Procena efekata lečenja meduloblastoma kod dece i omladine trodimenzionalnom konformalnom radioterapijom

Abstract

Savremenim multidisciplinarnim lečenjem meduloblastoma hirurgijom, kraniospinalnom radioterapijom i hemioterapijom značajno je poboljšano preživljavanje bolesnika. Cilj rada je bila analiza ishoda lečenja i nezavisnih prognostičkih faktora i analiza trodimenzionalne konformalne radioterapije koja omogućava optimalnu uniformnost i konformalnost distribucije doze u željenom volumenu mete i veću poštedu okolnih zdravih tkiva. Metod: Istraživanje je obuhvatilo grupu od 87 dece sa meduloblastomom koji su lečeni u Institutu za onkologiju i radiologiju Srbije u periodu od januara 2000. do decembra 2013.godine. Rezultati: Srednji uzrast bio je 8,3 godine ( rang 2,5-17,3). Klasični meduloblastom imalo je 61 (70,1%), nodularni/dezmoplastični 23 (26,4%), a krupnoćelijski/anaplastični 3 (3,4%) bolesnika. U odnosu na metastatski stadijum bolesti 62 (71,3%) su bili M0, 12 (13,8%) M1, a 13 (14,9%) M2 i/ili M3. Totalnu resekciju je imao najveći broj 53 (60,9%), a skoro totalnu resekciju 22 (25,3%) bolesnika. 2D radioterapiju imalo je 50 (57,5%), a 3D 37 (42,5%) bolesnika. Hemioterapijom je lečeno 78 (89,7%), neoadjuvantnom 11 (13%), konkomitantnom 9 (10%) i adjuvantnom najveći broj bolesnika 73 (83,9%). Kada je istraživanje završeno 51 (58,6%) je bilo živo, a 31 (35,6%) je umrlo. Pet pacijenata je izgubljeno iz praćenja. Relaps bolesti imalo je 26 (29,9%) bolesnika. Medijana praćenja iznosila je 58 meseci (rang 4-187). Ukupno preživljavanje (OS) iznosi: trogodišnje 76,4%, petogodišnje 66,2% a desetogodišnje 59,2%. Preživljavanje bez znakova bolesti (DFS) iznosi: trogodišnje 75,8%, petogodišnje 62,8% i desetogodišnje 56,6%. Postoji statistički značajna razlika u ukupnom preživljavanju nemetastatskih ( M0) u odnosu na metastatske meduloblastome (M1,M2,M3) ( p=0,003) OS za grupu sa lokalizovanom bolesti (M0) iznosi: trogodišnje 86,4%, petogodišnje 74%, a desetogodišnje 63,1%. OS za grupu sa diseminovanom bolesti (M1,M2,M3) iznosi: trogodišnje 48,9%, petogodišnje 44%, a desetogodišnje 37,7%...

Standard treatment for meduloblastoma consists of surgery, craniospinal radiation and chemotherapy. The use of these modalities has resulted in improvement of survival. The aim of this study was to analize survival and independent prognostic factors and to analize three-dimensional conformal radiotherapy who is achieving optimal uniformity and conformality dose distribution in treated volume and to minimize the risk of normal tissue damage. Methods: Da on 87 children diagnosed with meduloblastoma who were treated at the Institute for Oncology and Radiology of Serbia between January 2000 amd December 2013 were analysed. Results: The median age was 8,3 years (range 2,5-17,3). The classis histologic variant was observed in 61 (70,1%), nodular/desmoplastic in 23 (26,4%) and large cell/anaplastic variant was observed in 3 (3,4%) patients. Meningeal dissemination within the subarachnoid space ( cranial M2 or spinal M3) was observed in 13 (14,9%) and microscopic metastases within the CSF ( M1) was observed in 12 (13,8%) patients. Most of the patients (62,71,3%) had no metastatic disease (M0). Gross total resection had the most of the patients 53 (60,9%) and near total had 22 (25,3%) patients. Two-dimensional radiotherapy received 50 (57,5%) and three-dimensional radiotherapy received 37 (42,5%) patients. Chemotherapy was used in 78 (89,7%) patients. Postoperative neoadjuvant chemotherapy was used in 11 (13%), chemotherapy during the raditherapy was used in 9 (10%) patients. The majority of patients (73 83,9%) were treated with adjuvant platinum-based chemotherapy. At the end of the study 51 (58,6%) were alive and 31 (35,6%) had died. Five patients were lost to follow-up. Twenty-six (29,9%) patients relapsed. The median follow-up time was 50 months ( range 4-187)...