Ⅳ期高危神经母细胞瘤原发病变部位局部放疗的价值
The value of primary site radiotherapy in stage Ⅳ high-risk neuroblastoma
目的 探讨Ⅳ期高危神经母细胞瘤(NB)患者术后原发病变部位局部放疗对肿瘤局部控制率和生存率的影响.方法 回顾分析2003 -2010年本中心初治的47例Ⅳ期高危NB患者临床资料,其中发病年龄中位数4岁,术前化疗周期中位数5个;37例患者原发肿瘤切除(完全切除或大部切除),其中24例行原发病变部位局部放疗.局部控制率和生存率采用Kaplan-Meier计算并Logrank法检验,余用Fisher's精确概率法检验.结果 随访率为89%,随访满3年者34例.24例肿瘤切除加放疗和13例肿瘤切除未加放疗的局部复发率分别为13%( 3/24)和54%( 7/13),(P=0.016),3年局部控制率分别为84%和47%(χ2 =7.95,P=0.005),3年生存率分别为56%和46%(χ2=5.44,P=0.020).局部放疗未出现严重放疗反应.结论 Ⅳ期高危NB患者经化疗和手术切除原发肿瘤后局部放疗有助于降低局部复发率,有可能进一步改善生存率.
更多Objective To investigated the effect of post-operative primary site radiotherapy on stage Ⅳ neuroblastoma.Methods From Jan 2003 to Dem 2010,47 newly diagnosed stage Ⅳ neuroblastoma treated in Sun Yet-sen university cancer center.The treatment protocol for these patients were induction chemotherapy 4- 12 cycles,followed by surgery if possible,then 4-6 cycles consolidation chemotherapy and/or primary site radiotherapy and maintenance immunotherapy.The median age was 4 years old,the median induction chemotherapy cycles was 5.37 patients received resection of the primary tumor (total resection and nearly gross resection).24 out of 37 received primary site radiotherapy.Results The followup rate was 89%.34 cases were followed up more than 36 months.For patients with or without postoperative primary site radiotherapy,the local recurrence rate were 13% ( 3/24 ) and 54% ( 7/13 ),respectively ( P =0.016),the 3-year local control rate were 84% and 47%,respectively ( χ2 =7.95,P =0.005 ).The 3-year overall survival rate were 56% and 28%,respectively ( χ2 =5.44,P =0.020 ). There was no severe radiation side effect. Conclusions This study indicated that postoperative primary site after induction chemotherapy and surgery could reduce the local recurrence rate and possibly improve the overall survival rate of stage Ⅳ neuroblastoma.
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