摘要
目的:分析儿童复发髓母细胞瘤病例综合治疗方案和治疗结果。方法:回顾性分析2012年1月至2017年8月收治的确诊为复发髓母细胞瘤的患儿57例。初次治疗接受手术全部切除51例,次全切除6例。术后分别接受三维适形放疗、调强放疗,术后放疗期间同步化疗、单纯放疗,放疗期间同步化疗后持续5疗程化疗、单纯放疗后持续5疗程化疗。中位随访时间15月。结果:全组中位生存时间29.12月,6月、1年、2年、3年总生存率分别为91.23%、73.68%、54.38%和40.35%。单因素分析显示,儿童髓母细胞瘤患者总体生存率的因素包括手术切除范围(P=0.005)、肿瘤尺寸(P=0.048)及术后放疗期间同步化疗(P=0.002)。多因素分析显示肿瘤尺寸越大患儿预后越差(P=0.041),术后放疗期间同步进行化疗可以改善患儿预后(P=0.002)。结论:儿童髓母细胞瘤多为高级别肿瘤,预后较差,对儿童神经系统损伤较大,治疗方案应为手术切除结合放疗和化疗的综合性治疗,且在术后放疗期间同步进行化疗,以提高儿童患者生存率。
Objective： To analyze the comprehensive therapy and treatment results of medulloblastoma （MB） in children. Methods： A total of 57 patients diagnosed with medulloblastoma from January 2014 to August 2017 were enrolled in this retrospective analysis among which 51 children had total resection and 6 children partial resection during initial treatment. Following surgery, patients accepted three-dimensional radiotherapy （3DCRT） and intensity-modulated radiation therapy （IMRT）. During postoperative radiotherapy, patients underwent concurrent chemoradiotherapy or radiotherapy alone after which patients were treated with 5 courses of chemotherapy. The median follow-up period was 15 months. Results： Of all patients, the median survival length was 29.12 months. The 6-month, 1-, 2-, and 3-yeox overall survival rate was 91.23%, 73.68%, 54.38%, and 40.35%, respectively. Univariate analysis showed that the overall survival rate of children with medulloblastoma was affected by the range of surgical resection （P=0.005）, tumor size （P=0.048）, and concurrent chemotherapy during postoperative radiotherapy （P=0.002）. Multivariate analysis showed that the greater the tumor size, the worse the prognosis （P=0.041） and that simultaneous chemotherapy during postoperative radiotherapy could improve prognosis （P=0.002）. Conclusion： Medulloblastoma in children is predominantly a high-grade tumor with poor prognosis and can cause considerable damage to the children＇ s nervous system. The treatment program should consist of comprehensive therapy combining surgical resection with chemotherapy and radiotherapy and also chemotherapy during postoperative radiotherapy to improve patient survival rate.
作者
彭其斌
赵建农
王鹏程
陈宝智
刘颖
PENG Qi-bin;ZHAO Jian-nong;WANG Peng-chen;CflEN Bao-zhi;Liu Ying(Department oFNeurosurgery,Renmin Hospital of Hainan,Haikou 570311,China;Medical Research Institute,Wuhan University,Wuhan 430071,China)
出处
《神经损伤与功能重建》
2018年第11期555-557,571,共4页
Neural Injury and Functional Reconstruction
关键词
髓母细胞瘤
综合治疗
儿童
神经外科
预后
medulloblastoma
comprehensive treatment
children
neurosurgery
prognosis
