Ⅲ、Ⅳ期肾母细胞瘤综合治疗15年经验  

Multimodality therapy of stage Ⅲ、Ⅳ Wilms tumor in children： a single-center 15-year experience

作　　者：李民驹[1] 周银宝[2] 黄勇[1] 唐达星[1] 徐珊[1] 吴德华[1] 

机构地区：[1]浙江大学医学院附属儿童医院肿瘤外科,浙江省杭州市310003 [2]浙江大学医学院附属儿童医院放射介入科,浙江省杭州市310003

出　　处：《临床小儿外科杂志》2011年第4期243-246,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的总结近15年来对Ⅲ、Ⅳ期。肾母细胞瘤患儿的多模式综合治疗经验。方法1995年5月至2010年12月浙江大学医学院附属儿童医院共对26例单侧Ⅲ、Ⅳ期肾母细胞瘤患儿采用多模式的综合治疗。诊断标准：肾门、主动脉旁淋巴结转移；弥漫性腹腔播散或术时散落；腹膜有肿瘤种植；镜检或肉眼有肿瘤残留；局部浸润至重要脏器；肿瘤远处转移。全部病例按年限和治疗方式分为两组：①术前单纯介入治疗组（TACE组）11例，为1995年至2002年收治病例，采用术前肾动脉化疗栓塞（TACE），1周后手术切除瘤肾，术后化疗或加放疗的综合治疗；②术前介入治疗加短期全身化疗组（T＋S组）15例，为2003年至2010年收治病例，采用术前TACE加2～3周静脉化疗，然后手术切除瘤肾，术后化疗或加放疗的综合治疗。TACE采用吡柔比星40mg／m。，长春地辛3mg／m2，超液碘油5～10mL。术前短期静脉化疗采用长春地辛3mg／（m2·周），共2次；放线菌素D10we／（kg·d），共5次。术后化疗和放疗按照北京儿童医院肾母细胞瘤治疗方案。TACE组与T＋s组分别有3例和9例接受术后放疗。结果两组患儿术后分期为：TACE组Ⅲ期10例，Ⅳ期1例；T＋S组Ⅲ期11例，Ⅳ期4例。两组各有弥漫问变型2例。两组肿瘤完整切除率分别为63．6％（7／11）和80．0％（12／15），P=0．407。随访至2010年12月，两组平均随访时间分别为118（102—186）个月和43．5（1～92）个月，无瘤生存率分别为72．7％和100．0％，Kaplan-Meier生存分析显示两组差异有统计学意义（P=0．040）。结论本研究表明，术前动脉栓塞化疗加短期静脉化疗，手术切除瘤肾，术后继续化疗和放疗的多模式综合治疗是对Ⅲ、Ⅳ期肾母细胞瘤患儿的合理治疗方案。Objective To evaluate the therapeutic effect of muhimodality therapy in patients with stage Ⅲ、Ⅳ Wilms tumor. Methods This was a retrospective study on 26 patients with unilateral stage Ⅲ、Ⅳ Wilms tumor, aged 6 months to 8 years （median,2.9 years; 12 boys and 14 girls ） , treated at our hospital between 1995 and 2010. Characteristics of the patients were tumor involvement in periaortie lymph nodes, or tumor invasion into vital structures （positive surgical margins） ;or tumor penetration through peritoneal surface;or distant metastasis. Presence of necrotic tumors or chemotherapy-induced changes in a lymph node or at the resection margins were regarded as proof of a previous tumor. Patients were divided into 2 groups according to different time of admission and different modalities of preoperative treatment. Eleven patients were treated with preoperative transcatheter arterial ehemoembolization （TACE） using Lipiodol-pirarubicin-vindesine emulsion （ TACE group ） followed by surgery between May 1995 and December 2002. From January 2003 to December 2010, Fif- teen patients underwent TACE combined with short-term systematic chemotherapy using vindesine and aetinomycin D for 2 weeks preoperatively （ T ＋ S group）. Postoperative treatment was worked out according to the NWTS protocol modified by the Beijing Children＇ s Hospital. There were 3 and 9 patients received postoperative radiotherapy in the TACE group and T ＋ S group, respectively. Results No major treatment-related complication occurred in all patients. Complete surgical removal of the tumor was achieved in 7 （ 63.6% ） and 12 （ 80. 0% ） patients in the TACE and T ＋ S groups, respectively. At a median follow-up of 118 months, 3 of the

关 键 词：综合治疗 WILMS瘤 经导管的动脉化疗栓塞 化疗 

分 类 号：R735.705[医药卫生—肿瘤]