Lemerle J, Tournade M F, Pein F
Département d'Oncologie Pédiatrique, Institut Gustave-Roussy, Villejuif, France.
Bull Acad Natl Med. 1998;182(6):1231-43; discussion 1243-6.
Cancer incidence is low in children. Childhood tumors are different from cancers seen in adults: their growth is rapid, but they respond well to radiotherapy and chemotherapy. In the case of Wilms Tumor, Actinomycin D, Vincristine and Doxorubicin were first used with success. Ifosfamide, Etoposide and Carboplatin are now also used in selected cases. But efficient treatments have important drawbacks: growth defects in the case of radiotherapy, late cardiac toxicity due to Doxorubicin, leukemias as second tumors following Etoposide. Treatment strategy is based on prognostic factors in Wilms' tumor, and the risk/benefit ratio assessment for each group of patients, considering survival probability and the risk of late effects. Large randomised studies in the USA and in Europe resulted in cure rates over 90%, with very few expected sequelae. Preoperative chemotherapy is now successfully applied to other tumors in children.
儿童癌症发病率较低。儿童肿瘤与成人癌症不同：它们生长迅速，但对放疗和化疗反应良好。以肾母细胞瘤为例，放线菌素D、长春新碱和阿霉素首次使用就取得了成功。异环磷酰胺、依托泊苷和卡铂现在也用于特定病例。但有效的治疗方法有重要的缺点：放疗会导致生长缺陷，阿霉素会导致晚期心脏毒性，依托泊苷会引发白血病作为第二肿瘤。治疗策略基于肾母细胞瘤的预后因素，以及对每组患者的风险/收益比评估，同时考虑生存概率和晚期效应的风险。美国和欧洲的大型随机研究使治愈率超过90%，预期的后遗症很少。术前化疗现在已成功应用于儿童的其他肿瘤。
