Bergman I, Jakacki R I, Heller G, Finlay J
Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, PA, USA. Bergman+@Pitt.edu
Med Pediatr Oncol. 1997 Dec;29(6):563-7. doi: 10.1002/(sici)1096-911x(199712)29:6<563::aid-mpo8>3.0.co;2-i.
Improved outcome for children with medulloblastoma requires new treatment protocols which incorporate chemotherapeutic agents that are capable of eradicating minimal residual disease in the primary posterior fossa site and in the leptomeninges and whose toxicities are tolerable.
We treated 25 children with nondisseminated medulloblastoma with complete or near complete surgical resection of the posterior fossa tumor, 3,600 cGy craniospinal irradiation (CSRT) and 5,400 cGy posterior fossa irradiation followed by adjuvant chemotherapy with carboplatin and vincristine.
The estimated 3-year progression-free survival (PFS) was 0.73 (S.E. +/- 0.09) compared with a 3-year PFS of 0.69 in historical controls treated with surgical resection and CSRT but without chemotherapy. Six relapses occurred outside the posterior fossa and one relapse occurred both in the posterior fossa and in the lateral ventricle. The major acute toxicities were myelosuppression, anorexia and neuropathy.
Our experience with this adjuvant chemotherapy regimen with carboplatin and vincristine, as used by us, does not encourage its adoption in future clinical trials.
改善髓母细胞瘤患儿的治疗结局需要新的治疗方案，该方案应纳入能够根除后颅窝原发部位和软脑膜微小残留病灶且毒性可耐受的化疗药物。
我们对25例未播散性髓母细胞瘤患儿进行了治疗，后颅窝肿瘤行完全或近乎完全手术切除，给予3600 cGy全脑脊髓放疗（CSRT）和5400 cGy后颅窝放疗，随后用卡铂和长春新碱进行辅助化疗。
估计3年无进展生存率（PFS）为0.73（标准误±0.09），而历史对照中接受手术切除和CSRT但未化疗的患儿3年PFS为0.69。6例复发发生在后颅窝以外，1例复发同时发生在后颅窝和侧脑室。主要的急性毒性反应为骨髓抑制、厌食和神经病变。
我们使用卡铂和长春新碱的这种辅助化疗方案的经验不支持在未来临床试验中采用该方案。
