CAJ | 학술논문

目的：回顾分析标危型髓母细胞瘤采用全脑全脊髓放疗剂量≤24 Gy和＞24 Gy对预后的影响。方法标危型髓母细胞瘤定义为年龄＞3岁、未发生转移、肿瘤全切或近全切（残留≤1?5 cm3）。2003—2013年共入组72例初治儿童、青少年标危型髓母细胞瘤患者。患者术后接受全脑全脊髓＋局部瘤床放疗和8个疗程辅助化疗，化疗方案为顺铂、司莫司汀或卡莫司汀联合长春新碱。按放疗剂量≤24 Gy和＞24 Gy分为A、B组（20、52例），比较两组患者复发率和生存率。 Kaplan?Meier法计算复发率和生存率并Logrank法检验组间差异。结果 A组接受全脑全脊髓放疗19．2～24?0 Gy，B组接受全脑全脊髓放疗24．1～30?6 Gy。放疗后66例（92％）患者完成全部辅助化疗。共11例患者复发。随访满3年患者48例，其中复发11例，死亡7例。全组3年EFS率为83％，3年OS率为86％。 A组和B组患者3年EFS率分别为84％和83％（ P＝0?609），3年OS率分别为85％和87％（ P＝0?963）。结论标危型髓母细胞瘤经规范综合治疗效果较好，其中全脑全脊髓放疗剂量减少至19．2～24?0 Gy未影响疗效。
목적：회고분석표위형수모세포류채용전뇌전척수방료제량≤24 Gy화＞24 Gy대예후적영향。방법표위형수모세포류정의위년령＞3세、미발생전이、종류전절혹근전절（잔류≤1?5 cm3）。2003—2013년공입조72례초치인동、청소년표위형수모세포류환자。환자술후접수전뇌전척수＋국부류상방료화8개료정보조화료，화료방안위순박、사막사정혹잡막사정연합장춘신감。안방료제량≤24 Gy화＞24 Gy분위A、B조（20、52례），비교량조환자복발솔화생존솔。 Kaplan?Meier법계산복발솔화생존솔병Logrank법검험조간차이。결과 A조접수전뇌전척수방료19．2～24?0 Gy，B조접수전뇌전척수방료24．1～30?6 Gy。방료후66례（92％）환자완성전부보조화료。공11례환자복발。수방만3년환자48례，기중복발11례，사망7례。전조3년EFS솔위83％，3년OS솔위86％。 A조화B조환자3년EFS솔분별위84％화83％（ P＝0?609），3년OS솔분별위85％화87％（ P＝0?963）。결론표위형수모세포류경규범종합치료효과교호，기중전뇌전척수방료제량감소지19．2～24?0 Gy미영향료효。
Objective To retrospectively analyze the impacts of a craniospinal radiation dose ≤24 Gy or>24 Gy on the prognosis of patients with average?risk medulloblastoma. Methods Average?risk medulloblastoma was defined as non?metastatic cancer in children more than 3 years old with complete or near?complete ( residual tumor ≤1?5 cm3 ) resection of tumor. A total of 72 children and adolescents with newly diagnosed average?risk medulloblastoma were enrolled as subjects from 2003 to 2013. After radical resection of the tumor, all patients received craniospinal plus local tumor bed radiotherapy and 8 cycles of adjuvant chemotherapy using cisplatin?, semustine?, or plus vincristine?based regimens. Patients exposed to a radiation dose ≤24 Gy were enrolled into Group A ( n=20) , while patients exposed to a radiation dose>24 Gy were enrolled into Group B ( n=52) . The recurrence rate and survival rate were compared between the two groups. The recurrence rate and survival rate were calculated using the Kaplan?Meier method and the differences between the two groups were analyzed using the log ? rank test . Results Patients in Group A and Group B received craniospinal radiotherapy with a dose of 19?2?24?0 Gy and 24?1?30?6 Gy, respectively. After radiotherapy, 66 patients ( 92%) completed all adjuvant chemotherapy. A total of 11 patients were recurrence. In all patients, the 3?year sample size was 48;the 3?year event?free survival ( EFS) and overall survival ( OS ) rates were 83% and 86%, respectively. There were no significant differences in the 3?year EFS and OS rates between Group A and Group B (84% vs. 83%, P=0.609;85%vs. 87%, P=0.963). Conclusions The standard comprehensive therapy achieves satisfactory treatment outcomes for average?risk medulloblastoma, in which a craniospinal radiation dose decreased to 19?2?24?0 Gy has no impacts on treatment outcomes.