术前化疗在儿童颅内恶性肿瘤中的应用

Application of preoperative chemotherapy in pediatric brain maligant tumors patients

目的探讨术前化疗在儿童颅内恶性肿瘤中的适应证及应用价值。方法与结果回顾分析2017年1月至2019年8月共9例行术前化疗的儿童颅内恶性肿瘤患儿的临床资料,肿瘤位于松果体区5例、第三脑室1例、额颞叶和基底节区1例、第四脑室2例;术前临床诊断为生殖细胞肿瘤5例,髓母细胞瘤2例,松果体母细胞瘤1例,胚胎性肿瘤1例。术前2例予卡铂+依托泊苷方案,4例予顺铂+依托泊苷方案,1例予行卡铂+依托泊苷+异环磷酰胺方案,2例予顺铂+依托泊苷+异环磷酰胺方案;6例化疗1个周期,2例化疗2个周期,1例化疗3个周期;化疗1~3个周期后手术切除肿瘤,7例化疗后肿瘤体积缩小,1例体积增大,1例发生瘤卒中;7例肿瘤全切除,2例近全切除。术后病理诊断为生殖细胞肿瘤3例,松果体母细胞瘤2例,髓母细胞瘤2例,弥漫性中线胶质瘤1例,非典型畸胎样/横纹肌样肿瘤1例。平均随访18个月,3例死于肿瘤复发。结论对于临床诊断为对化疗敏感的儿童颅内肿瘤且手术风险较大者可考虑行术前化疗。术前化疗可缩小肿瘤体积,减少肿瘤血供,增加手术安全性及促使肿瘤最大程度切除。

Objective To investigate the indication and significance of preoperative chemotherapy for pediatric patients with brain malignant tumors.Methods and Results patients with brain malignant tumors who were admitted to Department of Neurosurgery,Tsinghua University Yuquan Hospital from January 2017 to August 2019 were retrospectively analyzed.The patients were 6 males and 3 females,aged from 1.50 months to 6 years.Among the 9 cases,5 cases were located in the pineal region,one case in the third ventricle,one case in the frontotemporal and the basal ganglia region and 2 cases in the fourth ventricle.The preoperative clinical diagnosis of the 9 patients included 5 cases of germ cell tumor,2 cases of medulloblastoma,one case of pineal blastoma and one case of embryonal tumor.Before the chemotherapy,6 patients were treated with ventriculo-peritoneat shunt,2 patients with ventricular puncture and external drainage,and one patient with endoscopic third ventriculostomy.Before surgery,2 cases were given carboplatin+etoposide regimen,4 cases were given cisplatin+etoposide regimen,one case was given carboplatin+etoposide+isophoramide regimen,and 2 cases were given cisplatin+etoposide+isophoramide regimen.6 patients received one cycle of chemotherapy before tumor resection,2 patients received 2 cycles and one patient received 3 cycles.All of the patients received tumor resection after 1-3 cycles of chemotherapy.The following treatments were depended on the pathological results.After preoperative chemotherapy,tumors’volume decreased in 7 cases while increased in one case.Additionally,there was one case of tumor apoplexy.The blood supply of tumors of all the 9 patients was not abundant.Among the 9 cases,total removal was achieved in 8 cases and subtotal in one case.The pathological results revealed 3 germ cell tumors,2 pineoblastomas,2 medulloblastomas,one diffuse midline glioma,and one atypical teratomoid/rhabdomyoid tumor(AT/RT).The 9 patients were followed up from 8 to38 months(mean 18 months).Three patients died of tumor recurrence and there were no tumor recurrences in the other 6 patients.Conclusions brain malignant tumors which are clinically sensitive to chemotherapy at high risk of surgery.Preoperative chemotherapy for brain tumors in infants and young children was effective in reduction of tumor volume and vascularity,which significantly facilitated maximal tumor resection.