????????(neuroblastoma,??NB)????????????????????,??????????,??????????

1
?????????????

• ??????????
• ??? ?? ??? ???

2

• ????????(neuroblastoma,??NB)??????????????
  ??????,??????????,??????????

3
????

• 2000 ?1 ?? 2009 ?10 ???36 ?

4
????

• ?????????????(CCSG)??
• ???????????
• ?????????????????? ???????
• ?????????????????
• ??????
• ?s?lt1??????????????????????

5
??????

• ???????B???????CT?PET-CT????
• ????? NSE??VMA
• ?????????????????
• ????????????????????
• ????????????

6
??????????

• I? ??????,???
• II???1?????????III?I V?????11.5?
• CA??CTX 150mg/m2/d,ivd,d 17ADM 35
  mg/m2/d,ivd,d8?3???
• ???????PVP??DDP6090mg/m2/d,ivd,d
  1VP16 160 mg/m2/d,ivd,d3
• ?3???,5??
• 1??III?I V?,?1?????????III?I V?
• A??????
• OPEC??CTX 1000mg/m2/d,d1VCR 1.5 mg/m2,
  d1DDP 90 mg/m2/d, d2 VP16
• 160 mg/m2/d,d4??3???,5??
• ?PECA??(????????)DDP 90 mg/m2/d,d1VP16
  160 mg/m2/d, d3CTX
• 150mg/m2/d,ivd/po,d713ADM 35
  mg/m2/d, d14??3???,5??
• B ?????? II?III?????11.5?,4??????????????
  ?????1.5????
• ??????????8?28??????????,??????????
• CTX 150mg/m2/d,ivd/po,D814VP16 150
  mg/m2/d,D15,16,17
• ????CR,??????,???CA?PVP?CAV,???1???3????,
  ?2????12?1??,?3?4????16?1??????CR,???????????
• ?????????????????
• CT?? CTX 70mg/kg/d,D12????2
  mg/m2/d,D13,46??

7
??

• ????1??10?,??3.6??24?,?12????4?,??3?,??4?,??24?(6
  7),?s ?1? ?
• ????
• ????????4?,???4?,????6?,???1??
• ????????????????/???????1?,?????????2?,???1?,?
  ?4?,??1??

8
??

• ????8?,??4????,2???,2??? ????????
• ?????????5?,??3???????
• ??????4?,??????,??1????????1?,1???????????????1
  ?,????????1?,????????????????????????????1?,????
  ??,?????,?????
• ?????4?,????3?,??1? ?
• ????????3?,?????/???????????
• ????2?1??horner ???????????????????
• ???,??????1???????B???????????
• ??????1?,?????,?????
• ????2?,??????
• ???????1???MR??????,??????,?????,?????
• ?????1??
• ??1??

9
??????????18?

• 1????????1??,??,?????????????????????,????????????
  ????,????NB????57.5,?????CT?NSE???NB?
• 2?????ALL???1???????,???,??????????,NSE??,MR??????
  ???????,?????,????????????????,?????,??NB
  ??86.5?
• ??????2?,1?MR????,T4S1??????,?????????,??????????
  ???NB, ??MR T4S1????????,C6T1???????1?????????,
  ???????,????B??????????,???????????

10
????

• 17???,??16????,1?????1??s????
• 18??????????5??3????,??2?????,1???????,????,?????
  ?????????,??????

11
????

• 2????,??1???????,?2OPEC/ 2PECA??,????,???????,????
  ???BM??,CTX??,??????,????,???
• ?1????????,????,??????????,????????,??CT??????????
  ???,????,??????,?????????OPEC??????????,1????,B???
  ????????????,???????,??????,?????,??????????????,?
  ??????,????7?????

12
????

• ??1?,?????4?,???????1?,??9??
• ???6?????,1??????,1?????,1??????????,???????????1?
  ??,??????????,????,MR??????????,????,?????????????
  ??????????MR??????,NSE??,????1?????????????,??????
  ?,????

13
?????????

• ????????????????????????36??????????????????,????,
  ???,??????????????
• ?????????,???????????????????????????????????
• ?????? ?
• Kushner BH, Kramer K, Modak S, et al
• A focal lesion in the falx cerebri Harbinger of
  classic stage 4 neuroblastoma in an infant cured
  despite residual disease after minimal therapy.
  Pediatr Blood Cancer. 2009 Dec 1553(7)1340-2.

14
????????????

• ?X????B??NSE??VMA??(??????)???????????,90????????
  ??????????
• ????NB????
• ????????????????50,??????????????????
• ?????????????????ALL?2???????????,1???????,1?
  ?ALL?????,
• ????????????NSE????????,????????????????
• ?????ALL???,???????????,?????????????,???????
  ????????????

15
????

• ?????????????30(5/17)??,????MIBG???3F8??????????
  
• ????NB,?????????????????????,???????MIBG??????????
  ????

16
????

• 1???????MR?C7-T3??,???????????,??????????CT???????
  ?????1?NB???????????,??????????????
• 1?1??????MR?????????????????????????????,??MR?????
  ?,NSE??,????1?????????????,????,????????,?????????
  1??????????????????,????????

17
??

• ???????????,???????????????????????????????????,??
  ???????????B??NSE?VMA?????????????????????????????
  ???,????????????????????????????,????,????,???MIBG
  ???3F8??????????