采用交替或多药联合化疗治疗晚期神经母细胞瘤

Alternate or multidrug combined chemotherapy for advanced neuroblastoma

目的 观察交替化疗与多药联合化疗治疗晚期儿童神经母细胞瘤的疗效 ,毒性反应及对生存期的影响。方法 对 2 9例晚期神经母细胞瘤的患儿给予术前或术后化疗 ,14例采用COA/VIP或VP方案交替化疗共 15 5疗程 ,15例采用COPE等多药联合化疗共 84疗程。结果 交替化疗组 14例可评价疗效 13例 ,CR 0 ,PR12例 ,NC1例 ,PD 0。有效率 12 / 13(92 .3% )。化疗后手术完整切除率 10 / 13(76 .9% )。多药联合化疗组 15例 ,可评价疗效 11例 ,CR1例 ,PR5例 ,NC3例 ,PD2例 ,有效率 6 / 11(5 4.5 % )。化疗后手术切除率为 5 / 11(4 5 .5 % )。两组比较P <0 .0 5 (X2 检验 ) ,化疗的毒性反应主要表现为骨髓抑制 ,恶心呕吐等 ,均为可逆性。两组生存期比较经秩和检验P >0 .0 5无统计学差异。结论 交替化疗较之多药联合化疗治疗晚期儿童神经母细胞瘤疗效好 ,手术切除率高。毒性反应大致相同 。

Objective To evaluate the efficacy, toxicity and survival period of alternate and multi drug combined chemotherapy for advanced neuroblastoma (ANB).Methods 29 pediatric patients with ANB were divided into two groups. All of them were treated by preoperative or postoperative combined chemotherapy. Of them, 14 patients (group A) were treated by COA regimen (cyclophosphamide, vincristine and adriamycin) alternating with VIP regimen (etoposide, ifosfamide and cisplatin) or VP regimen (etoposide and cisplatin), the other 15 patients (group B) by COPE regimen (cyclophosphamide, vincristine, cisplatin and etoposide) and other multidrug combined chemotherapy regimen. The total cycles of group A and B were 155 and 84 cycles, respectively.Results In group A and B, the evaluable, complete response, partial response, no change and progression patients were 13 and 11, 0 and 1, 12 and 5, 1 and 3, 0 and 2 patients, respectively. The response rates and the complete resection rates after chemotherapy of group A and B were 92.3 % (12/13) and 54.5 % (6/11), 76.9 % (10/13) and 45.5 % (5/11) ( P < 0.05 ), respectively. Main side effects of chemotherapy were reversible bone marrow suppression, nausea and vomiting. There was no significant difference in survival period between group A and B.Conclusions For ANB, alternate chemotherapy has better effect and higher complete resection rate than multidrug combined chemotherapy. But toxicity and survival period of the two regimens are essentially same.