CAJ | 학술논문

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.
목적 탐토단제순박화료대인동간모세포류(HB)술전간예적가행성.방법 대아과수치적9례HB안주제PRETEXT표준분조급의거SIOPEL진행위험도분급,균급여단제순박술전처리(80 mg·m-2 ·d-1,1차/2주,2～4개료정),평고류체대소변화、수술완정절제적가능성화화료상관독성관찰；약환인2개료정후치료반응차,칙화료가용아매소.결과 9례고위HB중,7례(77.8％)환인반응량호,류체명현축소(P＜0.01),AFP수평현저강저(P＜0.01),기중3례4개료정후,가용2개료정화료체도수술절제표준；2례HB(다결절형)2개료정후,인화료반응차이개용연합화료.소유병례균수술완정절제류체,기중7례반응량호,식인2년무사건생존솔100％；화료독성부표현위경도지중도적골수억제,2례표현위일과성경도적신공능개변.결론 인동고위단결절형HB대단제순박화료유량호적반응성,화료순응성호,감경료화료적독부반응；이다결절형HB대단제순박반응교차.
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.