Medulloblastom - Therapie

[so_ap_2000]

Hallo,

Herr Prof. Roland Felix schreibt das es unbedingt vermieden werden muß den Liquorabfluss in den Bauch oder das Herz zu verlegen, da es zu einer Verschleppung von Tumorzellen und damit zu einer Metastasierung außerhalb des ZNS kommen kann.

Wohin sollte der Liquorabfluss am besten hinverlegt werden damit es zu keiner Verschleppung von Tumorzellen kommt? In den Magen vielleicht?

Auch wenn dies etwas blöd klingt. Wenn die Tumorerkrankung im 15. Lebensjahr bemerkt wird, ist dies nun frühzeitig oder eher spät erkannt worden und wie sieht da die Chance zur Heilung aus? Die Voraussetzung für eine erfolgreiche Behandlung und Heilung soll ja eine frühzeitige Diagnose sein.

Vielleicht kann ja einer auf meine Fragen antworten.

mfg mathias

P.S. Der Sohn eines guten Freundes ist von dieser Tumorerkrankung betroffen, ich zwar nicht aber mache mir halt viele Gedanken.

[Prof. Wust]

RE: Medulloblastom - Therapie


Sie haben recht. Die Relevanz dieser mehr theoretischen Sorge ist umstritten, wie die unten als Abstract aufgeführte Untersuchung zeigt. Sie können sich ja diese Arbeit besorgen. Man hat auch den Einsatz von Filtern vorgeschlagen, diese können aber verstopfen.

The risks of metastases from shunting in children with primary central nervous system tu-mors.
AU: Berger,-M-S; Baumeister,-B; Geyer,-J-R; Milstein,-J; Kanev,-P-M; LeRoux,-P-D
AD: Department of Neurological Surgery, University of Washington School of Medicine, Seattle.
SO: J-Neurosurg. 1991 Jun; 74(6): 872-7
AB: The authors reviewed the hospital charts of 415 pediatric patients treated for benign or malignant primary brain tumors over the past 20 years at the Children's Hospital Medical Center, Seattle. Patients' ages ranged from the neonatal period to 18 years. A shunt was placed in 152 patients (37%), 45 before and 94 after surgery. Confirmation of extraneural metastases was based on clinical and diagnostic examination. Factors analyzed as possibly influencing the occurrence of extraneural metastases were: 1) the shunt: type, valve, locati-on, filter, and revisions; 2) extent of resection; 3) pathology; and 4) treatment regimen. Eight of the 415 patients developed extraneural metastases during life. All eight patients had a medulloblastoma (cerebellar primitive neuroectodermal tumor). These eight patients were separated into Group A (without a shunt) and Group B (with a shunt). In Group A (five pati-ents), the mean interval from primary diagnosis to metastasis was 15 months. Two children had gross total resection of the tumor. The predominant location of metastases in Group A was: bone (two cases); cervical lymph nodes (one); lung/bone (one); and retroperitoneal pel-vic mass (one). Three Group A patients had a simultaneous central nervous system (CNS) recurrence. Of the three Group B patients, two had a ventriculoperitoneal (VP) shunt and one a ventriculoatrial (VA) shunt; all were placed postoperatively. One Group B patient had a simultaneous CNS recurrence. No shunt revisions were performed in these three patients. The mean time from primary diagnosis to metastasis was 25 months. One patient had a total tumor resection. The predominant location of metastases was bone (one case), retroperito-neal pelvic mass (one), and abdominal cavity with ascites (one case). Only one patient in the entire series had a filter placed; this resulted in shunt obstruction and was removed 1 month following placement. It is concluded that cerebrospinal fluid shunts, regardless of type, loca-tion, revision rate, or filter insertion, do not predispose pediatric patients with brain tumors to develop extraneural metastases. A diagnosis of shunt-related metastases should be based on the development of intra-abdominal (VP shunt) or pulmonary (VA shunt) dissemination primarily with or without additional sites. The diagnosis of medulloblastoma is an important factor related to metastasis occurrence while the extent of resection and postoperative therapy are not influential.