨髓转移。12例患者有骨转移。所有患者均接受3个周期的CDV方案（环磷酰胺+阿霉素+长春新碱）和2个周期的CiE方案（顺铂+依托泊苷）治疗。采用神经母细胞瘤治疗反应评估标准及美国国立癌症研究所不良事件通用术语标准评估疗效及化疗相关毒性。
所有患者均接受了术前化疗。总有效率为82%。化疗后，24例患者接受了手术。14例患者（58%）实现了原发肿瘤的完全切除，10例患者（42%）实现了部分切除。最常见的化疗相关毒性是骨髓抑制：Ⅳ级中性粒细胞减少（n = 27）、血红蛋白降低（Ⅲ级，n = 7；Ⅳ级，n = 20）和血小板减少（Ⅲ级，n = 2；Ⅳ级，n = 25）。所有患者均发生感染，经抗生素控制。发现有消化、肝脏和肾脏的Ⅰ或Ⅱ级病变，治疗后可恢复。2例患者（7%）发生Ⅰ级神经毒性。所有患者均未发现心脏功能损害。
CDV联合CiE方案作为术前化疗方案可能对儿童Ⅳ期神经母细胞瘤有效。
