文章：

儿童与青少年复发性髓母细胞瘤的放射治疗：再程放疗与首次放疗后的生存分析

Radiotherapy for Recurrent Medulloblastoma in Children and Adolescents: Survival after Re-Irradiation and First-Time Irradiation

原文发布日期：22 May 2024

DOI: 10.3390/cancers16111955

类型: Article

开放获取: 是

英文摘要：

Background: Radiotherapy (RT) involving craniospinal irradiation (CSI) is important in the initial treatment of medulloblastoma. At recurrence, the re-irradiation options are limited and associated with severe side-effects. Methods: For pre-irradiated patients, patients with re-irradiation (RT2) were matched by sex, histology, time to recurrence, disease status and treatment at recurrence to patients without RT2. Results: A total of 42 pre-irradiated patients with RT2 were matched to 42 pre-irradiated controls without RT2. RT2 improved the median PFS [21.0 (CI: 15.7–28.7) vs. 12.0 (CI: 8.1–21.0) months] and OS [31.5 (CI: 27.6–64.8) vs. 20.0 (CI: 14.0–36.7) months]. Concerning long-term survival after ten years, RT2 only lead to small improvements in OS [8% (CI: 1.4–45.3) vs. 0%]. RT2 improved survival most without (re)-resection [PFS: 17.5 (CI: 9.7–41.5) vs. 8.0 (CI: 6.6–12.2)/OS: 31.5 (CI: 27.6–NA) vs. 13.3 (CI: 8.1–20.1) months]. In the RT-naïve patients, CSI at recurrence improved their median PFS [25.0 (CI: 16.8–60.6) vs. 6.6 (CI: 1.5–NA) months] and OS [40.2 (CI: 18.7–NA) vs. 12.4 (CI: 4.4–NA) months]. Conclusions: RT2 could improve the median survival in a matched cohort but offered little benefit regarding long-term survival. In RT-naïve patients, CSI greatly improved their median and long-term survival.

摘要翻译： 

背景：包含全脑全脊髓放疗的放射治疗是髓母细胞瘤初始治疗的重要手段。复发时，再程放疗的选择有限且常伴随严重副作用。方法：针对既往接受过放疗的患者，将接受再程放疗的患者与未接受再程放疗的患者按性别、组织学类型、复发时间、疾病状态及复发时治疗方案进行匹配。结果：共42例既往放疗后接受再程放疗的患者与42例既往放疗后未行再程放疗的对照组完成匹配。再程放疗显著延长了中位无进展生存期[21.0个月(95%CI:15.7-28.7) vs 12.0个月(95%CI:8.1-21.0)]和总生存期[31.5个月(95%CI:27.6-64.8) vs 20.0个月(95%CI:14.0-36.7)]。但就十年以上长期生存而言，再程放疗仅带来微小改善[总生存率8%(95%CI:1.4-45.3) vs 0%]。在未行（再次）手术切除的患者中，再程放疗的生存获益最为显著[无进展生存期:17.5个月(95%CI:9.7-41.5) vs 8.0个月(95%CI:6.6-12.2)/总生存期:31.5个月(95%CI:27.6-NA) vs 13.3个月(95%CI:8.1-20.1)]。在初治未行放疗的患者中，复发时接受全脑全脊髓放疗显著改善其中位无进展生存期[25.0个月(95%CI:16.8-60.6) vs 6.6个月(95%CI:1.5-NA)]和总生存期[40.2个月(95%CI:18.7-NA) vs 12.4个月(95%CI:4.4-NA)]。结论：在匹配队列中，再程放疗可改善髓母细胞瘤复发患者的中位生存期，但对长期生存获益有限。对于初治未行放疗的患者，复发时采用全脑全脊髓放疗能显著提升其中位生存期与长期生存率。

原文链接：

Radiotherapy for Recurrent Medulloblastoma in Children and Adolescents: Survival after Re-Irradiation and First-Time Irradiation