^(125)I粒子近距离放疗联合化疗对儿童脑膜旁横纹肌肉瘤的疗效及其预后分析  

Efficacy and prognostic analysis of 125I brathytherapy combined with chemotherapy for pediatric parameningeal rhabdomyosarcoma

作　　者：赵丹 吕晓鸣 陈鹏[2] 石妍[1] 黄明伟[1] 郑磊[1] 赵卫红[3] 马晓莉 张建国[1] Zhao Dan;Lyu Xiaoming;Chen Peng;Shi Yan;Huang Mingwei;Zheng Lei;Zhang Jianguo(Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology&National Center of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Laboratory for Digital and Material Technology of Stomatology&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China;Department of Oral and Maxillofacial Surgery,Fujian Medical University,Fuzhou,350005,China;Department of Pediatric Hematology,Peking University First Hospital,Beijing 100034,China;Blood Tumor Center,Beijing Children′s Hospital,Capital University of Medical Sciences,Beijing 100045,China)

机构地区：[1]北京大学口腔医学院·口腔医院口腔颌面外科国家口腔医学中心国家口腔疾病临床医学研究中心口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室,北京100081 [2]福建医科大学附属第一医院口腔颌面外科,福州350005 [3]北京大学第一医院小儿血液内科,北京100034 [4]首都医科大学附属北京儿童医院血液肿瘤中心,北京100045

出　　处：《中华医学杂志》2022年第20期1500-1505,共6页National Medical Journal of China

摘　　要：目的分析125I粒子近距离放疗联合化疗对儿童脑膜旁横纹肌肉瘤(PMRMS)的疗效及其预后。方法回顾性分析2013年7月至2018年10月在北京大学口腔医院采用125I粒子近距离放疗联合化疗治疗的33例PMRMS患儿的临床资料,分析其疗效和预后影响因素。结果 33例患儿中,男19例,女14例;年龄1~12岁,中位年龄4岁。胚胎型17例,腺泡型9例,多形型7例。原发PMRMS 26例,复发PMRMS 7例。颞下-乳突区15例,鼻腭-鼻旁区6例,咽旁-颌下区12例。美国儿童横纹肌肉瘤(RMS)协作组分期为Ⅲ期28例,Ⅳ期5例;中危组28例,高危组5例。中位随访时间52个月。33例儿童PMRMS的1、3和5年局部控制率分别为87.9%、58.6%和49.9%,1、3和5年生存率分别为93.8%、60.5%和47.5%。咽旁-颌下区患儿的5年局部控制率和5年生存率分别为91.7%和100%,鼻腭-鼻旁区患儿的5年局部控制率和5年生存率均为83.3%,颞下-乳突区患儿的3年局部控制率和3年生存率分别为17.5%和21.4%。Cox比例风险回归模型多因素分析显示,肿瘤位于颞下-乳突区是影响PMRMS患儿5年总生存率的危险因素(HR=38.40,95%CI:4.87~302.52,P=0.001)。粒子植入后3个月内,全组患儿的急性放疗不良反应发生率为84.8%(28/33)。21例(63.6%)患儿出现1级急性放疗反应,7例(21.2%)患儿出现2级急性放疗反应。无3级及以上急性放疗不良反应发生。粒子植入3个月后,急性放疗不良反应均有明显缓解,无皮肤溃疡、唾液腺纤维化等3级及以上远期放疗不良反应发生,无严重颅颌面畸形发生。结论 125I粒子近距离放疗联合化疗治疗儿童脑膜旁横纹肌肉瘤临床疗效肯定,肿瘤位于咽旁及鼻腭区的预后优于颞下-乳突区。Objective To analyze the efficacy and prognostic factors in children with parameningeal rhabdomyosarcoma(PMRMS)treated by 125I brachytherapy combined with chemotherapy.Methods A retrospective analysis of the clinical data of 33 pediatric patients treated with 125I brachytherapy combined with chemotherapy in Peking University Stomatological Hospital from July 2013 to October 2018 was carried out to analyze the efficacy and prognostic factors.Results Among the 33 patients,19 were males and 14 were females;the median age was 4 years old(1-12 years old).There were 17 cases with embryonic type,9 cases with alveolar type,and 7 with undifferentiated type;26 cases with original PMRMS,and 7 cases with recurrent PMRMS.The tumors occurred in subtemporal-mastoid area in 15 patients,while nasopalatine-paranasal area in 6 cases,and parapharyngeal-submandibular area in 12 cases.There were 28 patients in IRSⅢ,and 5 patients in IRSⅣ.As for the risk level,28 cases were in the middle-risk group and 5 cases in the high-risk group.The median follow-up time was 52 months.The 1,3,and 5-year local control rates were 87.9%,58.6%,and 49.9%,and the 1,3,and 5-year survival rates were 93.8%,60.5%,and 47.5%,respectively.The 5-year local control rate and 5-year survival rate of 12 patients with the tumor in the parapharyngeal-submandibular area were 91.7%and 100%,respectively.The 5-year local control rate and 5-year survival rate of the 6 patients with tumor in the nasopalatine-paranasal area were both 83.3%.The 3-year local control rate and 3-year survival rate of the 15 patients with tumor in the subtemporal-mastoid area were 17.5%and 21.4%.The multivariate survival analysis using Cox proportional risk regression model showed that the tumor located in the subtemporal-mastoid area was an independent risk factor affecting the 5-year overall survival rate(HR=38.40,95%CI:4.87-302.52,P=0.001).Within 3 months after 125I seed implantation,the incidence of acute radiotherapy adverse reactions in all patients was 84.8%(28/33).Twenty-one patients(

关 键 词：横纹肌肉瘤 近距离放疗 脑膜旁 儿童 预后 随访 

分 类 号：R739.45[医药卫生—肿瘤]