{"id":181,"date":"2012-04-19T02:30:03","date_gmt":"2012-04-18T17:30:03","guid":{"rendered":"\/sawamura\/wp\/?p=181"},"modified":"2015-03-16T17:32:23","modified_gmt":"2015-03-16T08:32:23","slug":"gliomachemo","status":"publish","type":"post","link":"https:\/\/plaza.umin.ac.jp\/sawamura\/pediattumor\/gliomachemo\/","title":{"rendered":"\u5c0f\u5150\u30b0\u30ea\u30aa\u30fc\u30de\u306e\u5316\u5b66\u7642\u6cd5"},"content":{"rendered":"
\n

\u5c0f\u5150\u30b0\u30ea\u30aa\u30fc\u30de\u306e\u5316\u5b66\u7642\u6cd5<\/h1>\n

\u65b0\u3057\u3044\u60c5\u5831\uff1a\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u795e\u7d4c\u82bd\u7d30\u80de\u816b\u3078\u306e\u52b9\u679c\u306b\u3064\u3044\u3066<\/h2>\n

\u8133\u816b\u760d\u3067\u306f\u306a\u3044\u5c0f\u5150\u60aa\u6027\u816b\u760d\u306b\u5bfe\u3059\u308b\u52b9\u679c\u3092\u898b\u305f\u3082\u306e\u3067\u3059\u3002<\/p>\n

Rubie H, et al: Pahse II study of temozolomide in relapsed or refractory high-risk neuroblastoma: a joint Societe Francaise des Cancers de l’Enfant and United Kingdom Children Cancer Study Group-New Agents Group Study. J Clin Oncol 24: 5259-5264, 2006<\/p>\n

\u30e8\u30fc\u30ed\u30c3\u30d1\u3067\u884c\u308f\u308c\u305f\u81e8\u5e8a\u8a66\u9a13\u306e\u7d50\u679c\u3067\u3059\u3002\u3044\u308d\u3044\u308d\u306a\u6cbb\u7642\u3092\u3057\u3066\u3082\u3055\u3089\u306b\u8ee2\u79fb\u3057\u305f\u308a\u518d\u767a\u3057\u3066\u3068\u3066\u3082\u56f0\u3063\u305f\u72b6\u614b\u306b\u306a\u3063\u3066\u3057\u307e\u3063\u305f25\u4eba\u306e\u5c0f\u5150\u306e\u795e\u7d4c\u82bd\u7d30\u80de\u816bneuroblastoma\u306e\u60a3\u8005\u3055\u3093\u306b\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u304c\u6295\u4e0e\u3055\u308c\u307e\u3057\u305f\u3002\uff15\u4eba(20%)\u306e\u60a3\u8005\u3055\u3093\u306b\u306f\u3063\u304d\u308a\u3057\u305f\u52b9\u679c\u304c\u898b\u3089\u308c\u307e\u3057\u305f(CR+PR)\u3002\u3068\u3066\u3082\u5e0c\u671b\u306e\u6301\u3066\u308b\u7d50\u679c\u3067\u3059\u3002\u795e\u7d4c\u82bd\u7d30\u80de\u816b\u306f\u9ac4\u82bd\u816b\u3084\u677e\u679c\u4f53\u82bd\u816b\u3084PNET\u306b\u4f3c\u305f\u816b\u760d\u3067\u3059\u304b\u3089\uff0c\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u304c\u3053\u308c\u3089\u306e\u8133\u816b\u760d\u306b\u3082\u6709\u52b9\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3044\u3046\u671f\u5f85\u304c\u6301\u3066\u307e\u3059\u3002\u3067\u3082\u307e\u3060\u305f\u304f\u3055\u3093\u306e\u7814\u7a76\u304c\u884c\u308f\u308c\u306a\u3044\u3068\u306f\u3063\u304d\u308a\u3057\u305f\u3053\u3068\u306f\u8a00\u3048\u307e\u305b\u3093\u3002<\/p>\n

\n

\u5c02\u9580\u5bb6\u5411\u3051\u3067\u3059<\/h2>\n

1. \u6982\u8ad6<\/h2>\n

\u3000\u795e\u7d4c\u81a0\u816b\uff08\u30b0\u30ea\u30aa\u30fc\u30de\uff09\u3068\u306f\u795e\u7d4c\u5916\u80da\u8449\u8d77\u6e90\u306e\u816b\u760d\u3092\u3044\u3046\u3002\u5f93\u3063\u3066\uff0c\u661f\u7d30\u80de\u816b\u306a\u3069\u306e\u30b0\u30ea\u30a2\u7cfb\u816b\u760d\u306e\u307f\u306a\u3089\u305a\u5c0f\u5150\u306e\u9ac4\u82bd\u816b\u3084PNET\uff08\u539f\u59cb\u795e\u7d4c\u5916\u80da\u8449\u6027\u816b\u760d\uff09\u3082\u795e\u7d4c\u81a0\u816b\u306e\u7bc4\u7587\u306b\u5165\u308b\u3002<\/p>\n

\u3000\u5c0f\u5150\u306b\u767a\u751f\u3059\u308b\u56fa\u5f62\u764c\u306e\u4e2d\u3067\u795e\u7d4c\u81a0\u816b\u306e\u983b\u5ea6\u306f\u9ad8\u304f\uff0c\u307e\u305f\u6b7b\u4ea1\u7387\u306e\u9ad8\u3044\u75be\u60a3\u3068\u3057\u3066\u77e5\u3089\u308c\u308b\u3002\u6700\u5927\u306e\u7279\u5fb4\u306f\u75c5\u7406\u7d44\u7e54\u304c\u591a\u5f69\u306a\u3053\u3068\u3067\u3042\u308a\uff0c\u9006\u306b\u500b\u3005\u306e\u7d44\u7e54\u578b\u306e\u767a\u751f\u983b\u5ea6\u306f\u6975\u3081\u3066\u4f4e\u3044\u3002\u3055\u3089\u306b\u7d44\u7e54\u8a3a\u65ad\u304c\u540c\u4e00\u3067\u3042\u3063\u3066\u3082\u767a\u751f\u90e8\u4f4d\u3068\u5e74\u9f62\u306b\u3088\u3063\u3066\u4e88\u5f8c\u304c\u5909\u308f\u308b\u305f\u3081\u306b\u6cbb\u7642\u6cd5\u306e\u9078\u629e\u304c\u8907\u96d1\u306b\u306a\u308b\u3068\u3044\u3046\u6cbb\u7642\u3059\u308b\u5074\u306b\u53d6\u3063\u3066\u306f\u3084\u3063\u304b\u3044\u306a\u7279\u5fb4\u3092\u6709\u3057\u3066\u3044\u308b\u3002<\/p>\n

