Strojan P, Petric-Grabnar G, Zupancic N, Jereb B
Institute of Oncology, Department of Radiotherapy, Ljubljana, Slovenia.
Med Pediatr Oncol. 1999 Feb;32(2):112-6. doi: 10.1002/(sici)1096-911x(199902)32:2<112::aid-mpo8>3.0.co;2-r.
In incompletely resected low-grade supratentorial astrocytoma, long-term survival is poor; the effect of any additional treatment to surgery still remains poorly defined. The aim of this study was to evaluate the response, the survival, and the benefit of concomitant chemoradiotherapy in eight children who had incompletely resected supratentorial low-grade astrocytoma.
There were six boys and two girls, aged 4-15 years. Four tumors were in the cerebral hemispheres, one in the hemisphere and thalamus, two in the third ventricle and/or thalamus, and one in the basal ganglia. Partial resection of the tumor was performed in four patients, biopsy in four; the extent of surgery was additionally evaluated with computed tomographic (CT) and/or magnetic resonance imaging (MRI) studies. A tumor dose of 50-56 Gy was delivered postoperatively in 1.8-2.1 Gy daily fractions five times per week. Chemotherapy was intercalated concomitantly in the radiotherapy protocol: cisplatin 20 mg/m2/2 weeks intravenously (IV) and vincristine 1.5 mg/m2/week IV (up to a maximum dose of 2 mg) were planned, starting on day 1 of irradiation. There were one to three cisplatin applications and one to seven vincristine applications.
Seven patients are alive 5.5-11.5 years (median, 8 years) after therapy. Six of seven are without evidence of tumor on CT and/or MRI. A residual mass is still visible in one patient, 11.5 years after therapy. He was treated at the age of 4; he is handicapped due to mental retardation and severe neurological impairment. One patient died 5 years after chemoradiotherapy, due to secondary glioblastoma multiforme, without recurrence at the site of the first tumor. Chemotherapy was discontinued in two patients because of severe nausea and vomiting; there was no hematologic or neurologic toxicity.
In view of the encouraging results, all patients with incompletely resected supratentorial low-grade astrocytomas will be treated as above.
在未完全切除的幕上低级别星形细胞瘤中，长期生存率较低；手术之外的任何其他治疗方法的效果仍不明确。本研究的目的是评估同步放化疗对8例幕上低级别星形细胞瘤未完全切除患儿的反应、生存情况及获益。
6名男孩和2名女孩，年龄4至15岁。4个肿瘤位于大脑半球，1个位于半球和丘脑，2个位于第三脑室和/或丘脑，1个位于基底神经节。4例患者进行了肿瘤部分切除术，4例进行了活检；手术范围还通过计算机断层扫描（CT）和/或磁共振成像（MRI）研究进行了评估。术后给予肿瘤剂量50至56 Gy，每周5次，每次1.8至2.1 Gy。化疗在放疗方案中同步进行：计划从放疗第1天开始，静脉注射顺铂20 mg/m²/2周，长春新碱1.5 mg/m²/周（最大剂量2 mg）。顺铂应用1至3次，长春新碱应用1至7次。
7例患者在治疗后5.5至11.5年（中位时间8年）存活。7例中的6例在CT和/或MRI上无肿瘤证据。1例患者在治疗11.5年后仍可见残留肿块。他4岁时接受治疗，因智力发育迟缓及严重神经功能障碍而残疾。1例患者在同步放化疗后5年死亡，死于继发性多形性胶质母细胞瘤，原肿瘤部位无复发。2例患者因严重恶心和呕吐停止化疗；无血液学或神经毒性。
鉴于取得的令人鼓舞的结果，所有幕上低级别星形细胞瘤未完全切除的患者都将按上述方法治疗。
