儿童髓母细胞瘤化疗的研究进展

Research progress in chemotherapy for childhood medulloblastoma

摘要:

髓母细胞瘤（medulloblastoma，MB）是儿童中枢神经系统常见的肿瘤，单纯手术预后不良，辅助放疗毒副反应严重，化疗是儿童MB重要的辅助治疗，但到目前没有标准的化疗方法。研究表明标准风险组通过强化化疗联合减量放疗可以提高生存率和降低副反应；而高风险组MB年龄大于3岁者可采用放疗、强化化疗联合干细胞移植提高生存率，在3岁及以下MB患儿应避免放疗，可通过甲氨喋呤的脑室应用、强化化疗联合自体干细胞移植来改善预后。而化疗的使用时间尚不能确定。本文从各级风险组MB化疗的应用，化疗开始时间，放疗与化疗的先后顺序等方面的研究进展进行综述。

Abstract:

Medulloblastoma（MB） is a common tumor in the central nervous system of children. It has a poor prognosis after surgery alone and severe side effects with adjuvant radiotherapy. Chemotherapy is an important adjuvant treatment for children with MB，but there is no standard chemotherapy. Studies have shown that the standard-risk group can improve survival rate and reduce side effects through intensified chemotherapy and dose-reduced radiotherapy. In the high-risk group，children more than 3 years old can use radiotherapy and intensified chemotherapy combined with stem cell transplantation to improve survival rate. Radiotherapy should be avoided in children aged ≤3 years with MB，and prognosis can be improved by intraventricular application of methotrexate and intensified chemotherapy combined with autologous stem cell transplantation. The duration of chemotherapy is still uncertain. In this article，the application of MB chemotherapy，the timing of chemotherapy，and the sequence of radiotherapy and chemotherapy in MB groups with different levels of risk are reviewed.