Preradiation high-dose intravenous methotrexate with leucovorin rescue for untreated primary childhood brain tumors.
Preradiation high-dose intravenous methotrexate with leucovorin rescue for untreated primary childhood brain tumors.
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放射前大剂量静脉注射甲氨蝶呤联合甲酰四氢叶酸可挽救未经治疗的原发性儿童脑肿瘤。
DOI：
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发表时间：
1988
影响因子：
45.3
通讯作者：
Gerald Rosen
中科院分区：
文献类型：
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作者：
J. C. Allen;R. Walker;Gerald Rosen
尽管高剂量静脉注射 (IV) 甲氨蝶呤 (MTX) 联合亚叶酸救援 (HDMTX) 对某些复发性原发性脑肿瘤有效，但由于担心诱发白质脑病，限制了其作为治疗性脑照射 (RT) 后辅助治疗的使用。我们在新辅助治疗中对 10 名新诊断的高危儿科原发性脑肿瘤患者进行了一项 I 至 II 期临床试验，每两周一次使用 HDMTX (8 g/m2) 四个疗程。单独使用 HDMTX 2 至 4 个疗程后，4 名患者出现客观缓解（髓母细胞瘤，1 例；松果体母细胞瘤，1 例；恶性脑星形细胞瘤，2 例）。所有十名患者随后接受了一个疗程的放疗治疗，其中七名患者接受了其他药物的辅助化疗。一名患者在放疗前患上急性短暂性脑病，但已完全缓解；另一名患者在放疗后出现癫痫发作，与磁共振成像 (MRI) 扫描中白质异常相关。 5 名患者至少存活了 33 个月以上，4 名患者仍处于持续缓解状态。新辅助 HDMTX 的急性和迟发神经毒性是可以接受的，我们赞成在 III 期试验中进一步使用这种新辅助方法。
Although high-dose intravenous (IV) methotrexate (MTX) with leucovorin rescue (HDMTX) is effective for certain recurrent primary brain tumors, concern for inducing leukoencephalopathy has restrained its use as adjuvant therapy following therapeutic brain irradiation (RT). We have conducted a phase I to II clinical trial using four biweekly courses of HDMTX (8 g/m2) in a neoadjuvant setting in ten patients with newly diagnosed high-risk pediatric primary brain tumors. Four patients experienced an objective response after two to four courses of HDMTX alone (medulloblastoma, one; pineoblastoma, one; malignant cerebral astrocytoma, two). All ten patients subsequently received a course of therapeutic RT, and in seven cases, adjuvant chemotherapy with other agents. One patient acquired an acute transient encephalopathy before RT that completely resolved, and another developed a seizure disorder following RT associated with white matter abnormalities on a magnetic resonance imaging (MRI) scan. Five patients have survived a minimum of 33+ months, and four remain in continuous remission. The acute and delayed neurotoxicity of neoadjuvant HDMTX is acceptable, and we favor further use of this neoadjuvant approach in the context of a phase III trial.