Division of Paediatrics, Fond. IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
J Neurooncol. 2010 Oct;100(1):65-71. doi: 10.1007/s11060-010-0136-6. Epub 2010 Feb 12.
After successfully using cisplatin (30 mg/m(2)/day) and etoposide (150 mg/m(2)/day) in ten three-day courses for progressive low-grade gliomas, a subsequent protocol reduced the daily doses of cisplatin (to 25 mg) and etoposide (to 100 mg), with the objective of achieving the same response and three-year PFS rates with lower neurotoxicity and myelotoxicity. We treated 37 patients (median age 6 years); 23 had optochiasmatic tumours and nine were metastatic cases. Diagnoses were clinical in 13 cases and histological in 24, and comprised: pilocytic astrocytoma (17), ganglioglioma (3), pilomyxoid astrocytoma (2), and fibrillary astrocytoma (2). Treatment was prompted by radiological evidence of progression and/or clinical deterioration a median 18 months after the first diagnosis. After initial MRI staging, neurological and clinical examinations were performed before each chemotherapy cycle, with MRI after the first three courses and every three months thereafter. After a median 48 months, a volume reduction was appreciable in 24 cases (65%) and response was maximum 12 months after starting treatment. The three-year EFS and OS rates were 65 and 97%, respectively. Clinical, neurological, or functional improvements were seen in 26/37 cases. No children had a WBC nadir below 2,000/mm(3). Audiological toxicity caused damage in 4/34 cases. The previous protocol had achieved volume reductions in 70% of cases, causing audiological damage (data updated) in 11/31 (P = 0.023), with three-year PFS and OS rates of 70 and 100%, respectively. Lower doses of cisplatin/etoposide are still effective in progressive low-grade glioma, with less acute and persistent morbidity.
在成功使用顺铂（30mg/m(2)/天）和依托泊苷（150mg/m(2)/天）治疗十个为期三天的进展性低级别胶质瘤疗程后，随后的方案降低了顺铂（至 25mg）和依托泊苷（至 100mg）的日剂量，目的是在较低的神经毒性和骨髓毒性下实现相同的反应和三年无进展生存率。我们治疗了 37 名患者（中位年龄 6 岁）；23 例有视交叉肿瘤，9 例为转移性病例。13 例为临床诊断，24 例为组织学诊断，包括：毛细胞星形细胞瘤（17 例）、神经节细胞瘤（3 例）、毛细胞粘液样星形细胞瘤（2 例）和纤维状星形细胞瘤（2 例）。治疗是在首次诊断后 18 个月，基于影像学进展证据和/或临床恶化而进行的。在初始 MRI 分期后，在每个化疗周期前进行神经学和临床检查，在前三轮化疗后和此后每三个月进行 MRI。中位随访 48 个月后，24 例（65%）的体积明显缩小，治疗后 12 个月达到最大反应。三年无进展生存率和总生存率分别为 65%和 97%。26/37 例患儿的临床、神经或功能均有改善。无患儿的白细胞计数最低点低于 2000/mm(3)。听力毒性导致 4/34 例患儿出现损害。之前的方案在 70%的病例中实现了体积缩小，导致听力损害（更新数据）在 11/31 例（P=0.023），三年无进展生存率和总生存率分别为 70%和 100%。较低剂量的顺铂/依托泊苷在进展性低级别胶质瘤中仍然有效，且急性和持续性发病率较低。
