小剂量顺钳联合依托泊昔治疗伴间脑综合征的儿童鞍区低级别胶质瘤(附四例报告)

Low-dose cisplatin combined with etoposide in the treatment of low-grade glioma in the sellar region of children with diencephalic syndrome: A report of four cases

目的观察小剂量顺钳联合依托泊昔治疗伴间脑综合征的儿童鞍区低级别胶质瘤的疗效。方法回顾性纳入2015年1月至2017年12月复旦大学附属儿科医院神经外科收治的4例鞍区低级别胶质瘤致间脑综合征患儿。其中男、女各2例;年龄中位数为16(6?34)个月。化疗前1例患儿因重度脑积水行脑室-腹腔分流术,4例均未行手术活组织检查或切除术;4例均采用顺钳(1mg·kg^-1·d^-1),第1 ~3天]和依托泊昔(5 mg·kg^-1·d^-1,第1 ~3天)治疗10个周期。观察患儿的临床疗效。结果4例患儿均顺利完成10个周期的化疗,无明显药物不良反应。化疗后随访中位时间为12(6-20)个月。临床症状均较前改善,体质量较前增加29.3%-50.0%,体质量开始增加的中位时间为化疗开始后7(3 ~ 12)个月。复查头颅MRI显示,2例肿瘤无进展,1例肿瘤较前缩小,1例肿瘤实质成分减少,1例环池病灶及1例第四脑室病灶均消失。激素水平较化疗前无明显变化。1例化疗后1年体质量增加,临床表现良好,遂行肿瘤部分切除;病理学证实为毛细胞型星形细胞瘤(WHO I级),术后进一步行放疗。结论小剂量顺钳联合依托泊昔的化疗方案对于改善鞍区低级别胶质瘤伴间脑综合征患儿的临床症状及控制肿瘤进展有良好的效果。

Objective To investigate the therapeutic effect of low-dose cisplatin combined with etoposide on low-grade glioma in the sellar region of children with diencephalic syndrome. Methods The clinical characteristics, treatment and outcomes of 4 children with diencephalic syndrome secondary to lowgrade glioma in the sellar region were retrospectively analyzed who were admitted to Department of Neurosurgery, Childrens Hospital of Fudan University from January 2015 to December 2017. Of 4 cases, 2 were females and 2 were males. The range of age was 6 months to 34 months, with the median age of 16 months. One case with severe hydrocephalus was treated with ventriculoperitoneal shunt surgery. Surgical biopsy or resection was not performed in this series. Low doses of cisplatin (1 mg·kg^-1·d^-1 d0 -d2) and etoposide (5 mg·kg^-1·d^-1 d0 -d2 ) were used for 10 cycles of chemotherapy to observe the clinical effect. Results All cases successfully completed chemotherapy and no obvious side effects of chemotherapy were reported. Follow-up post chemotherapy lasted for 6 to 20 months ( with the median duration of 12 months). The clinical symptoms were better than before and the weight was about 29.3%- 50.0% higher than before. The starting time to gain weight was 3 to 12 months after the initiation of chemotherapy (with the median duration of 7 months). There was no progress in the review of cranial MRI saddle area in 2 cases, tumor reduction in 1, substance decrease in 1, disappearance of cistema ambiens lesion in 1 and disappearance of the fourth ventricular lesion in 1. There was no significant change in hormone level compared with conditions prior to chemotherapy. One case gained weight at 1 year post chemotherapy and presented good clinical performance. Partial resection of tumor was performed. Its final pathological result was pilocytic astrocytoma (WHO I) and further radiotherapy was administered. Conclusions The chemotherapy regimen of low-dose cisplatin combined with etoposide seems to have a good effect which was to improve the clinical symptoms and postpone the tumor progression of children with diencephalic syndrome secondary to low-grade gliomas in the sellar region.