Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: A report from the children's cancer group
Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: A report from the children's cancer group
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DOI：
10.1200/jco.2005.09.095
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发表时间：
2005-10-20
影响因子：
45.3
通讯作者：
Shiminski-Maher, T
中科院分区：
文献类型：
--
作者：
Geyer, JR;Sposto, R;Shiminski-Maher, T
目的评估两种化疗方案治疗年龄小于36个月的儿童恶性脑肿瘤的反应率、事件树生存期（EFS）和毒性，并估计初始手术和诱导化疗后无肿瘤残留的儿童不放疗的控制间隔，以及诊断时有肿瘤残留或转移性疾病的患者延迟放疗的控制间隔。患者和方法患者被随机分配到两种诱导化疗方案中的一种（长春新碱、顺铂、环磷酰胺和依托泊苷）。长春新碱、卡铂、异环磷酰胺和依托泊苷。无进展性疾病的儿童诱导后开始维持化疗。在诱导治疗后没有残留肿瘤和诊断时没有转移性疾病的儿童除非肿瘤进展，否则不接受放射治疗。结果共纳入299名婴儿。42%的患者对诱导化疗有反应。研究开始后5年，EFS发生率为27% +/- 3%，生存率为43% +/- 3%。两组在反应率和EFS方面没有显著差异。对于髓母细胞瘤、幕上原始神经外胚层肿瘤、室管膜瘤和横纹肌瘤，5年EFS发生率分别为32% +/- 5%、17% +/- 6%、32% +/- 6%和14% +/- 7%。58%在研究开始后存活5年的患者没有接受放射治疗。结论强化诱导化疗对婴幼儿恶性脑肿瘤有较高的有效率。生存率与以前的研究相当，大多数存活的患者没有接受放射治疗。
Purpose To evaluate response rate, event-tree survival (EFS), and toxicity of two chemotherapeutic regimens for treatment of children younger than 36 months with malignant brain tumors and to estimate control intervals without irradiation in children with no residual tumor after initial surgery and induction chemotherapy and with delayed irradiation in patients with residual tumor or metastatic disease at diagnosis.Patients and Methods Patients were randomly assigned to one of two regimens of induction chemotherapy (vincristine, cisplatin, cyclophosphamide, and etoposide vvincristine, carboplatin, ifosfamide, and etoposide). Maintenance chemotherapy began after induction in children without progressive disease. Children with no residual tumors after induction therapy and no metastatic disease at diagnosis were not to receive radiation therapy unless their tumors progressed.Results Two hundred ninety-nine infants were enrolled. Forty-two percent of patients responded to induction chemotherapy. At 5 years from study entry, the EFS rate was 27% +/- 3%, and the survival rate was 43% +/- 3%. There was no significant difference between the two arms in terms of response rate or EFS. For medulloblastoma, supratentorial primitive neuroectodermal tumor, ependymoma, and rhabdoid tumors, 5-year EFS rates were 32% +/- 5%, 17% +/- 6%, and 32% +/- 6%, and 14% +/- 7%, respectively. Fifty-eight percent of patients who were alive 5 years after study entry had not received radiation therapy.Conclusion Intensified induction chemotherapy resulted in a high response rate of malignant brain tumors in infants. Survival was comparable to that of previous studies, and most patients who survived did not receive radiation therapy.