Arndt Carola A S
From the Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN.
Am Soc Clin Oncol Educ Book. 2012:621-3. doi: 10.14694/EdBook_AM.2012.32.137.
The role of doxorubicin in treatment of rhabdomyosarcoma (RMS) has been controversial for 30 years. Despite its known activity in RMS, because of its risk of cardiotoxicity, its use is not justified in low-risk patients who have an excellent chance of cure with vincristine, actinomycin with or without cyclophosphamide, and primary tumor treatment. For patients with intermediate and high risks, the risk/benefit ratio must be carefully considered. In addition, the peak incidence of RMS is in toddlers, with whom the risk of cardiotoxicity of anthracyclines is higher. A number of trials both in North America and Europe, which are reviewed in this article, have investigated the role of doxorubicin in RMS, with no conclusive outcomes. In addition, differences in risk-group assignment on two sides of the Atlantic further complicate comparisons and analyses. The current European EpSSG 2005 study for high-risk RMS (by the European definition) may come closest to giving an answer to the role of doxorubicin in RMS.
三十年来，阿霉素在横纹肌肉瘤（RMS）治疗中的作用一直存在争议。尽管其在RMS中具有已知活性，但由于存在心脏毒性风险，对于那些使用长春新碱、放线菌素（联合或不联合环磷酰胺）及原发性肿瘤治疗有极大治愈机会的低风险患者而言，使用阿霉素并不合理。对于中高风险患者，必须仔细权衡风险/获益比。此外，RMS的发病高峰在幼儿期，而幼儿使用蒽环类药物发生心脏毒性的风险更高。本文回顾了北美和欧洲的多项试验，这些试验研究了阿霉素在RMS中的作用，但尚无定论。此外，大西洋两岸风险组划分的差异使比较和分析进一步复杂化。当前欧洲EpSSG 2005针对高风险RMS（按照欧洲定义）的研究可能最接近给出阿霉素在RMS中作用的答案。
