CDV与CiE两种方案联合术前化疗治疗晚期儿童神经母细胞瘤的近期疗效观察

Curative effects of the protocol of CDV combined with CiE as pre-operative chemotherapy in high-risk childhood neuroblastoma

摘要:

目的:观察CDV(环磷酰胺+柔红霉素+长春新碱)与CiE(顺铂+足叶乙甙)联合术前化疗治疗晚期神经母细胞瘤患儿的近期疗效及相关毒性。方法:回顾分析27例IV期神经母细胞瘤患儿临床资料，年龄1岁2个月至8岁，原发部位腹部21例，后纵隔4例，盆腔2例，骨髓转移23例，多发性骨转移12例。均经CDV方案3疗程及CiE方案2疗程化疗。应用神经母细胞瘤治疗反应评价标准和美国国立癌症研究所通用不良反应分级标准对化疗近期疗效和相关毒副反应进行评价。结果:27例患儿经术前化疗，总有效率为82%；辅助化疗后24例患儿接受手术治疗，完全切除原发肿瘤14例（58%），部分切除10例（42%）。化疗相关毒副反应主要是骨髓抑制，27例患儿粒细胞下降均为IV级；血红蛋白下降III级7例(26%)，IV级20例(74%)；血小板下降III级2例(7%)，IV级25例(93%)。所有患儿均出现不同程度的感染，经积极的抗感染治疗可以控制。消化道、肝脏、肾脏损害多为Ⅰ、Ⅱ级，经治疗可恢复。2例（7%）出现Ⅰ级神经毒性病例。无心功能受损病例。结论: CDV与CiE联合术前化疗方案治疗IV期神经母细胞瘤有转好的疗效，可为手术治疗创造条件。［中国当代儿科杂志，2009，11（11）：885-887］

Abstract:

OBJECTIVE: To evaluate the effects and the toxicity of the protocol of CDV combined with CiE as pre-operative chemotherapy in childhood stage IV neuroblastoma. METHODS: The clinical data of 27 children aged from 1.2 to 8 years with neuroblastoma in stage IV was retrospectively studied. The primary sites of the diseases were abdomen (n=21), posterior mediastinum (n=4) and pelvic cavity (n=2). Twenty-three patients had bone marrow metastasis. Twelve patients had bone metastasis. All patients were treated with the CDV protocol (cyclophosphamide+doxorubicin+vincristine) for 3 cycles and the CiE protocol (cisplatin+etoposide) for 2 cycles. Neuroblastoma therapeutic response evaluation criterion and common terminology criteria for adverse events of National Cancer Institute were used to evaluate effects and chemotherapy-related toxicity. RESULTS: All patients received the pre-operative chemotherapy. The overall response rate was 82%. After chemotherapy, 24 patients received operations. Total resection of primary tumor was found in 14 patients (58%) and part resection in 10 patients (42%). The most common chemotherapy-related toxicity was bone marrow suppression: grade IV suppression of neutrophils (n=27), reduction in hemoglobin (III grade, n=7; IV grade, n=20) and reduction in platelet (III grade, n=2; IV grade, n=25). Infection was found in all patients and was controlled with antibiotics.I or II grade lesions of digestive, liver and kidney were found and could be recovered after therapy. Grade I neurotoxicity occurred in 2 patients (7%). The heart function damage was not found in any of patients. CONCLUSIONS: The protocol of CDV combined with CiE as pre-operative chemotherapy might be effective in children with stage IVneuroblastoma.［Chin J Contemp Pediatr, 2009, 11 (11):885-887］