中晚期肾母细胞瘤的综合治疗(附50例报告)

Combined therapy in the management of Wilm's tumor (report of 50 cases)

目的 总结肾母细胞瘤综合治疗效果。 方法 自１９７２ 年３ 月～１９９２ 年６ 月对５０ 例肾母细胞瘤患儿采用患侧肾根治性切除术、放疗（ 根据患儿年龄，总量１ ６００ ～４ ０００ｃＧｙ）、化疗（ 长春新碱、更生霉素单独或联合应用） 的综合治疗措施。 结果 ５ 、１０ 年生存率为７２％ （３６／５０） 和５３％（１８／３４）；小于５ 岁与大于５ 岁年龄组，１０ 年生存率分别为６０ ％（１５／２５） 、３３ ％（３／９），差异有显著性（Ｐ＜０ ．０５）；术后１０ 天内与３０ 天后接受放疗者５、１０ 年生存率分别为８３ ％（１０／１２）、５８ ％ （７／１２）和５３％（８／１５）、３３％ （５／１５），差异有显著性（ Ｐ＜ ０－０５） 。 结论 肾母细胞瘤综合治疗是提高生存率的关键。年龄越小，接受放疗时间越早，疗效越好。

Objective To evaluate the therapeutic efficacy of combined therapy for Wilm's tumor. Methods From 1972 to 1992,radical nephrectomy,postoperative irradiation dose was 1 600～4 000cGy according to an age modulated dose scheme and the chemotherapeutic agent used was Act D or VCR. Results The overall 5 year and 10 year survival rates were 72% (36/50) and 53%(18/34) respectively.In patients younger than 5 years of age the 10 year survival rates were 60%(15/25) whereas it was 33%(3/9) in patients more than 5 yaers of age ( P <0.05).The 5 year and 10 year survival rate were 83% (10/12) and 58% (7/12) when irradiation was conducted less than 10 days after nephrectomy whereas they were 53%(8/15) and 33%(5/15) when the irradiation was undertaken more than 30 days after nephrectomy.The difference is statistically significant. Conclusions Combined therapy would improve the survival rate of patients with Wilm's tumor especially in those younger than 5 years of age.Irradiation should be undertaken as early as possible after readical nephrectomy.