儿童髓母细胞瘤复发特征及治疗的研究进展

doi:10.12372/jcp.2023.22e1112

摘要/Abstract

摘要：

髓母细胞瘤（medulloblastoma，MB）是儿童常见颅内恶性肿瘤，经规范的多模式初始治疗后仍有较高复发率，即使予复发患儿高强度治疗后其预后仍极差。近年来对MB复发的临床及生物学特征理解逐渐深入，进而针对性指导设计相关治疗策略并开展临床试验。本文对以上研究进展进行回顾，希冀推进其临床转化应用的速度，最终益于临床实践。

关键词: 髓母细胞瘤, 复发, 治疗, 儿童

Abstract:

Medulloblastoma (MB) is a common intracranial malignancy in children with a high recurrence rate despite standardized multimodal initial treatment. The prognosis of recurrent children is very poor even after intensive treatment. In recent years, the in-depth understanding of the clinical and biological characteristics of MB recurrence can guide the clinical design of relevant treatment strategies and implement of clinical trials. This paper reviews the research progress of the above contents, hoping to promote the speed of its clinical transformation and application, and finally benefit the clinical practice.

Key words: medulloblastoma, recurrent, therapy, child

张再禹, 吴宇鑫, 梁平. 儿童髓母细胞瘤复发特征及治疗的研究进展[J]. 临床儿科杂志, 2023, 41(10): 708-714.

ZHANG Zaiyu, WU Yuxin, LIANG Ping. Research progress on characterization and therapeutics for recurrent medulloblastoma in children[J]. Journal of Clinical Pediatrics, 2023, 41(10): 708-714.

图/表 1

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临床试验名称	年龄	放射治疗方案	化学治疗方案	复发率/%	复发中位时间/a
HIT-SKK’2000^[12]	<4岁	化疗后完全缓解则不接受放疗	CTX+VCR+MTX+CBP+VP-16+ i.vc.MTX	37.5	1.3
Head Start I-II^[11]	<3岁	不接受放疗	诱导：CTX+VCR+VP-16+CDDP 巩固：CBP+VP-16+Thiotepa	33.3	NA
HIT-SIOP-PNET4^[10]	4~21岁	标准方案：全脑脊髓23.4 Gy+后颅窝54 Gy 超分割方案：全脑脊髓36 Gy+后颅窝60 Gy+瘤床68 Gy	CDDP+CCNU+VCR	19.5	2.2
SJMB96^[9]	3~21岁	标危组：全脑脊髓23.4 Gy+后颅窝36 Gy+瘤床55.8 Gy 高危组：全脑脊髓36~39.6 Gy+瘤床55.8 Gy+转移病灶50.4 Gy	VCR+CTX+CDDP	标危组/高危组： 15.1/29.2¹⁾	标危组/高危组： 2.0/1.6²⁾
SJMB03^[25]	3~21岁	标危组：全脑脊髓23.4 Gy+瘤床55.8 Gy 高危组：全脑脊髓36~39.6 Gy+瘤床55.8~59.4 Gy	VCR+CTX+CDDP	标危组/高危组： 16.3/34.0¹⁾	标危组/高危组： 2.0/1.3²⁾
SJYC07^[14]	<3岁	不接受放疗	诱导：MTX+VCR+CTX+CDDP 巩固：CTX+CBP+VP-16 维持：CTX+Topotecan+Erlotinib	65.8³⁾	0.7
COG-P9934^[13]	8月龄~3岁	化疗后完全缓解则不接受放疗	诱导：CTX+VCR+VP-16+CDDP 巩固：CBP+Thiotepa	39.2³⁾	NA