Hyperfractionated Accelerated Radiotherapy in the Milan Strategy for Metastatic Medulloblastoma
Hyperfractionated Accelerated Radiotherapy in the Milan Strategy for Metastatic Medulloblastoma
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DOI：
10.1200/jco.2008.18.4176
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发表时间：
2009-02-01
影响因子：
45.3
通讯作者：
Fossati-Bellani, Franca
中科院分区：
文献类型：
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作者：
Gandola, Lorenza;Massimino, Maura;Fossati-Bellani, Franca
为了改善转移性髓母细胞瘤患者的预后，我们测试了强化序贯化疗后超分割加速放射治疗(HART)方案的疗效和毒性。1998年至2007年期间，33例患者术后连续接受甲氨蝶呤(8g/m(2))、依托泊苷(2.4g/m(2))、环磷酰胺(4g/m(2))和卡铂(0.8g/m(2))治疗，疗程2个月。2次/d)，后颅窝放疗高达60Gy1.5次/次，2次/d。对HART前有持续性播散性疾病的患者进行两个疗程的清髓和外周血祖细胞挽救。结果患者分为M1病9例，M2病6例，M3病17例，M4病1例。7例10岁以下化疗后完全缓解的患者接受了较低剂量的神经轴照射(31.2Gy.在32名可评估的患者中，有22名对化疗有反应；5名患者病情稳定，5名患者病情恶化。1例败血症死亡发生在放疗前。8名患者在中位数12个月后复发。33例患者中有14例在HART后接受了巩固治疗。中位生存期为82个月，5年无事件、无进展和总存活率分别为70%、72%和73%。结论儿童转移性髓母细胞瘤术后加强化疗后行清髓化疗，HART是可行的。我们的治疗结果与其他使用传统疗法治疗的系列相比是有利的。
PurposeWith a view to improving the prognosis for patients with metastatic medulloblastoma, we tested the efficacy and toxicity of a hyperfractionated accelerated radiotherapy (HART) regimen delivered after intensive sequential chemotherapy.Patients and MethodsBetween 1998 and 2007, 33 consecutive patients received postoperative methotrexate (8 g/m(2)), etoposide (2.4 g/m(2)), cyclophosphamide (4 g/m(2)), and carboplatin (0.8 g/m(2)) in a 2-month schedule, then HART with a maximal dose to the neuraxis of 39 Gy (1.3 Gy/fraction, 2 fractions/d) and a posterior fossa boost up to 60 Gy (1.5 Gy/fraction, 2 fractions/d). Patients with persistent disseminated disease before HART were consolidated with two myeloablative courses and circulating progenitor cell rescue.ResultsPatients were classified as having M1 (n = 9), M2 (n = 6), M3 (n = 17), and M4 (n = 1) disease. Seven patients younger than 10 years old who achieved complete response after chemotherapy received a lower dose to the neuraxis (31.2 Gy). Twenty-two of the 32 assessable patients responded to chemotherapy; disease was stable in five patients and progressed in five patients. One septic death occurred before radiotherapy. Eight patients experienced relapse after a median of 12 months. Fourteen of the 33 patients underwent consolidation therapy after HART. With a median 82-month survivor follow-up, the 5-year event-free, progression-free, and overall survival rates were 70%, 72%, and 73%, respectively. No severe clinical complications of HART have emerged so far.ConclusionHART after intensive postoperative chemotherapy, followed by myeloablative chemotherapy in selected cases, proved feasible in children with metastatic medulloblastoma. The results of our treatment compare favorably with other series treated using conventional therapies.