Levin V A, Rodriguez L A, Edwards M S, Wara W, Liu H C, Fulton D, Davis R L, Wilson C B, Silver P
Department of Neurological Surgery, University of California, San Francisco.
J Neurosurg. 1988 Mar;68(3):383-7. doi: 10.3171/jns.1988.68.3.0383.
Forty-seven patients with medulloblastoma were treated postoperatively with procarbazine, followed by craniospinal radiation therapy in combination with hydroxyurea. The radiation dose to the posterior fossa was 55 Gy; the spinal cord received 25 Gy and the whole brain 25 to 35 Gy (mean 33 Gy). Seventeen tumors recurred. Only one initial recurrence was in the spinal subarachnoid space; 10 (59%) were in the posterior fossa, and four (24%) were supratentorial. The estimated 5-year disease-free survival probability was 55%; the 5-year overall survival rate was 66%. Myelotoxicity occurred in 38% of patients, but in only one case was it severe enough to warrant reducing the total dose of radiation. It was concluded that good-risk medulloblastoma patients may be treated with radiation dosages as low as 25 Gy to the spinal axis and to the whole brain without increasing the risk of recurrence outside the posterior fossa. Chemotherapy with procarbazine followed by radiation therapy and hydroxyurea during radiation therapy was well tolerated and may play a role in reducing radiation dosages outside the posterior fossa.
47例髓母细胞瘤患者术后接受丙卡巴肼治疗，随后进行颅脊髓放射治疗并联合羟基脲。后颅窝的放射剂量为55 Gy；脊髓接受25 Gy，全脑接受25至35 Gy（平均33 Gy）。17例肿瘤复发。仅1例初始复发位于脊髓蛛网膜下腔；10例（59%）位于后颅窝，4例（24%）位于幕上。估计5年无病生存概率为55%；5年总生存率为66%。38%的患者发生骨髓毒性，但仅1例严重到需要减少放射总剂量。得出的结论是，低风险髓母细胞瘤患者可接受低至25 Gy的脊髓轴和全脑放射剂量治疗，而不会增加后颅窝外复发的风险。丙卡巴肼化疗后进行放射治疗，并在放射治疗期间联合羟基脲，耐受性良好，可能在减少后颅窝外放射剂量方面发挥作用。
