Koschmann Carl, Bloom Karina, Upadhyaya Santhosh, Geyer J Russell, Leary Sarah E S
*Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Michigan School of Medicine, Ann Arbor, MI †Division of Pediatric Hematology-Oncology, Seattle Children's Hospital ‡Fred Hutchinson Cancer Research Center ∥Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Washington, Seattle, WA §Department of Oncology, Division of Neuro-Oncology, St Jude Children's Research Hospital, Memphis, TN.
J Pediatr Hematol Oncol. 2016 May;38(4):269-73. doi: 10.1097/MPH.0000000000000547.
Survival after recurrence of medulloblastoma has not been reported in an unselected cohort of patients in the contemporary era. We reviewed 55 patients diagnosed with medulloblastoma between 2000 and 2010, and treated at Seattle Children's Hospital to evaluate patterns of relapse treatment and survival. Fourteen of 47 patients (30%) over the age of 3 experienced recurrent or progressive medulloblastoma after standard therapy. The median time from diagnosis to recurrence was 18.0 months (range, 3.6 to 62.6 mo), and site of recurrence was metastatic in 86%. The median survival after relapse was 10.3 months (range, 1.3 to 80.5 mo); 3-year survival after relapse was 18%. There were trend associations between longer survival and having received additional chemotherapy (median survival 12.8 vs. 1.3 mo, P=0.16) and radiation therapy (15.4 vs. 5.9 mo, P=0.20). Isolated local relapse was significantly associated with shorter survival (1.3 vs. 12.8 mo, P=0.009). Recurrence of medulloblastoma is more likely to be metastatic than reported in previous eras. Within the limits of our small sample, our data suggest a potential survival benefit from retreatment with cytotoxic chemotherapy and radiation even in heavily pretreated patients. This report serves as a baseline against which to evaluate novel therapy combinations.
当代未经挑选的髓母细胞瘤患者队列中，复发后的生存率尚无报道。我们回顾了2000年至2010年间在西雅图儿童医院诊断并接受治疗的55例髓母细胞瘤患者，以评估复发治疗模式和生存率。47例3岁以上患者中有14例（30%）在标准治疗后出现髓母细胞瘤复发或进展。从诊断到复发的中位时间为18.0个月（范围3.6至62.6个月），86%的复发部位为转移灶。复发后的中位生存期为10.3个月（范围1.3至80.5个月）；复发后3年生存率为18%。接受额外化疗（中位生存期12.8个月对1.3个月，P=0.16）和放疗（15.4个月对5.9个月，P=0.20）与较长生存期之间存在趋势性关联。孤立的局部复发与较短生存期显著相关（1.3个月对12.8个月，P=0.009）。与既往报道相比，髓母细胞瘤复发更可能为转移灶。在我们小样本的局限性范围内，我们的数据表明，即使是经过大量预处理的患者，再次接受细胞毒性化疗和放疗可能有生存获益。本报告作为评估新型治疗组合的基线。
