Gasparini M, Lombardi F, Gianni M C, Massimino M, Gandola L, Fossati-Bellani F
Division of Pediatric Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
J Clin Oncol. 1990 Nov;8(11):1854-7. doi: 10.1200/JCO.1990.8.11.1854.
A series of 15 consecutive children with head and neck nonorbital rhabdomyosarcoma (RMSA) with meningeal extension were prospectively treated with chemotherapy consisting of Adriamycin (doxorubicin; Adria Laboratory, Columbus, OH) (ADM), vincristine (VCR), cyclophosphamide (CPM), and dactinomycin (DACT) followed by radiotherapy (60 Gy) to the primary tumor volume, along with intrathecal methotrexate (IT MTX). Thirteen of 15 responded to preradiation chemotherapy. Four of 13 relapsed. Relapse occurred at the level of the primary tumor in three of four. The 3-year progression-free survival (PFS) was 59%, similar to that achieved in a previous series treated with a comparable therapeutic approach that also included whole-brain radiotherapy as a prophylaxis of possible occult meningeal seeding. It is concluded that CNS prophylaxis with radiotherapy is questionable in the management of childhood RMSA with meningeal extension.
对连续15例伴有脑膜播散的头颈部非眼眶横纹肌肉瘤（RMSA）患儿进行前瞻性治疗，化疗方案包括阿霉素（多柔比星；阿德里亚实验室，俄亥俄州哥伦布市）（ADM）、长春新碱（VCR）、环磷酰胺（CPM）和放线菌素D（DACT），随后对原发肿瘤体积进行放射治疗（60 Gy），同时鞘内注射甲氨蝶呤（IT MTX）。15例中有13例对放疗前化疗有反应。13例中有4例复发。4例中有3例在原发肿瘤部位复发。3年无进展生存率（PFS）为59%，与先前采用类似治疗方法的系列研究结果相似，该研究也包括全脑放疗以预防可能的隐匿性脑膜播散。结论是，在伴有脑膜播散的儿童RMSA治疗中，采用放疗进行中枢神经系统预防存在疑问。