\u3000\u4f4e\u5e74\u9f62\u5150\u306e\u4e2d\u67a2\u795e\u7d4c\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u306b\u5bfe\u3057\u3066\u8010\u6027\u304c\u4f4e\u3044\u305f\u3081\u5316\u5b66\u7642\u6cd5\u304c\u6975\u3081\u3066\u91cd\u8981\u306a\u6cbb\u7642\u624b\u6bb5\u3068\u306a\u3063\u3066\u304a\u308a\uff0c\u624b\u8853\u6458\u51fa\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u5e7c\u5c0f\u5150\u306e\u8996\u5e8a\u4e0b\u90e8\uff0f\u8996\u4ea4\u53c9\u661f\u7d30\u80de\u816b\uff0c\u3042\u308b\u3044\u306f\u60aa\u6027\u5ea6\u306e\u9ad8\u3044\u9ac4\u82bd\u816b\uff0cPNET\u306a\u3069\u306e\u80ce\u5150\u6027\u816b\u760d(embryonal tumors)\uff0c\u5206\u5316\u578b\u3067\u3042\u3063\u3066\u3082\u5316\u5b66\u7642\u6cd5\u611f\u53d7\u6027\u3092\u6709\u3059\u308b\u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u816b\u760d\u306a\u3069\u304c\u5316\u5b66\u7642\u6cd5\u306e\u5bfe\u8c61\u3068\u306a\u308b\u3002<\/p>\n

\u3000\u306a\u3079\u3066\u795e\u7d4c\u81a0\u816b\u306f\u653e\u5c04\u7dda\u62b5\u6297\u6027\u3067\u3042\u308b\u3068\u5171\u306b\u5316\u5b66\u7642\u6cd5\u62b5\u6297\u6027\u3067\u3042\u308b\u306e\u3067\uff0c\u5316\u5b66\u7642\u6cd5\u5358\u72ec\u3067\u6cbb\u7652\u3092\u5c0e\u3051\u308b\u3053\u3068\u306f\u5c11\u306a\u3044\u3002\u5f93\u3063\u3066\u3001\u5316\u5b66\u7642\u6cd5\u306f\u60a3\u5150\u3092\u6cbb\u3059\u305f\u3081\u306e\u96c6\u5b66\u7684\u6cbb\u7642\u306e\u4e00\u7aef\u3092\u62c5\u3046\u3068\u7406\u89e3\u3057\u305f\u65b9\u304c\u3088\u3044\u3002\u307e\u305f\uff0c\u5c0f\u5150\u795e\u7d4c\u81a0\u816b\u306b\u5bfe\u3057\u3066\u79d1\u5b66\u7684\u306b\u7acb\u8a3c\u3055\u308c\u305f\u6a19\u6e96\u7684\u6cbb\u7642\u3068\u3044\u3046\u3079\u304d\u5316\u5b66\u7642\u6cd5\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u306f\u306a\u3044\u3002<\/p>\n

2. \u9ac4\u82bd\u816b<\/h2>\n

\u3000\u9ac4\u82bd\u816b\u3092\u6cbb\u7652\u306b\u5c0e\u304f\u78ba\u5b9f\u6027\u304c\u6700\u3082\u9ad8\u3044\u6cbb\u7642\u6cd5\u306f\u73fe\u5728\u306b\u304a\u3044\u3066\u3082\u8133\u810a\u9ac4\u7167\u5c04\u3067\u3042\u308b\u3002\u3057\u304b\u3057\uff0c\u767a\u9054\u904e\u7a0b\u306b\u3042\u308b\u4e73\u5e7c\u5150\u306e\u4e2d\u67a2\u795e\u7d4c\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u306b\u5bfe\u3057\u3066\u8457\u3057\u304f\u8010\u6027\u304c\u4f4e\u304f\u8106\u5f31\u3067\u3042\u308a\uff0c\u7279\u306b\uff13\u624d\u672a\u6e80\u306e\u5c0f\u5150\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u884c\u3048\u3070\u91cd\u7be4\u306a\u4e2d\u67a2\u795e\u7d4c\u767a\u9054\u969c\u5bb3\u3092\u62db\u304f\u78ba\u7387\u304c\u9ad8\u3044\u3002\uff13\u624d\u306b\u306a\u3063\u3066\u304b\u3089\u3082\u6210\u4eba\u3068\u540c\u69d8\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u3067\u304d\u308b\u308f\u3051\u3067\u306f\u306a\u304f\u5e74\u9f62\u306b\u6b63\u306e\u76f8\u95a2\u3068\u306a\u308b\u3088\u3046\u306b\u653e\u5c04\u7dda\u91cf\u3092\u8abf\u7bc0\u3059\u308b\u305f\u3081\u306b\uff0c\u4f4e\u5e74\u9f62\u5150\u307b\u3069\u5316\u5b66\u7642\u6cd5\u306e\u5f79\u5272\u306f\u5927\u304d\u3044\u3057\u307e\u305f\u305d\u308c\u306b\u3088\u3063\u3066\u6cbb\u7642\u671f\u9593\u304c\u9577\u671f\u306b\u306a\u308b\u3002<\/p>\n

