The Impact of Chemotherapy and Radiation Therapy on Secondary Operations for Neuroblastoma
The Impact of Chemotherapy and Radiation Therapy on Secondary Operations for Neuroblastoma
复制标题
化疗和放疗对神经母细胞瘤二次手术的影响
作者：
E. I. Smith;H. Krous;W. Tunell;D. Hitch
从1969年1月到1979年7月，俄克拉荷马州儿童纪念医院收治了37名神经母细胞瘤患儿。研究了19例广泛性疾病患者，以检查化疗、放疗和二次手术的相互关系。11名儿童在腹部或颈部进行了二次手术，其中1名术后死亡。所有患者在初次手术和二次手术或死亡之间均接受了化疗，10例接受了放疗。五个孩子活了下来。五分之四的幸存者在诊断和初步治疗时不到一岁。15例患者中有14例（1岁或1岁以上）死亡。治疗前后均行肿瘤病理检查。所有的存活者都显示出肿瘤组织的连续成熟，但只有一个非存活者有这个发现。在接受联合治疗的患者中发现了不寻常的转移扩散。晚期神经母细胞瘤的多模式治疗强调了合理选择时机和利用二次手术的必要性。二次手术理想地根除肿瘤的原发灶，并且还可以用于切除转移性疾病的选择性区域或活检残留疾病以帮助继续治疗。二次手术应该在放射治疗开始后4到6周，或化疗开始后12到24周。这种延迟允许最大限度地控制原发性和全身性疾病，以及广泛的最初不可切除的原发性肿瘤的成熟、分化、包裹和收缩。
From January, 1969 through July, 1979, 37 children with neuroblastoma were cared for at the Oklahoma Children's Memorial Hospital. Nineteen patients with extensive disease were studied to examine the interrelationships of chemotherapy, radiation therapy and secondary surgery. Eleven children had secondary surgery in the abdomen or cervical region with one postoperative death. All patients had chemotherapy and ten had radiation therapy between the primary and secondary operation or death. Five children survived. Four of five survivors were less than one year of age at diagnosis and initial treatment. Fourteen of 15 patients, one year of age or older, died. Each case had pathologic examination of tumor before and after therapy. All survivors showed sequential maturation of tumor tissue but only one nonsurvivor had this finding. Unusual metastatic spread was found in patients having combined therapy. Multimodal therapy for advanced neuroblastoma accentuates the need for sensible timing and utilization of secondary operative procedures. The secondary procedures ideally eradicate the primary focus of tumor, and may also serve to excise selective areas of metastatic disease or to biopsy residual disease in aiding continuing therapy. Secondary surgery ought to follow the onset of radiation therapy by four to six weeks, or of chemotherapy by 12 to 24 weeks. This delay allows maximum control of primary and generalized disease, as well as maturation, differentiation, encapsulation and shrinkage of extensive initially unresectable primary tumors.