Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):849-54. doi: 10.1016/j.ijrobp.2009.09.005. Epub 2010 Mar 6.
As systemic control of high-risk neuroblastoma (NB) has improved, relapse in the central nervous system (CNS) is an increasingly recognized entity that carries a grim prognosis. This study describes the use of craniospinal irradiation (CSI) for CNS relapse and compares outcomes to patients who received focal radiotherapy (RT).
A retrospective query identified 29 children with NB treated at Memorial Sloan-Kettering Cancer Center since 1987 who received RT for CNS relapse. At CNS relapse, 16 patients received CSI (median dose, 2160cGy), and 13 received focal RT. Of those who underwent CSI, 14 (88%) received intra-Ommaya (IO) radioimmunotherapy (RIT); one patient in the non-CSI cohort received IO-RIT.
Patient characteristics were similar between the groups. Time to CNS relapse was 20 and 17 months for the CSI and non-CSI cohorts, respectively. At a median follow-up of 28 months, 12 patients (75%) in the CSI group are alive without CNS disease, including two patients with isolated skeletal relapse. Another patient is alive without disease after a brain relapse was retreated with RT. Three patients died-one with no NB at autopsy, one of CNS disease, and one of systemic disease. The two patients who died of NB did not receive IO-RIT. All 13 patients in the non-CSI cohort died at a median of 8.8 months.
Low-dose CSI together with IO-RIT provides durable CNS remissions and improved survival compared with focal RT and conventional therapies. Further evaluation of long-term NB survivors after CSI is warranted to determine the treatment consequences for this cohort.
随着高危神经母细胞瘤（NB）的全身性控制得到改善，中枢神经系统（CNS）复发已成为一种日益被认识的实体，预后不良。本研究描述了颅脊髓照射（CSI）在 CNS 复发中的应用，并将其结果与接受局部放疗（RT）的患者进行了比较。
通过回顾性查询，确定了自 1987 年以来在 Memorial Sloan-Kettering 癌症中心接受 RT 治疗 CNS 复发的 29 例 NB 患儿。在 CNS 复发时，16 例患者接受 CSI（中位剂量 2160cGy），13 例患者接受局部 RT。在接受 CSI 的患者中，14 例（88%）接受了颅内 Ommaya（IO）放射性免疫疗法（RIT）；非 CSI 组中有 1 例患者接受了 IO-RIT。
两组患者的特征相似。CSI 和非 CSI 组的 CNS 复发时间分别为 20 个月和 17 个月。在中位随访 28 个月时，CSI 组中有 12 例（75%）患者无 CNS 疾病存活，包括 2 例仅有骨骼复发的患者。另一名患者在脑复发后接受 RT 治疗，疾病无复发。3 例患者死亡-1 例尸检未发现 NB，1 例死于 CNS 疾病，1 例死于全身疾病。两名死于 NB 的患者未接受 IO-RIT。非 CSI 组的 13 例患者全部在 8.8 个月的中位时间内死亡。
与局部 RT 和常规治疗相比，低剂量 CSI 联合 IO-RIT 可提供持久的 CNS 缓解和改善生存。需要进一步评估 CSI 后长期 NB 幸存者，以确定该队列的治疗后果。
