Wolff J E, Hauch H, Kühl J, Egeler R M, Jürgens H
Department of Pediatric Oncology, Alberta Children's Hospital, Calgary, Canada.
Anticancer Res. 1998 Jul-Aug;18(4B):2895-9.
In the treatment of children with brain tumors, dexamethasone and methotrexate are often utilized simultaneously. As previously shown, dexamethasone can reduce the efficacy of methotrexate in vitro (Anticancer Res. 14: 1585-8). Consequently, DEX has been avoided during high dose methotrexate infusions in a pilot study.
Side effects of methotrexate with dexamethasone (N = 33) were retrospectively compared with the side effects of methotrexate without dexamethasone (N = 24).
No serious brain edema in any of the groups was observed; there was no difference in bone marrow toxicity, or mucositis. Liver enzymes, however, were significantly higher when methotrexate was given with dexamethasone: GOT [glutamate oxalacetate transaminase] 76 +/- 73 versus 19 +/- 12, GPT (glutamate pyrovate transaminase) 140 +/- 199 versus 39 +/- 31 IU/I (P < 0.01). This higher hepatotoxicity was not related to differences in methotrexate serum-levels.
Dexamethasone can be eliminated from high dose methotrexate protocols for children.
在儿童脑肿瘤治疗中，地塞米松和甲氨蝶呤常同时使用。如先前所示，地塞米松在体外可降低甲氨蝶呤的疗效（《抗癌研究》14: 1585 - 8）。因此，在一项初步研究中，高剂量甲氨蝶呤输注期间避免使用地塞米松。
回顾性比较了使用地塞米松的甲氨蝶呤（N = 33）与未使用地塞米松的甲氨蝶呤（N = 24）的副作用。
两组均未观察到严重脑水肿；骨髓毒性或粘膜炎无差异。然而，当甲氨蝶呤与地塞米松联用时，肝酶显著更高：谷草转氨酶（GOT）76 ± 73 对比 19 ± 12，谷丙转氨酶（GPT）140 ± 199 对比 39 ± 31 IU/I（P < 0.01）。这种更高的肝毒性与甲氨蝶呤血清水平差异无关。
对于儿童高剂量甲氨蝶呤方案，可不用地塞米松。
