【作者】 汤静燕； 徐敏； 王常林； 孙晓非； 李穗生； 郑漪； 陆谨； 张宝欣； 张忠德； 王耀平；

【Author】 Tang JingYan Pan Ci Xu Min et al Dept. Of Hematology/Oncology, XinHua Hospital/Shanghai Children’ s Medical Center, Shanghai Second Medical University, Shanghai, 200127.

【机构】 上海第二医科大学附属上海儿童医学中心／新华医院； 中国医科大学附属第二院小儿泌尿外科； 中山大学附属肿瘤医院儿科； 中山大学附属第一医院； 宁夏医学院附属医院儿科； 南京儿童医院； 沈阳市儿童医院；

【摘要】 目的:探讨建立儿童肿瘤协作组可能性,改善我国儿童肾母细胞瘤预后。方法:在中国小儿肿瘤协会下建立儿童肿瘤协作组,制定儿童肾母细胞瘤WT-2003协作方案,方案包括诊断与分期标准、分组标准、各组包括外科手术、内科化疗、选择性放疗的治疗规则。协作组WT-2003方案先在上海儿童医学中心试行,证明安全性和有效性后2003年起在协作组内应用。根据病人分组术后接受18至24周不同强度化疗。方案规定I期及II期病理分型为预后良好型不放疗, 其余病例治疗均包含有手术、不同强度的放疗和化疗,估计手术不能完全切除时给予2个疗程术前化疗。结果:15家医院参加协作组,8家医院上报汇总资料,累计病例56例,其中4例为非本方案适应症被剔除。最大年龄12岁,最小6个月,中位29个月。病理分型为预后良好型(FH)35例,预后不良型(UFH)8例,透明细胞肉瘤(CS)5例,肾未分化肉瘤(US)2例,横纹肌样(RS)1例,影像学诊断1例。分期为I期17例,II期11例,III期17例,IV期6例,V期1 例。48例获完全缓解,占93％。目前无肿瘤生存45例,占本组病例的86％,时间为3—72个月,中位13个月。结论:中国儿童肿瘤多中心协作临床研究有可行性,通过这一方式可较快积累病例,使治疗更合理,提高我国儿童肿瘤整体诊治水平,本组病人所采用诊断治疗方案有效,安全性好。更多还原

【Abstract】 Objective: To find the possibility of establishing multi-center cooperative group in China. To improve the result of Wilms’ Tumor. Methods: To establish the multi-center cooperative group under Chinese Pediatric Society. The diagnosis and staging criteria, the regulation for surgery, chemotherapy and radiation were included in the protocol WT-2003 for Wilms tumor. This protocol was administed first at Shanghai Children’ s Medical Center. After the efficacy and safety were approved, the protocol is used within the cooperative group. The protocol was stratified by stage and histology in accordance with National Wilms’ Tumor Study (NWTS) criteria of U.S. A, seeking to reduce treatment of low-stage, favorable-histology (FH) tumors without impairing survival and to improve prognosis of stage III and IV (FH) and unfavorable-histology (UFH) tumors with more intensive chemotherapy. Whole chemotherapy is 18 weeks to 24 weeks with different intensity depends on individual criteria. For those un-resectable patients received 2 courses of Ifosfamide, Vcr and VP-16 as pre-surgery therapy. No radiation therapy for all stage I and FH stage II. No randomized comparisons were attempted. Results: Patients were from 8 hospitals. Four patients were kicked out of the analysis because they didn’ t fit the eligibility. Total 52 cases between 7 months to 12 years old, median 29months, were enrolled. Pathology showed 35 cases into FH, eight into UFH, five of clear cell, one of rhabdoid and another 2 into un-differentiated. Seventeen patients were stage I, eleven stage II, seventeen stage III, six stage IV and one stage V. Forty-eight (93%) reached complete remission (CR). One relapsed after CR 24 months and reached second TF after intensive chemotherapy and ABMT. No therapy related death happened. Disease free survive ( DFS ) at 3-72 months, average 13 months is 86% . All of them beside five already stopped the treatment depending on the protocol. Conclusion: Multi-center cooperative group model for childhood cancer has feasibility in China. The general medical level for childhood cancer can be improved through this model. Protocol WT-2003 are safe and effective for Wilms’ tumor.更多还原