卡铂联合长春新碱改良方案治疗儿童脑干低级别胶质瘤

A modified chemotherapy protocol with carboplatin and vincristine for pediatric brain stem low- grade gliomas

目的探讨卡铂联合长春新碱（CV）改良方案治疗儿童脑干低级别胶质瘤的疗效及不良反应。方法回顾性纳入2014年8月至2016年8月首都医科大学三博脑科医院神经肿瘤化疗科采用改良CV方案治疗的10例儿童脑干低级别胶质瘤患者，其中3例为术后复发病例。在传统CV方案基础上，改良卡铂剂量强度或辅以重组人血管内皮抑素（rhES）化疗。卡铂起始剂量为200～300mg／m^2，长春新碱为1．5mg／m^2（最大剂量2mg）。结果10例患儿中，客观有效5例（1例完全缓解，4例部分缓解），2例微小反应，3例稳定，疾病均得到控制；中位化疗起效时间为3．0（1．5～8．0）个月；3例复发者中，2例有效；3例联合了rhES化疗的患儿肿瘤均达有效缓解。不良反应主要是血液学毒性，262次化疗中，3—4级中性粒细胞、血红蛋白、血小板减少的发生率分别为8．8％（23／262）、5．3％（14／262）、1．5％（5／262），对症治疗均能恢复。中位随访时间为14．5（4—26）个月，均未发生肿瘤进展。结论改良CV方案治疗儿童脑干低级别胶质瘤有效。增大剂量及联合rhES提高了卡铂及长春新碱的疗效，有助于迅速缓解脑干功能损害。不良反应可耐受。

Objective To analyze the response and toxicity of a modified chemotherapy protocol with carboplatin and vincristine （CV） for pediatric low-grade gliomas （ LGGs ） in the brain stem. Methods Ten children with low-grade gliomas （LGGs） in the brain stem were administered the modified CV regimen at Department of Neuro-Oncology, Sanbo Brain Hospital, Capital Medical University from August 2014 to August 2016, and the data were retrospectively reviewed. The conventional CV regimen was modified by changing the carboplatin dose or adding recombinant human endostatin （rhES）. Carboplatin was administrated at a dose of 200-300 mg/m^2 and the vincristine dose was 1.5 mg/m^2 （ maximum dose： 2 mg）. Results Among the 10 children, 5 patients had objective response （ 1 had a complete response and 4 had a partial response） ; 2 got a minor response and 3 kept stable conditions. All patients＇illnesses were effectively controlled. The median time for response to chemotherapy was 3 （ 1.5 - 8.0） months. The median time for follow-up was 14. 5 （4 - 26） months. Objective response was reported in 2 of 3 patients with recurrence. All 3 cases undergoing combination chemotherapy of carboplatin, vincristine and a novel antiangiogenic drug had objective response. Hematologic toxicity was a major side effect. The incidences of severe neutrocytopenia, decreased hemoglobin and thrombocytopenia were 8.8% （23/262）, 5. 3% （14/262） and 1. 5% （5/262）, respectively, which could resolve following symptomatic treatment. Conclusions A modified CV regimen seems effective for pediatric brain stem LGGs. Increasing carboplatln dose or adding rhES could help with the effect improvement of CV regimen and fast relief of the brain stem dysfunction. Those drug regimens were relatively well tolerated.