Lai Mingyao,Li Shaoqun,Li Juan,et al.A real-world study of reirradiation plus CDK4/6 inhibitors in treating recurrent pediatric diffuse intrinsic pontine glioma[J].Journal of Clinical Pediatric Surgery,2024,(05):440-445.[doi:10.3760/cma.j.cn101785-202310016-008]
再程放疗联合CDK4/6抑制剂治疗儿童复发弥漫内生型脑桥胶质瘤的真实世界研究
- Title:
- A real-world study of reirradiation plus CDK4/6 inhibitors in treating recurrent pediatric diffuse intrinsic pontine glioma
- 关键词:
- 弥漫内生型脑桥胶质瘤; 再程放疗; 瑞博西尼; 外科手术; 儿童
- Keywords:
- Diffuse Intrinsic Pontine Glioma; Reirradiation; Ribociclib; Surgical Procedures; Operative; Child
- 摘要:
- 目的 分析儿童复发弥漫内生型脑桥胶质瘤 (diffuse intrinsic pontine glioma,DIPG) 再程放疗的疗效,初步探讨再程放疗同步联合瑞博西尼对DIPG患儿预后的影响。 方法 本研究为回顾性研究,以2021年5月至2023年5月广东三九脑科医院肿瘤科接受再程放疗联合(或不联合)瑞博西尼治疗的复发DIPG患儿为研究对象,根据国际肿瘤化疗药物通用不良反应术语标准(Common Terminology Criteria for Adverse Events,CTCAE)4.0版,评价再程放疗联合瑞博西尼治疗的疗效及不良反应。采用Kaplan-Meier法计算患儿生存时间,采用Log-rank检验比较再程放疗联合或不联合瑞博西尼患儿的生存情况差异。 结果 共纳入18例DIPG患儿,男5例、女13例,中位年龄7.0岁,其中7例采用再程放疗同步瑞博西尼治疗。首程放疗与再程放疗的中位间隔时间为9.0个月。再程放疗后64.3%(9/14)肢体乏力、62.5%(5/8)言语不清、50%(3/6)行走不稳症状改善。再程放疗后77.8%(14/18)的患儿肿瘤体积缩小。18例患儿再程放疗后中位生存期为4.7个月,中位总生存期为18.6个月。再程放疗联合瑞博西尼组与未联合瑞博西尼组的总中位生存期(17.2个月比18.9个月)、再程放疗后中位生存期(6.2个月比5.4个月)差异均无统计学意义(P值分别为0.714、0.390)。7例接受瑞博西尼同步治疗的患儿中,3例(42.9%)出现血液系统不良反应,分别为CTCAE 1、2、3级。 结论 再程放疗可改善儿童复发DIPG的临床症状,延长生存时间。同步瑞博西尼治疗并不能改善患儿生存时间,且增加治疗毒性。
- Abstract:
- Objective To explore the efficacy of reirradiation (re-RT) for recurrent pediatric diffuse intrinsic pontine glioma (DIPG) in China and preliminarily explore the impact of concurrent re-RT with ribociclib on the prognosis of DIPG patients.Methods A total of 18 children with recurrent DIPG who received re-RT with or without ribociclib were recruited from Department of Oncology,Guangdong Sanjiu Brain Hospital from May 2021 to May 2023.Common Terminology Criteria for Adverse Events (CTCAE 4.0) was utilized for evaluating the occurrences of adverse reactions.Kaplan-Meier method was employed for calculating overall survival and Log-rank for examining the survival difference between two groups.Results There were 5 boys and 13 girls with a median age of 7.0 years.Seven patients received concurrent reirradiation and ribociclib.Median interval between upfront radiotherapy and re-RT was 9.0 months.Among well-documented patients,64.3%(9/14) had relieved extremity weakness,62.5%(5/8) had improvement in slurred speech,50% (3/6) had better walking instability and 77.8%(14/18) had tumor regression.Median survival was 4.7 months from a start of re-RT to death and overall median survival 18.6 months from an initial diagnosis.No significant difference existed in median overall survival (17.2 months vs.18.9 months)or median survival from a start of re-RT to death (6.2 months vs.5.4 months) in patients receiving re-RT plus ribociclib as compared with those without ribociclib,with P values of 0.714 and 0.390,respectively.Among 7 children receiving concurrent re-RT and ribociclib,3 patients (42.9%) experienced hematological adverse events of CTCAE grade 1,2 and 3.Conclusions Re-RT may improve clinical symptoms and prolong survival time in children with recurrent DIPG.Concurrent re-RT and ribociclib therapy not only don’t improve survival but also increase toxicity in children with DIPG.
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备注/Memo
收稿日期:2023-10-10。
基金项目:广州市科技计划项目(202201011741)
通讯作者:蔡林波,Email:cailinbo999@163.com