Kretschmar C S, Tarbell N J, Kupsky W, Lavally B L, Loeffler J S, Wolfe L, Strand R, Scott R M, Sallan S E
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
J Neurosurg. 1989 Dec;71(6):820-5. doi: 10.3171/jns.1989.71.6.0820.
From March, 1984, through June, 1987, 21 newly diagnosed children with high-risk medulloblastoma (Chang Stage T3 to T4) were treated on a 9-week postoperative, pre-irradiation chemotherapy regimen consisting of vincristine and cisplatin. The children over 2 years old then received radiation therapy. Six infants (aged 6 to 18 months) were maintained on chemotherapy consisting of MOP (nitrogen mustard, vincristine, and procarbazine) until the age of 2 years, at which time they were referred for irradiation. Of 13 children with measurable disease following surgery, five showed a definite response on computerized tomography scans to vincristine and cisplatin (one complete response and four partial responses) and five others showed clear marginal responses. Four of the six infants were disease-free at 19, 32, 35, and 57 months from diagnosis. One infant developed progressive disease at the completion of the vincristine and cisplatin course, and a second infant had progression during MOP administration. Three of the 21 children developed hearing loss within the speech frequencies during cisplatin treatments, but there were no other major toxicities. Fifteen children remained disease-free with a median follow-up period of 35 months (range 19 to 57 months). Chemotherapy given between surgery and radiotherapy may allow for the direct evaluation of a specific drug regimen and permit the postponement of radiation therapy in infants. Pre-irradiation vincristine and cisplatin was well tolerated and effective in shrinking the tumor in most children with medulloblastoma. Such chemotherapy regimens have the potential for extending long-term survival in high-risk children.
从1984年3月至1987年6月，21例新诊断的高危髓母细胞瘤患儿（Chang分期T3至T4）接受了为期9周的术后、放疗前化疗方案，该方案由长春新碱和顺铂组成。2岁以上的儿童随后接受放射治疗。6例婴儿（年龄6至18个月）持续接受由MOP（氮芥、长春新碱和丙卡巴肼）组成的化疗，直至2岁，届时他们被转诊接受放疗。在13例术后有可测量疾病的儿童中，5例在计算机断层扫描上对长春新碱和顺铂有明确反应（1例完全缓解，4例部分缓解），另外5例有明显的边缘反应。6例婴儿中有4例在诊断后19、32、35和57个月时无疾病。1例婴儿在长春新碱和顺铂疗程结束时出现疾病进展，另1例婴儿在MOP治疗期间病情进展。21例儿童中有3例在顺铂治疗期间出现言语频率范围内的听力损失，但没有其他主要毒性反应。15例儿童无疾病生存，中位随访期为35个月（范围19至57个月）。手术和放疗之间给予化疗可能有助于直接评估特定的药物方案，并允许推迟对婴儿的放射治疗。放疗前使用长春新碱和顺铂耐受性良好，对大多数髓母细胞瘤患儿的肿瘤缩小有效。这样的化疗方案有可能延长高危儿童的长期生存率。
