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目的探讨不同分期髓母细胞瘤术后适形放疗30Gy联合化疗的临床疗效和不良反应。方法髓母细胞瘤患者56例分为低风险组22例和高风险组34例,术后均采用三维适形放疗联合化疗,观察治疗效果和不良反应。结果低风险组和高风险组5a生存率分别为81.8%(18/22)和44.1%(15/34),中位生存期分别为67、60个月,差异均有统计学意义(P<0.05);高风险组5a生存率M1期患儿为66.7%(12/18),M2期患儿为33.3%(3/9),M3期患儿为0;19例(33.9%)患儿发生Ⅰ、Ⅱ度骨髓抑制,7例(12.5%)发生Ⅲ度骨髓抑制,15例(26.8%)发生胃肠道反应。结论儿童髓母细胞瘤患者术后适形放疗30Gy联合化疗在低风险和高风险M1期患者疗效较好,高风险M2和M3期患者预后较差,治疗不良反应可耐受。
Objective To investigate the clinical efficacy and side effects of 30 Gy combined with chemotherapy after different stages of medulloblastoma. Methods Fifty-six patients with medulloblastoma were divided into low-risk group (n = 22) and high-risk group (n = 34). All patients were treated with three-dimensional conformal radiotherapy combined with chemotherapy after operation to observe the therapeutic effect and adverse reaction. Results The survival rates of low-risk group and high-risk group were 81.8% (18/22) and 44.1% (15/34), respectively. The median survival time was 67 and 60 months, respectively, and the differences were statistically significant (P < 0.05). The survival rate of high-risk group 5a was 66.7% (12/18) in M1, 33.3% (3/9) in M2, and 0 in 19 (33.9%) in M3 Myelosuppression in grade I and II occurred. Grade III myelosuppression occurred in 7 patients (12.5%) and gastrointestinal reaction in 15 patients (26.8%). Conclusions Patients with medulloblastoma after conformal radiotherapy combined with 30 Gy of radiotherapy in patients with low risk and high risk of M1 have better curative effect and patients with high risk of M2 and M3 have poorer prognosis and tolerable adverse reactions.