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贝伐珠单抗治疗儿童视路胶质瘤的疗效分析
武万水, 刘晶晶, 孙艳玲, 杜淑旭, 李春德, 李苗, 任思其, 张金, 龚小军, 孙黎明
中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (12) : 1193-1197.
PDF(1323 KB)
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贝伐珠单抗治疗儿童视路胶质瘤的疗效分析
Effect of bevacizumab in treatment of children with optic pathway glioma
目的 分析贝伐珠单抗治疗儿童视路胶质瘤（OPG）的效果，为儿童OPG的治疗探索新方向。方法 回顾性分析术后化疗的OPG患儿30例，根据是否加用贝伐珠单抗分为传统化疗组（卡铂、长春新碱、依托泊苷，n=12）和联合化疗组（贝伐珠单抗、卡铂、长春新碱、依托泊苷，n=18）。随访至化疗后6个月，比较两组患儿化疗前后的视力、肿瘤大小及化疗期间出现的不良反应。结果 联合化疗组肿瘤缩小患儿比例高于传统化疗组（P < 0.05）。两组视力好转率、不良反应发生率差异无统计学意义（P > 0.05）。两组均无化疗相关的死亡病例。结论 贝伐珠单抗联合传统化疗可有效使肿瘤体积缩小，且与传统化疗相比，化疗的不良反应并不增加，可作为儿童OPG新的治疗方向。
Objective To investigate the effect of bevacizumab in the treatment of children with optic pathway glioma (OPG). Methods A retrospective analysis was performed for the clinical data of 30 children with OPG who underwent chemotherapy. According to whether bevacizumab was used, they were divided into conventional chemotherapy (carboplatin, vincristine and etoposide) group with 12 children and combined chemotherapy (bevacizumab, carboplatin, vincristine and etoposide) group with 18 children. The children were followed up to 6 months after chemotherapy, and the two groups were compared in terms of visual acuity and tumor size before and after chemotherapy and adverse reactions during chemotherapy. Results The combined chemotherapy group had a significantly higher proportion of children achieving tumor regression than the conventional chemotherapy group (P < 0.05), while there were no significant differences between the two groups in the proportion of children with improved visual acuity or adverse reactions (P > 0.05). No chemotherapy-related death was observed in either group. Conclusions Bevacizumab combined with conventional chemotherapy can effectively reduce tumor size. Compared with conventional chemotherapy, such combination does not increase adverse reactions and can thus become a new direction for the treatment of OPG in children.
视路胶质瘤 / 贝伐珠单抗 / 传统化疗 / 肿瘤体积 / 儿童
Optic pathway glioma / Bevacizumab / Conventional chemotherapy / Tumor size / Child
[1] Jahraus CD, Tarbell NJ. Optic pathway gliomas[J]. Pediatr Blood Cancer, 2006, 46(5):586-596.
[2] Avery RA, Fisher MJ, Liu GT. Optic pathway gliomas[J]. J Neuroophthalmol, 2011, 31(3):269-278.
[3] Dodgshun AJ, Maixner WJ, Heath JA, et al. Single agent carboplatin for pediatric low-grade glioma:a retrospective analysis shows equivalent efficacy to multiagent chemotherapy[J]. Int J Cancer, 2016, 138(2):481-488.
[4] 刘玉含, 田永吉. 儿童视路胶质瘤的诊疗现状[J]. 中华神经外科杂志, 2017, 33(4):416-419.
[5] Lassaletta A, Scheinemann K, Zelcer SM, et al. Phase II weekly vinblastine for chemotherapy-naïve children with progressive low-grade glioma:a canadian pediatric brain tumor consortium study[J]. J Clin Oncol, 2016, 34(29):3537-3543.
[6] Avery RA, Hwang EI, Jakacki RI, et al. Marked recovery of vision in children with optic pathway gliomas treated with bevacizumab[J]. JAMA Ophthalmol, 2014, 132(1):111-114.
[7] Aguilera D, Mazewski C, Fangusaro J, et al. Response to bevacizumab, irinotecan, and temozolomide in children with relapsed medulloblastoma:a multi-institutional experience[J]. Childs Nerv Syst, 2013, 29(4):589-596.
[8] 张祎年, 黄文彪, 李峤, 等. 影响鞍区脑膜瘤患者术后视力的相关因素分析[J]. 中华神经外科杂志, 2015, 31(11):1112-1117.
[9] 孙燕. 内科肿瘤学[M]. 北京:人民卫生出版社, 2001:995.
[10] Hay JL, Atkinson TM, Reeve BB, et al. Cognitive interviewing of the US national cancer institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE)[J]. Qual Life Res, 2014, 23(1):257-269.
[11] Bergthold G, Bandopadhayay P, Bi WL, et al. Pediatric low-grade gliomas:how modern biology reshapes the clinical field[J]. Biochim Biophys Acta, 2014, 1845(2):294-307.
[12] Packer RJ, Ater J, Allen J, et al. Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas[J]. J Neurosurg, 1997, 86(5):747-754.
[13] Moreno L, Bautista F, Ashley S, et al. Does chemotherapy affect the visual outcome in children with optic pathway glioma? A systematic review of the evidence[J]. Eur J Cancer, 2010, 46(12):2253-2259.
[14] Bradfield SM, Sandler E, Geller T, et al. Glutamic acid not beneficial for the prevention of vincristine neurotoxicity in children with cancer[J]. Pediatr Blood Cancer, 2015, 62(6):1004-1010.
[15] van de Velde ME, Kaspers GL, Abbink FCH, et al. Vincristine-induced peripheral neuropathy in children with cancer:a systematic review[J]. Crit Rev Oncol Hematol, 2017, 114:114-130.
[16] Yu DY, Dahl GV, Shames RS, et al. Weekly dosing of carboplatin increases risk of allergy in children[J]. J Pediatr Hematol Oncol, 2001, 23(6):349-352.
[17] Rosca L, Robert-Boire V, Delisle JF, et al. Carboplatin and vincristine neurotoxicity in the treatment of pediatric low-grade gliomas[J]. Pediatr Blood Cancer, 2018, 65(11):e27351.
[18] Jain RK, di Tomaso E, Duda DG, et al. Angiogenesis in brain tumours[J]. Nat Rev Neurosci, 2007, 8(8):610-622.
[19] Tamura R, Tanaka T, Miyake K, et al. Bevacizumab for malignant gliomas:current indications, mechanisms of action and resistance, and markers of response[J]. Brain Tumor Pathol, 2017, 34(2):62-77.
[20] Chinot OL, Wick W, Mason W, et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma[J]. N Engl J Med, 2014,370(8):709-722.
[21] Diaz RJ, Ali S, Qadir MG, et al. The role of bevacizumab in the treatment of glioblastoma[J]. J Neuro Oncol, 2017, 133(3):455-467.
北京市医院管理局儿科学科协同发展中心儿科专项（XTYB201816）。
