Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
Pediatr Blood Cancer. 2021 May;68(5):e28925. doi: 10.1002/pbc.28925. Epub 2021 Feb 3.
To assess the safety and efficacy of concurrent carboplatin during craniospinal irradiation (CSI) in high-risk/metastatic medulloblastoma defined as either residual tumor >1.5 cm or leptomeningeal metastases.
This single-arm combined prospective (2005-2011) and retrospective (2011-2019) study was undertaken at a tertiary care cancer center in India. Following surgery, patients with newly diagnosed high-risk/metastatic medulloblastoma received concurrent carboplatin (35 mg/m ) for 15 days (day 1 to day 15) during CSI plus posterior fossa/tumor bed boost, followed by six cycles of standard adjuvant chemotherapy.
All 97 patients completed their planned course of radiotherapy without interruptions, except for two (2.1%) patients who had brief gaps due to treatment-related toxicity. Grade 3-4 anemia, neutropenia, thrombocytopenia, and febrile neutropenia were seen in four (4.1%), 41 (42.2%) 21 (21.6%), and 18 (18.6%) patients, necessitating packed cell transfusion, granulocyte colony-stimulating factor, and platelet support in five (5.1%), 41 (42.2%), and five (5.1%) patients, respectively, during the concurrent phase. Following myelorecovery, 92 (94.9%) patients completed the planned six cycles of standard adjuvant systemic chemotherapy. There were no treatment-related deaths during the concurrent chemo-radiotherapy phase, while three (3.1%) toxic deaths were ascribed to adjuvant chemotherapy-related complications. At a median follow-up of 82 months, the 5-year Kaplan-Meier estimates of progression-free survival and overall survival were 60.2% and 62.1%, respectively. On univariate analysis, leptomeningeal metastases (M0/M1 vs. M2/M3) and histological subtype (large cell/anaplastic vs. others) emerged as significant prognostic factors for survival.
Addition of concurrent carboplatin to RT as radiosensitizing chemotherapy is a simple and effective way of treatment intensification in high-risk/metastatic medulloblastoma.
评估高危/转移性髓母细胞瘤患者在颅脊髓照射（CSI）期间同时使用卡铂的安全性和有效性，这些患者的肿瘤残留＞1.5cm 或存在脑膜转移。
本研究为印度一家三级癌症中心进行的单臂联合前瞻性（2005-2011 年）和回顾性（2011-2019 年）研究。在手术后，新诊断为高危/转移性髓母细胞瘤的患者在 CSI 期间同时接受卡铂（35mg/m ）治疗 15 天（第 1 天至第 15 天），并进行后颅窝/肿瘤床加量照射，随后进行六个周期的标准辅助化疗。
97 例患者均顺利完成了计划的放疗，除了 2 例（2.1%）患者因治疗相关毒性而短暂中断。4 例（4.1%）患者出现 3-4 级贫血、中性粒细胞减少、血小板减少和发热性中性粒细胞减少，5 例（5.1%）患者需要输注红细胞、粒细胞集落刺激因子，5 例（5.1%）患者需要血小板支持；41 例（42.2%）患者在同期出现上述情况。骨髓恢复后，92 例（94.9%）患者完成了计划的 6 个周期标准辅助全身化疗。同期放化疗期间无治疗相关死亡，3 例（3.1%）因化疗相关并发症而死亡。中位随访 82 个月后，无进展生存和总生存的 5 年 Kaplan-Meier 估计值分别为 60.2%和 62.1%。单因素分析显示，脑膜转移（M0/M1 与 M2/M3）和组织学亚型（大细胞/间变性与其他）是生存的显著预后因素。
在高危/转移性髓母细胞瘤患者中，将同期卡铂加入放疗作为增敏化疗是一种简单有效的治疗强化方法。
