Combination chemotherapy with ifosfamide, cisplatin, and etoposide for medulloblastoma: single-institute experience and differences in efficacy for subgroups of medulloblastoma
Combination chemotherapy with ifosfamide, cisplatin, and etoposide for medulloblastoma: single-institute experience and differences in efficacy for subgroups of medulloblastoma
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DOI：
10.1007/s00381-011-1485-y
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发表时间：
2011-09-01
影响因子：
1.4
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Saito, Ryuta;Kumabe, Toshihiro;Tominaga, Teiji
髓母细胞瘤的治疗包括手术切除、放射治疗和化疗。在日本，由顺铂、异环磷酰胺和依托泊苷组成的ICE化疗是最常见的方案之一。在这里，我们总结ICE化疗的毒性和有效性，并评估最近引入的分子分类方案在预测结果方面的有效性。我们回顾了我所17例接受ICE化疗作为初始治疗的髓母细胞瘤患者。其中11人被归类为标准风险组，6人被归类为高风险组。所有患者均接受了最大限度的细胞减灭术、放射治疗和ICE化疗。手术标本用Dkk1、SFRP1、NPR3和KCNA1四种抗体进行免疫组织化学染色，将病例分为WNT组、SHH组、C组和D组。大多数患者在手术和放疗后进行ICE化疗，但只要处理得当，仍可耐受骨髓抑制和听力障碍。标准风险疾病患者和高危疾病患者之间的存活率没有显著差异。17例患者的5年生存率和5年无进展生存率分别为80.7%和63.5%。其中WNT组3例，SHH组2例，C组1例，D组11例。D组患者ICE化疗后预后较差。
Treatment for medulloblastoma consists of surgical resection, radiation therapy, and chemotherapy. In Japan, ICE chemotherapy consisting of cisplatin, ifosfamide, and etoposide is one of the most common regimens. Here, we summarize the toxicity and efficacy of ICE chemotherapy and evaluate the usefulness of the recently introduced molecular classification scheme to predict the outcome.Seventeen patients with medulloblastoma treated by ICE chemotherapy as an initial therapy at our institute were retrospectively reviewed. Eleven were categorized in the standard-risk group and six in the high-risk group. All patients underwent maximum cytoreductive surgery, radiation therapy, and ICE chemotherapy. Operative specimens were subjected to immunohistochemical staining using four antibodies-DKK1, SFRP1, NPR3, and KCNA1-to classify the cases into four subgroups, WNT group, SHH group, group C, and group D, respectively.ICE chemotherapy following surgery and radiation therapy was tolerable in most patients with appropriate management, although myelosuppression and hearing disturbance occurred. There was no significant difference in survival between patients with standard-risk disease and high-risk disease. Five-year survival and 5-year progression-free survival for the 17 patients were 80.7% and 63.5%, respectively. Three patients were classified as WNT group, 2 as SHH group, 1 as group C, and 11 as group D. Group D tended to have poorer prognosis after ICE chemotherapy.ICE chemotherapy was tolerable and active against medulloblastomas. Patients categorized as group D tended to have worse outcome after ICE chemotherapy.