显微外科为主的综合治疗对小儿髓母细胞瘤预后的影响

Long term Results of Combined Therapy on Medulloblastoma

目的 分析显微手术辅以放疗、化疗对小儿髓母细胞瘤治疗效果及其预后的影响。方法 将髓母细胞瘤患儿分为二组， 手术全切除组和手术未全切除组。前者术后只接受全神经轴放射治疗， 后者术后辅以放疗和化疗， 观察二组治疗效果和预后的差异。结果 手术全切除组术后肿瘤复发率２９ ．３ ％ ，１、２ 、５ 年生存率分别为１００ ％ 、９４．１ ％ 、８２．４％ ； 手术未全切除组术后肿瘤复发率８５．７％ ，１ 、２、５ 年的生存率分别为７１．４ ％ 、４２．９％ 、２８ ．６％ 。两组术后复发率和生存率均存在显著差异（ Ｐ＜０ ．０１） 。结论 显微外科手术能否行肿瘤全切除是影响小儿髓母细胞瘤治疗效果和预后的决定性因素， 术后放射治疗有利于防止肿瘤复发， 化疗对于未能行手术全切除的小儿髓母细胞瘤的治疗可能具有广阔的前景。

Objective The purpose of the study is to assess the long term results of a combined microsurgery, radiotherapy with chemotherapy to treat medulloblastoma in children. Methods After microsurgery, the patients were grouped according to the extent of resection: (1) The complete resection group underwent radiation to the whole neuroaxis and (2) The incomplete resection group received postoperative radiation and chemotherapy. The results of the two groups were compared. Results The recurrence rate, 1 year, 2 year and 5 year survival rates were 29.3% , 100%, 94.1% and 82.4% for complete resection group respectively, while those for in complete resection group were 85.7% , 71.4% , 42.9% , 28.6% respectively. The recurrence rate and survival rate differed significantly between the two groups ( P < 0.01 ). Conclusions Resectability of medulloblastoma determines the prognosis. Postoperative radiotherapy may prevent recurrence. Chemotherapy is a promising mode of treatment in children with incompletely resected medulloblastoma.