Postoperative chemotherapy without irradiation for ependymoma in children under 5 years of age: A multicenter trial of the French Society of Pediatric Oncology
Postoperative chemotherapy without irradiation for ependymoma in children under 5 years of age: A multicenter trial of the French Society of Pediatric Oncology
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DOI：
10.1200/jco.2001.19.5.1288
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发表时间：
2001-03-01
影响因子：
45.3
通讯作者：
Kalifa, C
中科院分区：
文献类型：
--
作者：
Grill, J;Le Deley, MC;Kalifa, C
目的：为了评估一种策略，避免放疗在一线治疗5岁以下的儿童脑或后颅窝室管膜瘤，专门管理16个月的辅助多药化疗后surgery.Patients和方法：1990年6月至1998年10月，73名儿童室管膜瘤（82%的高级别肿瘤）被纳入到这个多中心试验。儿童接受辅助常规化疗手术后，包括7个周期的三个疗程交替两种药物在每个疗程（丙卡巴肼和卡铂，依托泊苷和顺铂，长春新碱和环磷酰胺）超过一年半。化疗结束时未考虑全身放疗。在复发或进展的情况下，挽救治疗包括第二次手术，然后局部照射或不二线chemotherapy.Results：常规化疗耐受性良好，可以在门诊进行。没有放射学记录的化疗反应超过50%。中位随访时间为4.7年（范围：5个月至8年），该系列的4年无进展生存率为22%（95%置信区间[CI]，13%至43%），总生存率为59%（95% CI，47%至71%）。总体而言，40%（95% CI，29%至51%）的患者在化疗开始后2年内从未接受过放疗，23%（95% CI，14%至35%）的患者在4年内仍然存活，没有求助于这种方式。在多变量分析中，与良好结局相关的两个因素是幕上肿瘤位置（P = .0004）和完整手术（P = .0009）。在4年的总生存率为74%（95%CI，59%至86%）的患者中，切除术是完全的放射学和35%（95%CI，18%至56%）的患者与不完整的surgence.Conclusion：一个显着比例的室管膜瘤的儿童可以避免长期辅助化疗放疗。在复发时推迟放疗并不影响整个患者群体的总生存率。J Clin Oncol 19：1288-1296. (C)2001年，美国临床肿瘤学会。
Purpose: To evaluate a strategy that avoids radiotherapy in first-line treatment in children under 5 years of age with brain or posterior fossa ependymoma, by exclusively administering 16 months of adjuvant multiagent chemotherapy after surgery.Patients and Methods: Between June 1990 and October 1998, 73 children with ependymoma (82% with high-grade tumors) were enrolled onto this multicenter trial. Children received adjuvant conventional chemotherapy after surgery consisting of seven cycles of three courses alternating two drugs at each course (procarbazine and carboplatin, etoposide and cisplatin, vincristine and cyclophosphamide) over a year and a half. Systematic irradiation was not envisaged at the end of chemotherapy. In the event of relapse or progression, salvage treatment consisted of a second surgical procedure followed by local irradiation with or without second-line chemotherapy.Results: Conventional chemotherapy was well tolerated and could be administered in outpatient clinics. No radiologically documented response to chemotherapy more than 50% was observed. With a median follow-up of 4.7 years (range, 5 months to 8 years), the 4-year progression-free survival rate in this series was 22% (95% confidence interval [CI], 13% to 43%) and the overall survival rate was 59% (95% CI, 47% to 71%). Overall, 40% (95% CI, 29% to 51%) of the patients were alive having never received radiotherapy 2 years after the initiation of chemotherapy and 23% (95% CI, 14% to 35%) were still alive at 4 years without recourse to this modality. In the multivariate analysis, the two factors associated with a favorable outcome were a supratentorial tumor location (P = .0004) and complete surgery (P = .0009). Overall survival at 4 years was 74% (95% CI, 59% to 86%) for the patients in whom resection was radiologically complete and 35% (95% CI, 18% to 56%) for the patients with incomplete resection.Conclusion: A significant proportion of children with ependymoma can avoid radiotherapy with prolonged adjuvant chemotherapy. Deferring irradiation at the time of relapse did not compromise overall survival of the entire patient population. J Clin Oncol 19:1288-1296. (C) 2001 by American Society of Clinical Oncology.