\u30001990\u5e74Hoppe-Hirsch\u3089\u306f\u9ac4\u82bd\u816b120\u4f8b\u3092\u8ffd\u8de1\u3057\u3001\u6cbb\u7642\uff15\u5e74\u5f8c\u306b\u306f42%\u306e\u60a3\u5150\u3067IQ\u306f80\u3092\u4e0b\u56de\u308a\uff0c\u6cbb\u764210\u5e74\u5f8c\u306b\u306f85%\u306e\u60a3\u5150\u3067IQ\u306f80\u3092\u4e0b\u56de\u308b\u3068\u5831\u544a\u3057\u305f\u3002(1) <\/sup>2001\u5e74\u306eRis\u3089\u306e\u5831\u544a\u306b\u3088\u308c\u3070\uff0c23.4Gy\u306e\u4f4e\u7dda\u91cf\u8133\u810a\u9ac4\u7167\u5c04\u306b\u3088\u3063\u3066\u3082\u77e5\u80fd\u4f4e\u4e0b\u306f\u660e\u3089\u304b\u3067\u306f\u3042\u308b\u304c\uff0c\u65e7\u6765\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u3068\u6bd4\u8f03\u3059\u308c\u3070\u77e5\u7684\u6a5f\u80fd\u306e\u6e29\u5b58\u7387\u306f\u6539\u5584\u306e\u50be\u5411\u304c\u3042\u3063\u305f\u3068\u3044\u3046\u3002\u3057\u304b\u3057\uff0c\u60a3\u5150\u306eIQ\u306f\uff11\u5e74\u3042\u305f\u308a4.3\u4f4e\u4e0b\u3057\u3066\u3044\u304d\uff0c7\u6b73\u4ee5\u4e0b\u3067\u4f4e\u4e0b\u7387\u306f\u8457\u3057\u304f\uff0c3\u5e74\u7d4c\u904e\u89b3\u5bdf\u3057\u305f15\u75c7\u4f8b\u306e\u5e73\u5747FSIQ\u306f75.7\u3067\u3042\u308a\u66f4\u306b\u4f4e\u4e0b\u306e\u50be\u5411\u3092\u305f\u3069\u308b\u3068\u3044\u3046\u3002(2)<\/sup>\u3055\u3089\u306b\u8fd1\u5e74\uff0c5\u6b73\u4ee5\u4e0b\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u8133\u810a\u9ac418Gy\u3068\u3044\u3046\u4f4e\u7dda\u91cf\u3082\u7528\u3044\u3089\u308c\u305f\u304c\uff0c\u5185\u5206\u6ccc\u6a5f\u80fd\u969c\u5bb3\u3068\u77e5\u80fd\u306e\u4f4e\u4e0b\u306f\u907f\u3051\u3089\u308c\u306a\u3044\u3068\u5831\u544a\u3055\u308c\u305f(3)<\/sup>\u3002\u3053\u308c\u3089\u306e\u77e5\u898b\u304c\u9ac4\u82bd\u816b\u306e\u5316\u5b66\u7642\u6cd5\u306b\u5bfe\u3059\u308b\u671f\u5f85\u3092\u9ad8\u3081\u305f\u3002<\/p>\n

\u3000\u9ac4\u82bd\u816b\u3067\u306f\u9ad8\u30ea\u30b9\u30af\u7fa4\u3068\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u6cbb\u7642\u6cd5\u304c\u9078\u629e\u3055\u308c\u308b\u3002\u9ad8\u30ea\u30b9\u30af\u7fa4\u3068\u306f\uff0c\uff13\u6b73\u672a\u6e80\u306e\u4e73\u5e7c\u5150\uff0c\u9ac4\u8154\u5185\u8ee2\u79fb\u306e\u5b58\u5728\uff0c\u8853\u5f8c\u306e1.5cm2<\/sup>\u4ee5\u4e0a\u306e\u6b8b\u5b58\u816b\u760d\u306e\u5b58\u5728\u306e\u4e00\u3064\u3092\u542b\u3080\u3082\u306e\u3068\u7406\u89e3\u3055\u308c\u308b\u3002(4)<\/sup>\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u306f\uff0c\u624b\u8853\u306b\u3088\u308b\u5168\u6458\u51fa\u306e\u5f8c\u306b\u8133\u810a\u9ac4\u7167\u5c04\u3092\u884c\u3046\u304c\uff0c\u5316\u5b66\u7642\u6cd5\u306e\u4f75\u7528\u306b\u306f\u7d50\u8ad6\u306f\u306a\u3044\u3002\u73fe\u5728\u306b\u304a\u3044\u3066\u3082\u9ad8\u3044\u751f\u5b58\u7387\u3092\u6c42\u3081\u308b\u306a\u3089\u3070\u6a19\u6e96\u6cbb\u7642\u306f35-36Gy\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3067\u3042\u308b\u3002\u4e00\u65b9\u3001\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u306f\u53ef\u80fd\u306a\u9650\u308a\u306e\u6458\u51fa\u306e\u5f8c\u306b\u8133\u810a\u9ac4\u7167\u5c0435-36Gy\u3068\u591a\u5264\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u304c\u7528\u3044\u3089\u308c\u308b\u3002\u3044\u305a\u308c\u3082\u816b\u760d\u5c40\u6240\u7dda\u91cf\u306f55Gy\u7a0b\u5ea6\u3067\u3042\u308b\u3002\u3057\u304b\u3057\u306a\u304c\u3089\u524d\u8ff0\u306e\u7406\u7531\u304b\u3089\uff0c\u5316\u5b66\u7642\u6cd5\u3092\u4f75\u7528\u3057\u306a\u304c\u3089\u3088\u308a\u4f4e\u3044\u7dda\u91cf\u3092\u7528\u3044\u3066\u6cbb\u7642\u3057\u3088\u3046\u3068\u3059\u308b\u65b9\u5411\u6027\u306b\u3042\u308b\u306e\u304c\u4e16\u754c\u7684\u306a\u50be\u5411\u3067\u3042\u308b\u3002<\/p>\n

\u3000\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u5bfe\u3059\u308b\u7167\u5c04\u524d\u5316\u5b66\u7642\u6cd5\u306e\u6709\u7528\u6027\u306b\u306f\u8b70\u8ad6\u304c\u3042\u308b\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u6642\u671f\u3092\u9045\u3089\u305b\u308b\u3053\u3068\u3067\u4e2d\u67a2\u795e\u7d4c\u306e\u767a\u9054\u3092\u5f85\u3064\u3053\u3068\u304c\u3067\u304d\u308b\u3068\u3044\u3046\u5229\u70b9\u306e\u4e00\u65b9\u3067\uff0c\u751f\u5b58\u7387\u3092\u4e0b\u3052\u308b\u3068\u3044\u3046\u610f\u898b\u3082\u591a\u3044\u3002(4,5)<\/sup>2003\u5e74\u306b\u5831\u544a\u3055\u308c\u305f217\u4f8b\u306e\u30e9\u30f3\u30c0\u30e0\u5316\u8a66\u9a13\u306e\u7d50\u679c\u3067\u306f\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u5358\u72ec\u7fa4\u3068\u7167\u5c04\u524d\u5316\u5b66\u7642\u6cd5\u4f75\u7528\u7fa4\u306e\u7121\u5897\u60aa\uff15\u5e74\u751f\u5b58\u5272\u5408\u306f\u305d\u308c\u305e\u308c59.8%\u306874.2%\u3067\u3042\u308a\u7d71\u8a08\u5b66\u7684\u306b\u6709\u610f\u306a\u5dee(p=0.366)\u304c\u307f\u3089\u308c\u305f\u304c\uff0c\u5168\u751f\u5b58\u671f\u9593\u3067\u306f\u6709\u610f\u306a\u5dee(p=0.0928)\u304c\u306a\u304b\u3063\u305f\u3068\u3055\u308c\u305f\u3002(5)<\/sup>\u3053\u306e\u8a66\u9a13\u3067\u7528\u3044\u3089\u308c\u305f\u85ac\u5264\u306f\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u3001\u30a8\u30c8\u30dd\u30b7\u30c9\u3001\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\uff0c\u30b7\u30af\u30ed\u30db\u30b9\u30d5\u30a1\u30df\u30c9\u3067\u3042\u308b\u3002<\/p>\n

