摘要
目的回顾分析Ⅳ期高危神经母细胞瘤(HR-NB)患儿放疗疗效、安全性及影响因素。方法2014—2017间在北京儿童医院肿瘤内科按照BCH-HR-NB-2007方案治疗并行局部放疗的Ⅳ期HR-NB患儿120例中男56例、女64例,中位年龄43(9~148)个月。治疗方案为4疗程CAV方案化疗,3疗程CVP方案化疗,第4疗程后行手术切除,7疗程后予自体造血干细胞移植及局部15.0~30.6 Gy放疗(仅原发瘤灶放疗82例、原发瘤灶+转移灶放疗38例),后予13顺式-维甲酸维持治疗,总疗程约1.5年。结果随访中位时间21个月。3年局部控制率为84.4%,3年无事件生存率放疗前转移灶无残留组高于有残留组(78.4%∶30.4%,P=0.003),放疗距瘤灶切除时间<6个月组高于≥6个月组(66.1%∶50.6%,P=0.018)。转移灶有残留患儿未行、行转移灶放疗的进展率分别为66.6%、20.0%(P=0.001)。所有患儿均未发生肝脏、肾脏、心脏等放疗相关不良反应,3-4级骨髓抑制率放疗后1周为24.5%,2周为8%。结论放疗对于Ⅳ期HR-NB患儿局部控制存在确切疗效,术后尽早放疗及对病初转移灶进行放疗有助于进一步改善预后。短期观察未见重要脏器损害,放疗后2周骨髓抑制呈恢复趋势。
Objective To retrospectively analyze the clinical efficacy, safety and influencing factors of radiotherapy in children with stage Ⅳ high-risk neuroblastoma (HR-NB). Methods A total of 120 children with HR-NB who were diagnosed and treated with local radiotherapy according to the BCH-HR-NB-2007 protocol in the Oncology Department of Beijing Children′s Hospital from January 2014 to December 2017 were enrolled. Among them, 56 children were male and 64 female with a median age of 43 months (9-148 months). The treatment protocol consisted of 4 cycles of CAV chemotherapy, 3 cycles of CVP chemotherapy, surgical resection after 4 cycles, autologous hematopoietic stem cell transplantation after 7 cycles, local radiotherapy at a dose of 15.0-30.6 Gy for 82 cases of primary tumors and 38 cases of primary and metastatic tumors, followed by 13 cis-retinoic acid as maintenance therapy. The entire treatment protocol endured for approximately 18 months. Results The median follow-up time was 21 months. The 3-year local control rate was 84.4%. Before radiotherapy, the 3-year event-free survival rate was 78.4% in children without metastases, significantly higher compared with 30.4% in the residual group (P=0.003). The 3-year event-free survival rate was 66.1% in patients who underwent radiotherapy within 6 months after surgery, significantly higher than 50.6% in their counterparts receiving radiotherapy at 6 months or more after surgery (P=0.018). Among the children with residual metastases before radiotherapy, the progression rate in children who did not receive radiotherapy was 66.6%, significantly higher compared with 20.0% in those receiving radiotherapy (P=0.001). All patients had no radiation-related adverse reactions in the liver, kidney and heart, etc. The incidence rate of grade Ⅲ-IV myelosupression was 24.5% at 1 week post-radiotherapy, and 8% at 2 weeks after radiotherapy. Conclusions Radiotherapy yields definite clinical efficacy in the local control of children with stage Ⅳ HR-NB. Early radiotherapy after surgery and radiotherapy for the metastatic lesions can improve the clinical prognosis. No vital organ injuries are observed during the short-term follow-up. At 2 weeks after radiotherapy, the myelosupression is gradually restored.
作者
周宇晨
苏雁
蒋持怡
蔡思雨
金眉
张大伟
张福泉
马晓莉
Zhou Yuchen;Su Yan;Jiang Chiyi;Cai Siyu;Jin Mei;Zhang Dawei;Zhang Fuquan;Ma Xiaoli(Center of Hematological and Oncology,Beijing Children' s Hospital,Capital Medical University,NationalCenter for Children' s Health,Beijing 100045,China;Center of Clinical Epidemiology and Evidence-Based Medicine,Beijing Children' s Hospital,Capital Medical University,National Center for Children' s Health,Beijing 100045,China;Department of Radiation Oncology,Beijing Union Hospital,Chinese Academy of Medical Sciences,Beiijing 100730,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2019年第4期258-261,共4页
Chinese Journal of Radiation Oncology
