Wolff J E, Bauch H J, Roessner A, Boos J, Gressner-Brocks V, Ritter J, Jürgens H
Department of Pediatric Oncology, University Hospital of Münster, Germany.
Med Pediatr Oncol. 1993;21(6):460-4. doi: 10.1002/mpo.2950210615.
A case of stage 4 neuroblastoma that developed excessive hypertension on day 120 of chemotherapy is presented. The tumor initially had responded well to chemotherapy; however, while the tumor mass decreased, plasma and urine catecholamines and the blood pressure increased. The plasma concentrations of noradrenaline, adrenaline, and dopamine increased to 26.4, 1.8, and 36.2 micrograms/l, respectively. The profile of catecholamine metabolites changed: on day 150 of therapy, noradrenaline, adrenaline, and dopamine levels were increased, whereas HVA and VMA levels were decreased when compared to day 1 of therapy. The only residual neuroblastoma tissue visible on MIBG scintigraphy on day 150 of treatment was a metastasis in the left tibia which was irradiated with 24 Gy. The adrenaline concentration in the left femoral vein was twice as high compared to the right femoral vein. A treatment, possibly radiation-associated tumor cell alteration resulting in a different catecholamine production, is discussed.
本文报告一例4期神经母细胞瘤患者，在化疗第120天出现高血压。肿瘤最初对化疗反应良好；然而，随着肿瘤体积减小，血浆和尿液儿茶酚胺水平及血压却升高。去甲肾上腺素、肾上腺素和多巴胺的血浆浓度分别增至26.4、1.8和36.2微克/升。儿茶酚胺代谢产物谱发生变化：治疗第150天时，与治疗第1天相比，去甲肾上腺素、肾上腺素和多巴胺水平升高，而高香草酸（HVA）和香草扁桃酸（VMA）水平降低。治疗第150天时，间碘苄胍（MIBG）闪烁扫描可见的唯一残留神经母细胞瘤组织是左胫骨的一处转移灶，对其进行了24 Gy的放射治疗。左股静脉中的肾上腺素浓度是右股静脉的两倍。文中讨论了一种可能与放疗相关的肿瘤细胞改变导致儿茶酚胺产生不同的治疗方法。
