Padovani Laetitia, Andre Nicolas, Gentet Jean Claude, Figarella Branger Dominique, Scavarda Didier, Verschuur Arnaud, Chinot Olivier, Cowen Didier, Muracciole Xavier
Radiation Oncology Department, CHU La Timone, Assistance Publique de Marseille, France.
J Pediatr Hematol Oncol. 2011 Dec;33(8):600-4. doi: 10.1097/MPH.0b013e3182331eaf.
Medulloblastoma (MB) is the most common malignant pediatric brain tumor and a rare adulthood tumor. Twenty percent to 30% of patients relapses and displays a poor prognosis. The management of recurrent disease represents a medical challenge as salvage therapy with high-dose chemotherapy is disappointing. We report a pilot study of reirradiation and concomitant metronomic temozolomide of MB focal recurrence. Five patients from 10 to 27 years old at time of first diagnosis were treated initially with upfront radiation therapy at full dose. They relapsed focally and progressed under chemotherapy with a time recurrence ranged from 2 to 15 years after initial diagnosis. Patients were then treated with 3-dimensional conformal reirradiation focused on the relapsed disease with a median dose of 28 Gy (1.8 Gy per fraction) and concomitant temozolomide (75 mg/m/d) alone or as part of a multidrug metronomic regimen. Five complete responses were obtained at the end of metronomic radiochemotherapy. The median follow-up was 28 months. At last follow-up, 3 patients progressed outside radiation field under maintenance chemotherapy, and 1 is free of disease. Only 1 patient relapsed in the reirradiation field. No neurological toxicity was observed. These results indicate a possible radiosensitizing effect of concomitant metronomic temozolomide with radiation therapy. This association could play a role in the management of high-risk MB patient with oligometastasis disease to increase local control.
髓母细胞瘤（MB）是最常见的儿童恶性脑肿瘤，在成人中较为罕见。20%至30%的患者会复发且预后较差。复发性疾病的治疗是一项医学挑战，因为高剂量化疗的挽救治疗效果令人失望。我们报告了一项关于髓母细胞瘤局灶性复发再照射联合节拍性替莫唑胺的试点研究。首次诊断时年龄在10至27岁的5例患者最初接受了全剂量的 upfront 放射治疗。他们出现局灶性复发，并在化疗过程中病情进展，复发时间距初次诊断为2至15年。然后患者接受针对复发性疾病的三维适形再照射，中位剂量为28 Gy（每次分割1.8 Gy），并单独或作为多药节拍性方案的一部分联合使用替莫唑胺（75 mg/m²/天）。节拍性放化疗结束时获得了5例完全缓解。中位随访时间为28个月。在最后一次随访时，3例患者在维持化疗期间在放射野外病情进展，1例无疾病。仅1例患者在再照射野复发。未观察到神经毒性。这些结果表明节拍性替莫唑胺与放射治疗联合可能具有放射增敏作用。这种联合可能在治疗伴有寡转移疾病的高危髓母细胞瘤患者以提高局部控制方面发挥作用。