\u3000\u3053\u306e\u7814\u7a76\u7d50\u679c\u306f\u7167\u5c04\u524d\u5316\u5b66\u7642\u6cd5\u304c\u5c11\u306a\u304f\u3068\u3082\u9577\u671f\u751f\u5b58\u7387\u3092\u4e0b\u3052\u306a\u3044\u3053\u3068\u3092\u8a3c\u660e\u3057\u3066\u3044\u308b\u3002\u3057\u304b\u3057\u306a\u304c\u3089\uff0c\u3053\u3053\u3067\u7528\u3044\u3089\u308c\u305f\u8133\u810a\u9ac4\u7dda\u91cf\u306f35Gy\u3067\u3042\u308a\u73fe\u5728\u65e5\u672c\u3067\u591a\u7528\u3055\u308c\u3066\u3044\u308b23-25Gy\u3088\u308a\u3082\u591a\u3044\u306e\u3067\uff0c35Gy\u3068\u3044\u3046\u8133\u810a\u9ac4\u7167\u5c04\u306e\u30d0\u30c3\u30af\u30a2\u30c3\u30d7\u304c\u3042\u3063\u3066\u59cb\u3081\u3066\u5f97\u3089\u308c\u308b\u6210\u7e3e\u3067\u3042\u308b\u3053\u3068\u3092\u8a8d\u8b58\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3057\uff0c\u3053\u306e\u6cbb\u7642\u306b\u985e\u4f3c\u3057\u305f\u7167\u5c04\u524d\u5316\u5b66\u7642\u6cd5\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3092\u7528\u3044\u308b\u306e\u306b\u7dda\u91cf\u309224Gy\u3042\u308b\u3044\u306f\u3055\u3089\u306b18Gy\u306b\u4e0b\u3052\u3089\u308c\u308b\u3068\u3044\u3046\u6839\u62e0\u306f\u306a\u3044\u3002<\/p>\n

\u3000\u7b46\u8005\u3089\u306f1992\u5e74\u304b\u3089\u30a4\u30db\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30a8\u30c8\u30dd\u30b7\u30c9\u3092\u4f75\u7528\u3059\u308bICE\u5316\u5b66\u7642\u6cd5\u3092\uff16\u30b3\u30fc\u30b9\u7528\u3044\u308b\u5316\u5b66\u7642\u6cd5\u3068\u5e74\u9f62\u306b\u5fdc\u3058\u305f18-24Gy\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3092\u4f75\u7528\u3059\u308b\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3092\u7528\u3044\u3066\u3044\u308b\u304c\u6cbb\u7642\u5f8c\u8ffd\u8de1\u671f\u9593\u4e2d\u592e\u502460\u30f6\u6708\u3067\u306e\uff15\u5e74\u751f\u5b58\u7387\u306f64%\u3067\u3042\u308a\u6b27\u7c73\u304b\u3089\u306e\u5831\u544a\u3068\u5927\u5dee\u306f\u306a\u3044\u3082\u306e\u3067\u3042\u308b\u3002<\/p>\n

\u3000\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u304a\u3044\u3066\uff0c\u4f4e\u7dda\u91cf\u7167\u5c04\u3092\u7528\u3044\u308b\u4ee3\u8868\u7684\u6210\u7e3e\u306f\uff0c23.4Gy\u306e\u7167\u5c04\u3068\u30ed\u30e0\u30b9\u30c1\u30f3\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u306e\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u7528\u3044\u308b\u3082\u306e\u3067\uff0c\u7d0465%\u306e\uff15\u5e74\u751f\u5b58\u7387\u304c\u5f97\u3089\u308c\u305f\u3068\u306e\u5831\u544a\u304c\u3042\u308b\u3002(6)<\/sup>\u307e\u305f\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u306e\u4e2d\u3067\u3082\u7279\u306b\uff13\u6b73\u672a\u6e80\u306e\u75c7\u4f8b\u3067\u306f\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u5f85\u6a5f\u3059\u308b\u305f\u3081\u306b\u5316\u5b66\u7642\u6cd5\u304c\u5148\u884c\u3057\u3066\u884c\u308f\u308c\u308b\u3053\u3068\u304c\u4e16\u754c\u6a19\u6e96\u306b\u306a\u3063\u305f\u3002\u3057\u304b\u3057\u672c\u90a6\u3067\u306f\u30ed\u30e0\u30b9\u30c1\u30f3\u304c\u4f7f\u7528\u3067\u304d\u306a\u3044\u306e\u3067\u3053\u306e\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3092\u4f7f\u7528\u3067\u304d\u306a\u3044\u3057\uff0c\u7d4c\u53e3\u6295\u4e0e\u304c\u53ef\u80fd\u306a\u30ed\u30e0\u30b9\u30c1\u30f3\u3068\u9759\u6ce8\u306e\u30cb\u30e0\u30b9\u30c1\u30f3\u3092\u5dee\u3057\u66ff\u3048\u3066\u306e\u6cbb\u7642\u65b9\u6cd5\u3067\u540c\u69d8\u306e\u6210\u7e3e\u304c\u5f97\u3089\u308c\u308b\u3068\u3044\u3046\u4fdd\u8a3c\u306f\u306a\u3044\u3002<\/p>\n

