新辅助化疗在儿童肾母细胞瘤治疗中的应用

Neo-adjuvant Chemotherapy for Wilms’Tumor in Children

目的探讨术前化疗在儿童肾母细胞瘤手术治疗中的价值,评价新辅助化疗在提高手术切除率及患者生存率中的意义.方法我院从1996年12月至2007年2月共收治21例肾母细胞瘤患儿,年龄9个月～4岁.术前常规给予AV方案[更生霉素15μg/(kg.d),静脉滴注,连用5d;长春新碱1.5mg/m2.w,静脉推注,连用2周]1～2个周期的化疗.结果本组21例中有18例(18/21,85.7%)肿瘤明显缩小,其中17例得到完整的肿瘤切除,3例(3/21,14.3%)缩小不明显,其中有2例在化疗过程中肿瘤体积增大失去手术机会.本组患者随访8个月～11a,平均3a,其中死亡2例(2/21,9.5%),失访2例,其余17例均得到长期无瘤生存.整个化疗过程中所有患儿均未发生血象降低、肝肾功能损害等化疗毒副作用.结论儿童患者对AV化疗方案具有较好的耐受性.术前化疗可使肾母细胞瘤瘤体明显缩小,降低手术风险,提高肿瘤完整切除率及患儿的生存率.

Objective To investigate the value of nee-adjuvant chemotherapy for wilms＇ tumor in children, and evaluate the chemotherapy in improving the survival rate of the children. Methods 21 cases of wilms＇tumor patients whose age February of 2007. ranged from 9 months to 4 years were treated in our hospital during December of 1996 and Chemotherapy were performed to all of those patients before the operation. AV project [Actiomycin D：15 μg/（kg.d）, ivgtt × 5 days; Vincristine： 1.5 mg/m^2.w, iv × 2 weeks] were carried out. Resuits The tumor volume became smaller significantly after the chemotherapy in 18 cases, in which 17 cases got successful surgical resection. However the other 3 cases had little reaction to the chemotherapy, in which 2 cases didn＇t get the opportunity of resection. All of the patients were followed up for 3 years in average after our treatment, in which 2 cases died and other 2 cases were lost in our follow up, the remained 17 cases survived without tumor. All of our patients had no serious side effects such as myelosuppression and liver function damage during the chemotherapy. Conclusions Child patients have good tolerance to the AV project, the nee-adjuvant chemotherapy can effectively decrease the volume of the tumor which helps to reduce the risk of the operation and increase the survival rates.