摘要
目的 探讨伊立替康/替莫唑胺/长春新碱治疗儿童、青少年复发/难治性实体瘤的疗效和毒性。方法 从2011年9月-2014年4月,58例复发或难治儿童、青少年恶性实体肿瘤患者入组。采用替莫唑胺100 mg/（m^2·d）,口服,第1～5 d;伊立替康50 mg/（m^2·d）,在替莫唑胺口服1 h后静脉滴注,第1-5 d;长春新碱1.5 mg/m^2,第1 d。每3周重复。每两个疗程评估疗效。结果 58例患者中,男32例,女26例。中位年龄6（1～18）岁。神经母细胞瘤28例,横纹肌肉瘤12例,尤文氏肉瘤/原始神经外胚叶瘤3例,肝母细胞瘤3例,横纹肌样瘤3例,肾母细胞瘤2例,生殖细胞瘤、骨肉瘤、间叶源性恶性肿瘤、纤维肉瘤、恶性外周神经鞘瘤、髓母细胞瘤和鼻咽癌各1例。化疗后完全缓解（CR）5例,部分缓解（PR）13例,稳定（SD）17例,进展（PD）23例。全组患者客观有效率（CR＋PR）为31.0%,疾病控制率（CR＋PR＋SD）为60.3%。其中神经母细胞瘤有效率为39.3%;横纹肌肉瘤25.0%。共16例（27.6%）患者化疗后能获得局部治疗机会。神经母细胞瘤1年无进展生存率和总生存率分别为（23.4±10.8）%和（39.0±11.0）%。主要毒性为骨髓抑制和腹泻,对症处理可恢复。结论 伊立替康/替莫唑胺/长春新碱联合方案是儿童、青少年复发/难治实体瘤有效的挽救化疗方案,毒性可耐受。
Objective To determine the efficacy of irinotecan plus temozolomide and vincristine in children and adolescents with recurrent/refractory solid tumors. Methods Fiftyeight children and adolescents with recurrent or refractory solid tumors were included. Temozolomide （100 mg/m^2 ·d） was given orally for 5 consecutive days, and irinotecan （50 mg/m^2 ·d） was administered intravenously one hour after oral temozolomide for 5 consecutive days, and vincristine （ 1.5 mg/m^2 ·d） was administered intravenously on day one. The cycles were repeated three-weekly. The efficacy was evaluated every two weeks. Results Among the 58 patients, 32 were male and 26 were female, with the median age of 6 years old. The solid tumors including neuroblastoma （28 cases）, rhabdomyosarcoma （12 cases）, Ewing＇s sarcoma/primitive neuroectodermal tumor （ 3 cases ）, hepatoblastoma （ 3 cases ）, rhabdoid tumor （3 cases）, nephroblastoma （2 cases）, germ-cell tumor （1 case）, osteosarcoma （1 case ）, mesenchymal tumors （1 case）, fibrosarcoma （1 case）, malignant peripheral nerve sheath tumor （1 case）, medulloblastoma （1 case） and nasopharyngeal carcinoma （1 case）. Five cases reached complete remission （CR）, 13 cases reached partial remission （PR）, 17 cases reached stable disease （SD）, and 23 cases reached progression disease （PD）. After chemotherapy, the objective response rate was 31.0% , and the disease control rate was 60.3%. The objective response rate for neuroblastoma and rhabdomyosarcoma were 39.3% and 25.0% , respectively. Sixteen patients （27.6%） underwent local treatment after chemotherapy. In the 28 patients with NB, the estimated 1-year progression-free survival and overall survival were （23.4 ＋ 10.8）% and （39.0 _＋ 11.0）%, respectively. The main side- effects were myelosuppression and diarrhea. Conclusions The salvage regimen of irinotecan plus temozolomide and vincristine was safe and effective in children and adolescents with recurrent and refractory solid tumors.
出处
《中国小儿血液与肿瘤杂志》
CAS
2015年第1期17-21,共5页
Journal of China Pediatric Blood and Cancer
关键词
儿童
复发
肿瘤
化疗
Children
Relapse
Tumor
Chemotherapy