\u3000\uff13\u6b73\u672a\u6e80\u306e\u4f4e\u5e74\u9f62\u5c64\u306b\u306f\u9020\u8840\u5e79\u7d30\u80de\u6551\u63f4\u3092\u4f75\u7528\u3059\u308b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306e\u6709\u7528\u6027\u304c\u671f\u5f85\u3055\u308c\u3066\u3044\u308b\u3002\u3057\u304b\u3057\u3053\u308c\u3082\u660e\u3089\u304b\u306a\u5229\u70b9\u3092\u8a3c\u660e\u3059\u308b\u306b\u306f\u81f3\u3063\u3066\u306f\u304a\u3089\u305a\uff0c\u5316\u5b66\u7642\u6cd5\u6b7b\u3092\u542b\u3081\u305f\u526f\u4f5c\u7528\u3068\u751f\u5b58\u671f\u9593\u5ef6\u9577\u306e\u5229\u5bb3\u304c\u53b3\u5bc6\u306b\u6bd4\u8f03\u691c\u8a0e\u3055\u308c\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u6642\u671f\u306b\u3042\u308b\u3002\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\uff0c\u30c1\u30aa\u30c6\u30fc\u30d1\uff0c\u30a8\u30c8\u30dd\u30b7\u30c9\u3092\u7528\u3044\u308b\u5730\u56fa\u3081\u7642\u6cd5\u309221\u4f8b\u306e\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u7528\u3044\u305f\u7814\u7a76\u7d50\u679c\u3067\u306f\uff0c\u7121\u5897\u60aa\uff13\u5e74\u751f\u5b58\u7387\u304c49%\u3067\u3042\u3063\u305f\u3068\u5831\u544a\u3055\u308c\u305f\u3002\u3053\u306e\u7814\u7a76\u306f\u9ac4\u6db2\u64ad\u7a2e\u3092\u4f34\u3046\u4f4e\u5e74\u9f62\u5150\u3092\u591a\u6570\u542b\u3093\u3067\u304a\u308a\u7167\u5c04\u3092\uff16\u6b73\u307e\u3067\u5f85\u6a5f\u3059\u308b\u65b9\u91dd\u3067\u3042\u308b\u306e\u3067\u671f\u5f85\u304c\u6301\u3066\u308b\u6210\u679c\u3068\u306f\u3044\u3048\u308b\u304c\u3001\u9006\u306b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3068\u3044\u3048\u3069\u3082\u5358\u72ec\u3067\u306f\u534a\u6570\u4ee5\u4e0a\u306b\u518d\u71c3\u304c\u751f\u3058\u308b\u3053\u3068\u3092\u793a\u3057\u3066\u3044\u308b\u3002 (7,8)<\/sup> 2005\u5e74\u521d\u982d\u6642\u70b9\u306b\u304a\u3044\u3066\uff0c\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306b\u3088\u3063\u3066\u6cbb\u7642\u3055\u308c\u305f\u60a3\u5150\u306e\uff15\u5e74\u751f\u5b58\u7387\u3042\u308b\u3044\u306f\u9577\u671f\u7684\u306a\u77e5\u7684\u6a5f\u80fd\u4e88\u5f8c\u306b\u95a2\u3057\u3066\u306e\u6210\u7e3e\u3092\u8a18\u8ff0\u3057\u305f\u5831\u544a\u306f\u306a\u3044\u3002<\/p>\n

\u3000\u9ac4\u82bd\u816b\u306e\u304a\u3088\u305d\uff14\u5206\u306e\uff11\u306b\u307f\u3089\u308c\u60aa\u6027\u578b\u3068\u5206\u985e\u3055\u308c\u308b\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b(large cell \/ anaplastic medulloblastoma)\u306f\u9ad8\u983b\u5ea6\u306bERBB2\u86cb\u767d\u3092\u767a\u73fe\u3059\u308b\u3002Gajjar\u3089\u306b\u3088\u308c\u3070\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u304b\u3064ERBB2\u9670\u6027\u306e26\u4f8b\u3067\u306e\uff15\u5e74\u751f\u5b58\u7387\u304c100%\u3067\u3042\u308a\uff0c\u4e00\u65b9ERBB2\u967d\u6027\u306e13\u4f8b\u3067\u306e\uff15\u5e74\u751f\u5b58\u7387\u304c54%(P=0.0001)\u3067\u3042\u3063\u305f\u3068\u3044\u3046\u3002\u3053\u306e\u4e8b\u5b9f\u304c\u691c\u8a3c\u3055\u308c\u308c\u3070\u8fd1\u3044\u5c06\u6765\uff0c\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306e\u6cbb\u7642\u5f37\u5ea6\u306fERBB2\u306e\u767a\u73fe\u306e\u6709\u7121\u306b\u3088\u308a\u5927\u304d\u304f\u5909\u5316\u3059\u308b\u306e\u3067\u3042\u308d\u3046\u3002(9)<\/sup>\u307e\u305f\u5316\u5b66\u7642\u6cd5\u611f\u53d7\u6027\u306e\u7570\u306a\u308a\u3092\u628a\u63e1\u3067\u304d\u308b\u304b\u3089\u5316\u5b66\u7642\u6cd5\u306b\u91cd\u70b9\u3092\u7f6e\u3044\u305f\u500b\u5225\u5316\u6cbb\u7642\u306e\u9053\u304c\u958b\u304b\u308c\u308b\u306e\u304b\u3082\u3057\u308c\u306a\u3044\u3002<\/p>\n

\u3000\u9ac4\u82bd\u816b\u306e\u518d\u767a\uff0f\u518d\u71c3\u306f\u9ac4\u6db2\u64ad\u7a2e\u306b\u3088\u3063\u3066\u751f\u3058\u308b\u3053\u3068\u304c\u591a\u3044\u306e\u3067\uff0c\u9ac4\u8154\u5185\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u6ce8\u5165\u306b\u3088\u308b\u5316\u5b66\u7642\u6cd5\u304c\u5e83\u304f\u8a66\u307f\u3089\u308c\u305f\u304c\u5931\u6557\u306b\u7d42\u308f\u3063\u305f\u3002\u64ad\u7a2e\u306e\u4e88\u9632\u3068\u8133\u810a\u9ac4\u7167\u5c04\u306e\u8ca0\u62c5\u3092\u8efd\u6e1b\u3059\u308b\u305f\u3081\u306b\u6c34\u6eb6\u6027\u30a2\u30eb\u30ad\u30eb\u5316\u5264\u30de\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\u306a\u3069\u3092\u7528\u3044\u308b\u9ac4\u8154\u5185\u5316\u5b66\u7642\u6cd5\u306e\u958b\u767a\u306f\u73fe\u5728\u3082\u7d9a\u3051\u3089\u308c\u3066\u3044\u308b\u304c\u7d50\u8ad6\u3092\u898b\u308b\u306b\u306f\u81f3\u3063\u3066\u3044\u306a\u3044\u3002(10)<\/sup><\/p>\n

