Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2023; 22: 108-113
Эффективность стереотаксических методов облучения с последующей метрономной терапией МЕММАТ у детей с олигометастатическим рецидивом медуллобластомы
https://doi.org/10.24287/1726-1708-2023-22-4-108-113Аннотация
Низкие показатели выживаемости детей с рецидивом медуллобластомы (МБ) диктуют необходимость поиска терапевтических стратегий, являющихся альтернативными действующим стандартам лечения. Благодаря дозиметрическим характеристикам в целях локального лучевого контроля при олигометастатических рецидивах МБ в педиатрической практике оправдано применение стереотаксических методов облучения. Учитывая сохраняющийся риск метастатической диссеминации, для потенцирования достигаемого облучением ответа и улучшения выживаемости без прогрессии может быть рассмотрена метрономная и молекулярнонаправленная антиангиогенная терапия для детей с рецидивирующей/прогрессирующей МБ MEMMAT (Medulloblastoma European Multitarget Metronomic Anti-Angiogenic Trial). Целью работы является описание 2 клинических случаев, демонстрирующих эффективность стратегии последовательного применения стереотаксического облучения и метрономного режима МЕММАТ в лечении олигометастатического рецидива МБ у пациентов детского возраста. Родители пациентов дали согласие на использование информации, в том числе фотографий детей, в научных исследованиях и публикациях.
Список литературы
1. Sabel M., Fleischhack G., Tippelt S., Gustafsson G., Doz F., Kortmann R., et al.; SIOP-E Brain Tumour Group. Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol 2016; 129 (3): 515–24.
2. Gaab C., Adolph J.E., Tippelt S., Mikasch R., Obrecht D., Mynarek M., et al. Local and Systemic herapy of Recurrent Medulloblastomas in Children and Adolescents: Results of the P-HITREZ 2005 Study. Cancers (Basel) 2022; 14 (3): 471. DOI: 10.3390/cancers14030471
3. Lo S.S., Fakiris A.J., Abdulrahman R., Henderson M.A., Chang E.L., Suh J.H., Timmerman R.D. Role of stereotactic radiosurgery and fractionated stereotactic radiotherapy in pediatric brain tumors, Expert Review of Neurotherapeutics 2008; 8 (1): 121–32. DOI: 10.1586/14737175.8.1.121
4. Robison N.J., Campigotto F., Chi S.N., Manley P.E., Turner C.D., Zimmerman M.A., et al. A phase II trial of a multi-agent oral antiangiogenic (metronomic) regimen in children with recurrent or progressive cancer. Pediatr Blood Cancer 2014; 61 (4): 636–42.
5. Peyrl A., Chocholous M., Slavc I., André N., Kieran M.W., Azizi A.A. A Phase II study of metronomic and targeted anti-angiogenesis therapy for children with recurrent/progressive medulloblastoma MEMMAT (Medulloblastoma European Multitarget Metronomic Anti-Angiogenic Trial). ClinicalTrials.gov Identifier: NCT01356290.
6. Peyrl A., Chocholous M., Kieran M.W., Azizi A.A., Prucker C., Czech T., et al. Antiangiogenic metronomic therapy for children with recurrent embryonal brain tumors. Pediatr Blood Cancer 2012; 59 (3): 511–7.
7. Slavc I., Mayr L., Stepien N., Gojo J., Aliotti Lippolis M., Azizi A.A., et al. Improved Long-Term Survival of Patients with Recurrent Medulloblastoma Treated with a “MEMMAT-like” Metronomic Antiangiogenic Approach. Cancers (Basel) 2022; 14 (20): 5128. DOI: 10.3390/cancers14205128
Pediatric Hematology/Oncology and Immunopathology. 2023; 22: 108-113
The effectiveness of stereotactic irradiation followed by metronomic MEMMAT therapy in children with oligometastatic recurrent medulloblastoma
https://doi.org/10.24287/1726-1708-2023-22-4-108-113Abstract
Low survival rates in children with recurrent medulloblastoma (MB) necessitate the search for new therapeutic approaches as alternatives to the existing treatment standards. Favorable dosimetric characteristics of stereotactic radiation techniques justify the use of such treatments for local radiation control in children with oligometastatic recurrent MB. Given the constant risk of metastatic dissemination and in order to potentiate response to radiation therapy and improve progression-free survival, metronomic molecular-targeted antiangiogenic therapy (MEMMAT, Medulloblastoma European Multitarget Metronomic AntiAngiogenic Trial) can be considered in children with recurrent/progressive MB. Here, we report 2 clinical cases that demonstrate the effectiveness of the treatment approach involving stereotactic irradiation followed by the metronomic MEMMAT regimen for oligometastatic recurrent MB in pediatric patients. The patients’ parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.
References
1. Sabel M., Fleischhack G., Tippelt S., Gustafsson G., Doz F., Kortmann R., et al.; SIOP-E Brain Tumour Group. Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol 2016; 129 (3): 515–24.
2. Gaab C., Adolph J.E., Tippelt S., Mikasch R., Obrecht D., Mynarek M., et al. Local and Systemic herapy of Recurrent Medulloblastomas in Children and Adolescents: Results of the P-HITREZ 2005 Study. Cancers (Basel) 2022; 14 (3): 471. DOI: 10.3390/cancers14030471
3. Lo S.S., Fakiris A.J., Abdulrahman R., Henderson M.A., Chang E.L., Suh J.H., Timmerman R.D. Role of stereotactic radiosurgery and fractionated stereotactic radiotherapy in pediatric brain tumors, Expert Review of Neurotherapeutics 2008; 8 (1): 121–32. DOI: 10.1586/14737175.8.1.121
4. Robison N.J., Campigotto F., Chi S.N., Manley P.E., Turner C.D., Zimmerman M.A., et al. A phase II trial of a multi-agent oral antiangiogenic (metronomic) regimen in children with recurrent or progressive cancer. Pediatr Blood Cancer 2014; 61 (4): 636–42.
5. Peyrl A., Chocholous M., Slavc I., André N., Kieran M.W., Azizi A.A. A Phase II study of metronomic and targeted anti-angiogenesis therapy for children with recurrent/progressive medulloblastoma MEMMAT (Medulloblastoma European Multitarget Metronomic Anti-Angiogenic Trial). ClinicalTrials.gov Identifier: NCT01356290.
6. Peyrl A., Chocholous M., Kieran M.W., Azizi A.A., Prucker C., Czech T., et al. Antiangiogenic metronomic therapy for children with recurrent embryonal brain tumors. Pediatr Blood Cancer 2012; 59 (3): 511–7.
7. Slavc I., Mayr L., Stepien N., Gojo J., Aliotti Lippolis M., Azizi A.A., et al. Improved Long-Term Survival of Patients with Recurrent Medulloblastoma Treated with a “MEMMAT-like” Metronomic Antiangiogenic Approach. Cancers (Basel) 2022; 14 (20): 5128. DOI: 10.3390/cancers14205128
