小儿不可切除性恶性实体瘤区域性动脉化疗的探讨

目的 探讨经导管的区域性动脉灌注化疗对小儿全身各部位的不可切除性恶性实体瘤治疗的可行性和疗效.方法 1999年7月至2006年12月对15例不同部位的小儿不可切除性恶性实体瘤行经导管的区域性动脉灌注化疗33次(每例1～4次).患儿年龄5个月至12岁(中位年龄3.6岁).男6例,女9例.病种包括:横纹肌肉瘤5例(盆腔1例,阴道2例,膀胱1例,盆腔臀部1例),内胚窦瘤4例(骶尾部3例,大网膜1例),恶性畸胎瘤2例(卵巢、小脑各1例),腹腔促结缔组织增生性小圆细胞肿瘤1例,肠系膜根部胰母细胞瘤1例,小脑室管膜瘤1例,上臂皮肤纤维肉瘤1例.其中13例为术前治疗、2例为手术时有肉眼残留的术后治疗.方法 为对肿瘤的供血动脉行经导管的灌注化疗.对盆腔、膀胱、子宫阴道肿瘤选用双侧髂内动脉,骶尾部畸胎瘤选用双侧髂内动脉加骶中动脉,腹腔内肿瘤选用肠系膜上动脉,上肢肿瘤选用肱动脉分支,小脑肿瘤选用椎动脉,药物为顺铂80 mg/m2、吡柔比星40 mg/m2,长春地辛3 mg/m2,溶于生理盐水120 ml,灌注时间60 min,间隔4周重复.间歇期加用静脉途径的全身化疗(长春地辛、异环磷酰胺、依托泊苷).结果 全组15例的33次动脉灌注化疗后均无肝、肾、心和听力功能障碍,但有恶心呕吐和Ⅰ～Ⅱ度骨髓抑制,1例小脑室管膜瘤出现轻度偏瘫,4周后恢复.术前治疗的13例均肿瘤明显缩小、局限,可完全切除.术后治疗的2例均无复发.随访24～100个月,无瘤生存13例,失访1例,死亡1例.结论 经导管的区域性动脉灌注化疗可用于各种部位的不可切除性儿童恶性实体肿瘤,具有较强的肿瘤杀灭作用,副作用小,与静脉途径的全身化疗可交替应用,实现双途径的多药联合化疗,可使不可切除的肿瘤变为可完全切除,或杀灭术后残留的肿瘤、避免复发转移.

Regional intra-arterial chemotherapy for treatment of advanced malignant tumors in children

Objective To evaluate the efficacy and long-term outcomes of regional intra-arterial chemotherapy for the treatment of advanced malignant solid tumors in children.Methods During Jul 1999 and Dec 2006,regional intra-arterial chemotherapy was performed in 15 patients (aging from 0.5 to 12 years,6 males and 9 females) with advanced malignant solid tumors in various parts of their bodies.In all the eases,13 accepted preoperative treatment and 2 accepted postoperative treatment.The tumors included rhabdomyosarcoma (2 cases in pelvis,2 in vagina and 1 in bladder),endodermal sinus tumor (3 in sacroiliac and 1 in colic omentum),malignant teratoma (1 in ovary and 1 in cerebellum),desmoplastic small round cell tumor (1 in abdomen),pancreablastoma (1 in root of mesentery),ependymoma (1 in cerebellum) and dermatofibrosareoma (1 in upper arm).Transcatheter arterial infusion chemotherapy (TAIC) of cisplatin,pirarubicin and vindesine was performed with the doses as follows:cisplatin 80 mg/m2,pirarubicin 40 mg/m2 and vindesine 3 mg/m2.Internal lilac artery was chosen as the route of administration for tumors in pelvis,bladder and vagina,internal I|iac artery and coccygeal artery for tumors in sacroiliac,superior mesenteric artery for tumors in abdomen,branch of brachial artery for tumors in upper arm and vertebral artery for tumors in cerebellum.TAIC was repeated every 4 weeks.In the intermission of TALC,intravenous systemic chemotherapy with vindesine,VP16,and ephosphamide were administered.Results In the period of chemotherapy,no cardiotoxicity,nephrotoxicity or hepatic dysfunction were observed except for grade Ⅰ-Ⅱ bone marrow suppression.One patient with ependymoma in the cerebellum got mild hemiplegia and recovered 4 weeks later.The tumors of the 13 patients accepting preoperative treatment were significantly shrunken,localized and could be completely resected.Remnant tumors of the 2 patients who underwent postoperative TAIC disappeared with no recurrence.Thirteen patients survived during the following-up for 4.2 years (2-9 years).One patient lost follow-up.One patient died of tumor recurrence.Conclusions Regional intra-arterial chemotherapy for the treatment of advanced malignant solid tumors in children is feasible and effective.It can be used as preoperative treatment to reduce the tumor size,induce necrosis of the tumor and improve the radical tumor resection rates or can be used to eliminate the postoperative residual tumor to avoid recurrence and metastasis.