摘要
目的：回顾分析标危型髓母细胞瘤采用全脑全脊髓放疗剂量≤24 Gy和＞24 Gy对预后的影响。方法标危型髓母细胞瘤定义为年龄＞3岁、未发生转移、肿瘤全切或近全切（残留≤1.5 cm3）。2003—2013年共入组72例初治儿童、青少年标危型髓母细胞瘤患者。患者术后接受全脑全脊髓＋局部瘤床放疗和8个疗程辅助化疗，化疗方案为顺铂、司莫司汀或卡莫司汀联合长春新碱。按放疗剂量≤24 Gy和＞24 Gy分为A、B组（20、52例），比较两组患者复发率和生存率。 Kaplan.Meier法计算复发率和生存率并Logrank法检验组间差异。结果 A组接受全脑全脊髓放疗19．2～24.0 Gy，B组接受全脑全脊髓放疗24．1～30.6 Gy。放疗后66例（92％）患者完成全部辅助化疗。共11例患者复发。随访满3年患者48例，其中复发11例，死亡7例。全组3年EFS率为83％，3年OS率为86％。 A组和B组患者3年EFS率分别为84％和83％（ P＝0.609），3年OS率分别为85％和87％（ P＝0.963）。结论标危型髓母细胞瘤经规范综合治疗效果较好，其中全脑全脊髓放疗剂量减少至19．2～24.0 Gy未影响疗效。
Objective To retrospectively analyze the impacts of a craniospinal radiation dose ≤24 Gy or＆gt;24 Gy on the prognosis of patients with average-risk medulloblastoma. Methods Average-risk medulloblastoma was defined as non-metastatic cancer in children more than 3 years old with complete or near-complete （ residual tumor ≤1-5 cm3 ） resection of tumor. A total of 72 children and adolescents with newly diagnosed average-risk medulloblastoma were enrolled as subjects from 2003 to 2013. After radical resection of the tumor, all patients received craniospinal plus local tumor bed radiotherapy and 8 cycles of adjuvant chemotherapy using cisplatin-, semustine-, or plus vincristine-based regimens. Patients exposed to a radiation dose ≤24 Gy were enrolled into Group A （ n=20） , while patients exposed to a radiation dose〉24 Gy were enrolled into Group B （ n=52） . The recurrence rate and survival rate were compared between the two groups. The recurrence rate and survival rate were calculated using the Kaplan-Meier method and the differences between the two groups were analyzed using the log - rank test . Results Patients in Group A and Group B received craniospinal radiotherapy with a dose of 19-2-24-0 Gy and 24-1-30-6 Gy, respectively. After radiotherapy, 66 patients （ 92%） completed all adjuvant chemotherapy. A total of 11 patients were recurrence. In all patients, the 3-year sample size was 48;the 3-year event-free survival （ EFS） and overall survival （ OS ） rates were 83% and 86%, respectively. There were no significant differences in the 3-year EFS and OS rates between Group A and Group B （84% vs. 83%, P=0.609;85%vs. 87%, P=0.963）. Conclusions The standard comprehensive therapy achieves satisfactory treatment outcomes for average-risk medulloblastoma, in which a craniospinal radiation dose decreased to 19-2-24-0 Gy has no impacts on treatment outcomes.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2015年第5期540-543,共4页
Chinese Journal of Radiation Oncology