3. \u4e73\u5e7c\u5150\u306e\u6bdb\u69d8\u7d30\u80de\u6027\u661f\u7d30\u80de\u816b<\/h2>\n

\u3000WHO\u3067\u306f\u6bdb\u69d8\u7d30\u80de\u6027\u661f\u7d30\u80de\u816b\u3092grade I\u3068\u3057\u3066\u898f\u5b9a\u3057\uff0c\u5168\u6458\u51fa\u3067\u304d\u308c\u3070\u4e88\u5f8c\u306e\u826f\u3044\u816b\u760d\u3068\u3057\u3066\u77e5\u3089\u308c\u308b\u3002\u601d\u6625\u671f\u306e\u5c0f\u8133\u661f\u7d30\u80de\u816b\u306e\u9577\u671f\u751f\u5b58\u7387\u306f95%\u3092\u8d8a\u3048\u795e\u7d4c\u8131\u843d\u75c7\u72b6\u3092\u6b8b\u3059\u3053\u3068\u3082\u5c11\u306a\u3044\u304c\uff0c\u4e73\u5e7c\u5150\u306e\u8996\u5e8a\u4e0b\u90e8\uff0f\u8996\u4ea4\u53c9\u306b\u767a\u751f\u3057\u305f\u6642\u306b\u306f\u6b7b\u4ea1\u7387\u304c\u9ad8\u304f\u304b\u3064\u751f\u5b58\u3057\u5f97\u305f\u3068\u3057\u3066\u3082\u793e\u4f1a\u7684\u306b\u81ea\u7acb\u3067\u304d\u308b\u5150\u306f\u307b\u3068\u3093\u3069\u3044\u306a\u3044\u3002<\/p>\n

\u3000\u4e73\u5e7c\u5150\u306e\u8996\u5e8a\u4e0b\u90e8\u3068\u8996\u4ea4\u53c9\u306b\u767a\u751f\u3059\u308b\u3082\u306e\u306e\u591a\u304f\u306f\u6bdb\u69d8\u985e\u7c98\u6db2\u6027\u661f\u7d30\u80de\u816b(pilomyxoid astrocytoma)\u3067\u3042\u308a\uff0c\u6982\u3057\u3066\u5897\u5927\u901f\u5ea6\u304c\u65e9\u304f\u9ac4\u8154\u5185\u64ad\u7a2e\u3059\u308b\u3053\u3068\u3082\u3042\u308b\u3002\u307e\u305f\u3053\u308c\u306f\u8996\u5e8a\u4e0b\u90e8\u3068\u4e21\u5074\u306e\u8996\u8def\u3078\u6d78\u6f64\u3059\u308b\u305f\u3081\u306b\u6458\u51fa\u304c\u56f0\u96e3\u3067\u3042\u308a\uff0c\u6642\u3068\u3057\u3066\u306f\u8996\u4ea4\u53c9\u306b\u9650\u5c40\u3059\u308b\u305f\u3081\u306b\u751f\u691c\u8853\u3055\u3048\u5371\u967a\u306a\u75c7\u4f8b\u3082\u3042\u308b\u3002\u653e\u5c04\u7dda\u7167\u5c04\u304c\u6709\u52b9\u3067\u3042\u308b\u304c\uff0c\u3053\u306e\u5e74\u9f62\u5c64\u3068\u90e8\u4f4d\u3067\u306e\u91cd\u7be4\u306a\u653e\u5c04\u7dda\u8133\u969c\u5bb3\u3092\u9451\u307f\u308c\u3070\u3053\u308c\u3082\u9078\u629e\u3057\u96e3\u3044\u3002\u3053\u306e\u3088\u3046\u306a\u72b6\u6cc1\u304b\u3089\u8fd1\u5e74\uff0c\u3053\u306e\u816b\u760d\u306b\u5bfe\u3057\u3066\u306f\u30d7\u30e9\u30c1\u30ca\u88fd\u5264\uff08\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u3082\u3057\u304f\u306f\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\uff09\u3068\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u3092\u7528\u3044\u305f\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u304c\u7b2c\u4e00\u9078\u629e\u80a2\u3068\u3057\u3066\u7528\u3044\u3089\u308c\u308b\u3002(11) <\/sup><\/p>\n

