Mosijczuk A D, Nigro M A, Thomas P R, Burger P C, Krischer J P, Morantz R A, Kurdunowicz B, Mulne A F, Towbin R B, Freeman A I
Fitzsimons Army Medical Center, St. Louis, Missouri.
Cancer. 1993 Nov 1;72(9):2755-62. doi: 10.1002/1097-0142(19931101)72:9<2755::aid-cncr2820720937>3.0.co;2-v.
Children diagnosed with medulloblastoma whose tumor involves the brain stem or has spread through the cerebrospinal fluid pathways to other areas of the brain or spinal cord have a poor prognosis despite therapy with surgery, craniospinal irradiation (CSI), and chemotherapy. Preradiation chemotherapy may improve the outlook for these patients.
To further study the role and feasibility of preradiation chemotherapy, children between the ages of 4 and 21 years diagnosed with advanced medulloblastoma and measurable disease were enrolled in the Pediatric Oncology Group 8695 study. Patients were treated with a 9-week course of vincristine, cisplatin, and cyclophosphamide followed by CSI. Imaging films were reviewed centrally for eligibility and response to chemotherapy. Toxicity to chemotherapy and radiation as well as delays and modifications in subsequent CSI were recorded.
Thirteen of 30 fully evaluable patients achieved complete or partial response (43%) to chemotherapy. Toxicity was mostly fever and neutropenia after cyclophosphamide, which is predictable and tolerable. Radiation therapy was delivered in full doses and volumes in most patients but was delayed in its start in most patients. Central review of films revealed frequent use of different imaging modalities at baseline and after therapy, making accurate assessment of tumor response difficult.
Preradiation chemotherapy with vincristine, cisplatin, and cyclophosphamide is active in patients with advanced medulloblastoma but should be modified to minimize the risk of progressive disease while on therapy and to avoid delays in starting radiation therapy. Consistent use of the same neuroimaging modality is essential in documenting response.
被诊断为髓母细胞瘤且肿瘤累及脑干或已通过脑脊液途径扩散至脑或脊髓其他区域的儿童，尽管接受了手术、全脑全脊髓放疗（CSI）和化疗，预后仍较差。放疗前化疗可能会改善这些患者的预后。
为进一步研究放疗前化疗的作用和可行性，年龄在4至21岁、被诊断为晚期髓母细胞瘤且疾病可测量的儿童被纳入儿童肿瘤学组8695研究。患者接受为期9周的长春新碱、顺铂和环磷酰胺治疗，随后进行CSI。对影像片进行集中审查以确定入选资格和化疗反应。记录化疗和放疗的毒性以及后续CSI的延迟和调整情况。
30例可全面评估的患者中有13例（43%）对化疗达到完全或部分缓解。毒性主要是环磷酰胺治疗后的发热和中性粒细胞减少，这是可预测且可耐受的。大多数患者接受了全剂量和全容积的放疗，但大多数患者放疗开始时间延迟。影像片的集中审查显示，在基线和治疗后经常使用不同的成像方式，使得准确评估肿瘤反应变得困难。
长春新碱、顺铂和环磷酰胺的放疗前化疗对晚期髓母细胞瘤患者有效，但应进行调整，以尽量降低治疗期间疾病进展的风险，并避免放疗开始延迟。在记录反应时，持续使用相同的神经成像方式至关重要。
