髓母细胞瘤患儿放化疗后并发脑损伤的治疗、危险因素及预后分析
摘要
目的通过分析髓母细胞瘤(MB)患儿合并脑损伤的临床病理特征,探讨其有效治疗方法,分析其危险因素及预后。方法接受放疗和化疗的髓母细胞瘤患儿300例,其中13例并发脑损伤,年龄4.5岁～14岁,给予口服泼尼松治疗,每月随访患儿头颅增强MRI,对比治疗前后脑损伤好转程度。对脑损伤患儿与同期未出现脑损伤的髓母细胞瘤患儿临床病理特征进行比较,Logistic回归分析MB患儿脑损伤危险因素。采用Kaplan-Meier法计算患儿总体生存(OS)率。结果髓母细胞瘤放化疗后并发脑损伤的13例患儿中,12例为放疗所致,1例为化疗药所致。放疗所致脑损伤多发生在放疗结束后8个月(3～15个月),经激素治疗1～5个月好转,中位好转时间2个月。化疗药所致脑损伤患儿于10个月后脑损伤回复正常;脑损伤与无脑损伤患儿性别、年龄、病理分型、分子分型比较,P均>0.05;两组手术范围、M分期比较,P均<0.05。Logistic回归分析结果显示,TNM分期中M分期为髓母细胞瘤患儿放化疗后出现脑损伤的独立危险因素(P<0.05)。髓母细胞瘤患儿放化疗后脑损伤患儿3年OS率为(84.6±10.0)%,同期无脑损伤患儿3年OS率为(73.3±3.2)%,二者比较,P>0.05。结论髓母细胞瘤患儿放化疗后并发的脑损伤经激素治疗很快好转,TNM分期中M分期为髓母细胞瘤患儿放化疗后出现脑损伤的独立危险因素。髓母细胞瘤患儿放化疗后脑损伤不影响髓母细胞瘤患儿的远期预后。
引文
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[2] Johnson KJ, Cullen J, Barnholtz-Sloan JS, et al. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review[J]. Cancer Epidemiol Biomarkers Prev, 2014,23(12):2716-2736.
[3] Gittleman HR, Ostrom QT, Rouse CD, et al. Trends in central nervous system tumor incidence relative to other common cancers in adults, adolescents, and children in the United States, 2000 to 2010[J]. Cancer, 2015,121(1):102-112.
[4] Chintagumpala M, Gajjar A. Brain tumors[J]. Pediatr Clin North Am, 2015,62(1):167-178.
[5] Kumar LP, Deepa SF, Moinca I, et al. Medulloblastoma: A common pediatric tumor: Prognostic factors and predictors of outcome[J]. Asian J Neurosurg, 2015,10(1):50.
[6] Samkari A, White JC, Packer RJ. Medulloblastoma: toward biologically based management[J]. Semin Pediatr Neurol, 2015,22(1):6-13.
[7] 武万水,杜淑旭,任思其,等.采用HIT-2000方案治疗的41例髓母细胞瘤患儿疗效分析[J].中华实用儿科临床杂志,2017,32(3):191-194.
[8] Massimino M, Biassoni V, Gandola L, et al. Childhood medulloblastoma[J]. Crit Rev Oncol Hematol, 2016,105:35-51.
[9] Giantsoudi D, Sethi RV, Yeap BY, et al. Incidence of CNS injury for a cohort of 111 patients treated with proton therapy for medulloblastoma: LET and RBE associations for areas of injury[J]. Int J Radiat Oncol Biol Phys, 2016,95(1):287-296.
[10] Nieder C, Andratschke NH, Grosu AL. Re-irradiation for recurrent primary brain tumors[J]. Anticancer Res, 2016,36(10):4985-4995.
[11] Kramer K, Pandit-Taskar N, Zanzonico P, et al. Low incidence of radionecrosis in children treated with conventional radiation therapy and intrathecal radioimmunotherapy[J]. J Neurooncol, 2015,123(2):245-249.
[12] Murphy ES, Merchant TE, Wu S, et al, Necrosis after craniospinal irradiation:results from a prospective series of children with central nervous system embryonal tumors[J]. Int J Radiat Oncol Biol Phys, 2012,83(5):e655-e660.