Ladenstein R, Philip T, Gardner H
One St. Anna Children's Hospital, Vienna, Austria.
Curr Opin Pediatr. 1997 Feb;9(1):55-69. doi: 10.1097/00008480-199702000-00013.
The dose-effect relationship in pediatric oncology conventional chemotherapy is emphasized. Rationales for the use of megatherapy protocols with stem cell support and associated procedures are given. It has been more than 15 years since this approach was used in neuroblastoma, and it has subsequently been applied to most of advanced, common childhood solid tumors. The ongoing use of new strategies for dose intensification with peripheral blood stem cell or autologous purged bone marrow rescue has raised expectations for cure. To date, results of megatherapy followed by autologous stem cell reinfusion are encouraging in metastatic neuroblastoma and Ewing's sarcoma, with an increase in event-free survival rates of about 30% as compared with that of conventional treatments. However, with the exception of metastatic neuroblastoma, there is still no proven role for this treatment strategy. Thus, there is still an urgent need for international collaboration to design randomized studies that could rapidly address the issue of these expensive and high-morbidity procedures in childhood cancer.
强调了儿科肿瘤学传统化疗中的剂量效应关系。给出了使用伴有干细胞支持及相关程序的大剂量疗法方案的理论依据。自这种方法用于神经母细胞瘤已有15年多，随后它被应用于大多数晚期常见儿童实体瘤。持续使用外周血干细胞或自体净化骨髓解救进行剂量强化的新策略提高了治愈的期望。迄今为止，大剂量疗法后进行自体干细胞回输的结果在转移性神经母细胞瘤和尤因肉瘤中令人鼓舞，与传统治疗相比，无事件生存率提高了约30%。然而，除转移性神经母细胞瘤外，这种治疗策略仍未得到证实。因此，仍迫切需要国际合作来设计随机研究，以迅速解决儿童癌症中这些昂贵且高发病率程序的问题。