\u3000\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u3092\u7528\u3044\u308b\u5834\u5408\u306b\u306f\u7b2c\uff11\u65e5\u76ee\u304b\u3089\uff15\u65e5\u76ee\u307e\u3067\u306e\u9023\u7d9a\u6295\u4e0e\u3068\u3057\u3066\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u3092\u7b2c\uff11\uff0c\uff18\uff0c15\u65e5\u306b\u4f75\u7528\uff0c\uff11\u30b3\u30fc\u30b9\u3092\uff14\u9031\u9593\u6bce\u3068\u3057\u3066\u3053\u308c\u3092\u53cd\u5fa9\u3059\u308b\u3002\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u306e\u70b9\u6ef4\u9759\u6ce8\u306e\u65b9\u304c\u4e00\u822c\u7684\u3067\u306f\u3042\u308a\u307e\u305f\u6295\u4e0e\u306e\u65b9\u6cd5\u304c\u5bb9\u6613\u3067\u306f\u3042\u308b\u304c\u3001\u8457\u8005\u306f\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u306e\uff15\u65e5\u9593\u6301\u7d9a\u6295\u4e0e\u3092\u7528\u3044\u3066\u3044\u308b\u3002\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u3088\u308a\u3082\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u306e\u65b9\u304c\u9577\u6642\u9593\u816b\u760d\u306b\u5bfe\u3059\u308b\u6709\u52b9\u8840\u4e2d\u6fc3\u5ea6\u304c\u4fdd\u3061\u5f97\u308b\u3068\u8003\u3048\u3089\u308c\u308b\u304b\u3089\u3067\u3042\u308b\u3002\u30b0\u30ea\u30aa\u30fc\u30de\u306e\u4e2d\u3067\u3082\u6bdb\u69d8\u7d30\u80de\u6027\u661f\u7d30\u80de\u816b\u306f\u7d30\u80de\u5468\u671f\u304c\u9045\u3044\u56fa\u5f62\u816b\u760d\u3067\u3042\u308b\u306e\u3067\uff0c\u7406\u8ad6\u7684\u306b\u306f\u9ad8\u3044\u8840\u4e2d\u6fc3\u5ea6\u3092\u77ed\u6642\u9593\u66b4\u9732\u3059\u308b\u6295\u4e0e\u65b9\u6cd5\u3088\u308a\u6301\u7d9a\u6295\u4e0e\u304c\u512a\u308b\u3002\u3053\u308c\u306f\u6700\u8fd1\uff0c\u30ed\u30e0\u30b9\u30c1\u30f3\u3001\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\uff0c\u30d7\u30ed\u30ab\u30eb\u30d0\u30b8\u30f3\u306a\u3069\u30b0\u30ea\u30aa\u30fc\u30de\u5168\u822c\u306b\u7d4c\u53e3\u6297\u816b\u760d\u85ac\u304c\u591a\u7528\u3055\u308c\u308b\u3053\u3068\u306b\u3082\u4e00\u81f4\u3059\u308b\u8003\u3048\u65b9\u3067\u3042\u308b\u3002<\/p>\n

\u3000\u3053\u306e\u816b\u760d\u306b\u304a\u3044\u3066\u306f\u6570\u30f6\u6708\u304b\u3051\u3066\u5316\u5b66\u7642\u6cd5\u3092\u7d99\u7d9a\u3059\u308b\u3053\u3068\u306b\u3088\u308a\u5f90\u3005\u306b\u816b\u760d\u7e2e\u5c0f\u52b9\u679c\u304c\u660e\u3089\u304b\u3068\u306a\u308b\u306e\u3067\uff0c\uff11\u30b3\u30fc\u30b9\u3084\uff12\u30b3\u30fc\u30b9\u306e\u5316\u5b66\u7642\u6cd5\u3067\u9855\u8457\u306a\u816b\u760d\u7e2e\u5c0f\u304c\u306a\u3044\u304b\u3089\u7121\u52b9\u3067\u3042\u308b\u3068\u5224\u65ad\u3057\u3066\u306f\u3044\u3051\u306a\u3044\u3002\u3053\u306e\u89b3\u70b9\u304b\u3089\u306e\u5316\u5b66\u7642\u6cd5\u306e\u594f\u52b9\u7387\u306f\u9ad8\u304f\uff0c\u5316\u5b66\u7642\u6cd5\u306e\u958b\u59cb\u3068\u3068\u3082\u306b\u9593\u8133\u75c7\u5019\u7fa4\u306e\u6539\u5584\u3084\u9032\u884c\u6027\u8996\u529b\u8996\u91ce\u969c\u5bb3\u306e\u505c\u6b62\u304c\u5f97\u3089\u308c\u308b\u3053\u3068\u304c\u591a\u3044\u3002\u8457\u8005\u306f\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u3068\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u306e\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u3092\u307e\u305a\uff16\u30b3\u30fc\u30b9\u884c\u3063\u3066\u7d4c\u904e\u3092\u307f\u308b\u3053\u3068\u306b\u3057\u3066\u3044\u308b\u3002\u518d\u71c3\u6642\u306b\u306f\uff0c\u5316\u5b66\u7642\u6cd5\u306e\u518d\u958b\u304b\u90e8\u5206\u6458\u51fa\u304b\u534a\u5b9a\u4f4d\u7684\u5206\u5272\u7167\u5c04\u304b\u306e\u9078\u629e\u3068\u306a\u308b\u304c\u816b\u760d\u306e\u6b8b\u5b58\u90e8\u4f4d\u3068\u5e74\u9f62\u3092\u8003\u616e\u3057\u3066\u6c7a\u5b9a\u3059\u308b\u5fc5\u8981\u304c\u751f\u3058\u308b\u3057\uff0c\u9006\u306b\u5e74\u9577\u5150\u306b\u306a\u308c\u3070\u81ea\u7136\u7de9\u89e3\u3057\u3066\u6cbb\u7652\u306b\u81f3\u308b\u75c7\u4f8b\u3082\u3042\u308b\u306e\u3067\uff0c\u5316\u5b66\u7642\u6cd5\u5f8c\u306e\u6b8b\u5b58\u816b\u760d\u306e\u89b3\u5bdf\u306b\u306f\u614e\u91cd\u306a\u5224\u65ad\u3092\u8981\u3059\u308b\u3002<\/p>\n

4. \u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u816b\u760d<\/h2>\n

\u3000\u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u7d30\u80de\u306f\u661f\u7d30\u80de\u7cfb\u816b\u760d\u3088\u308a\u4e88\u5f8c\u304c\u3088\u304f\uff0c\u5c0f\u5150\u306b\u304a\u3044\u3066\u9ad8\u5206\u5316\u578b\u306e\u4e4f\u7a81\u8d77\u81a0\u816b\u3092\u5168\u6458\u51fa\u3067\u304d\u305f\u5834\u5408\u306b\u306f\u88dc\u52a9\u7642\u6cd5\u306f\u4e0d\u8981\u3067\u3042\u308b\u3002\u90e8\u5206\u6458\u51fa\u3067\u3042\u3063\u3066\u3082\u307e\u305a\u306f\u7d4c\u904e\u89b3\u5bdf\u3057\u305f\u307b\u3046\u304c\u3088\u3044\u3057\uff0c\u6210\u4eba\u3068\u7570\u306a\u308a\u60aa\u6027\u578b\u306f\u983b\u5ea6\u304c\u4f4e\u3044\u3002\u307e\u305f\u653e\u5c04\u7dda\u6cbb\u7642\u3078\u306e\u611f\u53d7\u6027\u3082\u9ad8\u3044\u816b\u760d\u578b\u3067\u3042\u308b\u306e\u3067\uff0c\u7121\u6761\u4ef6\u306b\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u308b\u306e\u3067\u306f\u306a\u304f\u500b\u3005\u306e\u75c7\u4f8b\u3067\u5316\u5b66\u7642\u6cd5\u304c\u5fc5\u8981\u304b\u5426\u304b\u306e\u5224\u65ad\u3092\u307e\u305a\u884c\u3046\u5fc5\u8981\u304c\u3042\u308b\u3002\u3057\u304b\u3057grade 3\u306e\u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u816b\u760d\u306b\u306f\u4e00\u822c\u7684\u306b\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u305f\u65b9\u304c\u3088\u3044\u3068\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n

