顺铂单剂治疗儿童肝母细胞瘤  

Single-agent of cisplatin in pretreatment of hepatoblastoma

作　　者：常健[1] 张语桐[1] 王立哲 钟晓丹[1] 冯永波[2] 董春钰[2] 

机构地区：[1]吉林大学第一医院儿内科,长春130021 [2]吉林大学第一医院小儿外科,长春130021

出　　处：《中华小儿外科杂志》2011年第10期737-740,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的 探讨单剂顺铂化疗对儿童肝母细胞瘤（HB）术前干预的可行性.方法 对我科收治的9例HB按周际PRETEXT标准分组及依据SIOPEL进行危险度分级,均给予单剂顺铂术前处理（80 mg·m-2 ·d-1,1次/2周,2～4个疗程）,评估瘤体大小变化、手术完整切除的可能性和化疗相关毒性观察；若患儿2个疗程后治疗反应差,则化疗加用阿霉素.结果 9例高危HB中,7例（77.8％）患儿反应良好,瘤体明显缩小（P＜0.01）,AFP水平显著降低（P＜0.01）,其中3例4个疗程后,加用2个疗程化疗达到手术切除标准；2例HB（多结节型）2个疗程后,因化疗反应差而改用联合化疗.所有病例均手术完整切除瘤体,其中7例反应良好,息儿2年无事件生存率100％；化疗毒性仅表现为轻度至中度的骨髓抑制,2例表现为一过性轻度的肾功能改变.结论 儿童高危单结节型HB对单剂顺铂化疗有良好的反应性,化疗顺应性好,减轻了化疗的毒副反应；而多结节型HB对单剂顺铂反应较差.Objective To investigate the feasibility of single-agent of cisplatin in pretreatment of children with hepatoblastoma （HB）.Methods Nine cases of children with high-risk HB in accordance with PRETEXT stages and SIOPEL risk stratification criteria were eligible for inclusion in the study.After preoperative treatment of 2 or 4 courses of cisplatin （80 mg·m-2 ·d- 1,administered at a 24-hour continuous infusion with an interval of 14 days）,the tumor size and the operability of complete resection and chemotherapy-related toxicity were evaluated.For children showed ineffective for 2 courses of chemotherapy,they received combined chemotherapy （Cisplatin ＋ Doxorubicin）.Results After chemotherapy pretreatment,tumor masses were significantly reduced in 7 cases （77.8%）,with significantly decreased level of AFP （P〈0.01 ）.Among them,3cases were given two or more courses of cisplatin,and could resect the masses completely.Two cases （22.2%） with multi-nodular HB were treated with combined chemotherapy after 2 courses of single-agent cisplatin.All patients got the chance of tumor complete resection.The 2-year event-free survival rate of the 7 patients with good chemotherapeutic response was 100%.For chemotherapy-related toxicity,children just presented mild to moderate myelosuppression during every treatment course,2 cases showed a transient mild renal dysfunction.Conclusions Children with high-risk factors and single-nodular hepatoblastoma responsewell to cisplatin alone,but children with multinodular HB present poor response.

关 键 词：肝母细胞瘤 抗肿瘤联合化疗方案 顺铂 

分 类 号：R735.7[医药卫生—肿瘤]