\u3000\u7b2c\uff11\u67d3\u8272\u4f53\u77ed\u8155\u306b\u6b20\u5931\u3092\u8a8d\u3081\u308b\u9000\u5f62\u6210\u6027\u4e4f\u7a81\u8d77\u81a0\u816b(grade 3)\u3068\u9000\u5f62\u6210\u6027\u4e4f\u7a81\u8d77\u661f\u7d30\u80de\u816b(grade 3)\u306b\u5bfe\u3059\u308bPCV\uff08\u30d7\u30ed\u30ab\u30eb\u30d0\u30b8\u30f3\uff0c\u30ed\u30e0\u30b9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\uff09\u5316\u5b66\u7642\u6cd5\u306e\u6709\u52b9\u6027\u306f\u5e83\u304f\u77e5\u3089\u308c\u308b\u306b\u81f3\u3063\u305f\u3002\u3053\u306e\u5316\u5b66\u7642\u6cd5\u306f\u795e\u7d4c\u81a0\u816b\u306e\u4e2d\u3067\u306f\u552f\u4e00\u306e\u6a19\u6e96\u7684\u6cbb\u7642\u3068\u3044\u3048\u308b\u3082\u306e\u3067\u3042\u308a\uff0cgrade 3\u306e\u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u816b\u760d\u306b\u5bfe\u3057\u3066\u306f60%\u5f37\u306e\u594f\u52b9\u7387\u304c\u3042\u308b\u3068\u3055\u308c\u308b\u3002\u3057\u304b\u3057\u306a\u304c\u3089\u7de9\u89e3\u5f8c\u306e\u518d\u71c3\u7387\u306f\u9ad8\u304fPCV\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u306e\u6cbb\u7652\u3078\u306e\u671f\u5f85\u306f\u4f4e\u3044\u3002<\/p>\n

\u3000\u307e\u305f\u6700\u8fd1\u3067\u306fgrade 2\u306e\u4e4f\u7a81\u8d77\u81a0\u816b\u3068\u4e4f\u7a81\u8d77\u661f\u7d30\u80de\u816b\u306b\u3082PCV\u7642\u6cd5\u306f\u6709\u52b9\u3067\u3042\u308a\uff0c\u304b\u3064\u7b2c\uff11\u67d3\u8272\u4f53\u77ed\u8155\u3042\u308b\u3044\u306f\u7b2c19\u67d3\u8272\u4f53\u9577\u8155\u306e\u6b20\u5931\u304c\u306a\u304f\u3068\u3082\u52b9\u679c\u304c\u8a8d\u3081\u3089\u308c\u305f\u3068\u3044\u3046\u5831\u544a\u3082\u73fe\u308c\u305f\u3002(12)<\/sup>\u7279\u306b\u5927\u304d\u306a\u4e4f\u7a81\u8d77\u795e\u7d4c\u81a0\u816b\u306b\u304a\u3044\u3066T2\u5f37\u8abf\u753b\u50cf\u9ad8\u4fe1\u53f7\u9818\u57df\u306e\u7e2e\u5c0f\u3068\u75c7\u72b6\u306e\u6539\u5584\u304c\u3042\u308a\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u306a\u304f\u3057\u3066\u3082\u5316\u5b66\u7642\u6cd5\u5f8c\u518d\u71c3\u307e\u3067\u306e\u4e2d\u592e\u671f\u9593\u306f24\u30f6\u6708\u3092\u8d8a\u3048\u305f\u3068\u3044\u3046\u3002<\/p>\n

\u3000\u65e5\u672c\u3067\u306f\u30ed\u30e0\u30b9\u30c1\u30f3\u304c\u4f7f\u7528\u3067\u304d\u306a\u3044\u306e\u3067\u4e4f\u7a81\u8d77\u81a0\u816b\u306b\u5bfe\u3057\u3066PAV\uff08\u30d7\u30ed\u30ab\u30eb\u30d0\u30b8\u30f3\uff0c\u30cb\u30e0\u30b9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\uff09\u7642\u6cd5\u304c2005\u5e74\u306b\u627f\u8a8d\u3055\u308c\u308b\u4e88\u5b9a\u3067\u3042\u308b\u3002\u3057\u304b\u3057\u9ac4\u82bd\u816b\u3068\u540c\u69d8\u306b\u30ed\u30e0\u30b9\u30c1\u30f3\u3068\u30cb\u30e0\u30b9\u30c1\u30f3\u3092\u5dee\u3057\u66ff\u3048\u3089\u308c\u308b\u3068\u3044\u3046\u81e8\u5e8a\u7684\u306a\u691c\u8a3c\u306f\u306a\u3044\u3002\u3055\u3089\u306b\u6210\u4eba\u4f8b\u3067\u306f\u7b2c\uff11\u67d3\u8272\u4f53\u77ed\u8155\u6b20\u5931\u3092\u8a8d\u3081\u308b\u4e4f\u7a81\u8d77\u81a0\u816b\u3068\u4e4f\u7a81\u8d77\u661f\u7d30\u80de\u816b(grade 2)\u306b\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u975e\u5e38\u306b\u9ad8\u3044\u6709\u52b9\u6027\u304c\u5831\u544a\u3055\u308c\uff0cPCV\u5316\u5b66\u7642\u6cd5\u306b\u4ee3\u7528\u3057\u5f97\u308b\u85ac\u5264\u3067\u3042\u308b\u3068\u3055\u308c\u3066\u3044\u308b\u3002(13)<\/sup>\u5c0f\u5150\u306b\u304a\u3044\u3066\u3082\u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u816b\u760d\u306f\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306b\u53cd\u5fdc\u3059\u308b\u795e\u7d4c\u81a0\u816b\u3067\u3042\u308b\u306e\u304b\u3082\u3057\u308c\u306a\u3044\u3002<\/p>\n

5. \u60aa\u6027\u795e\u7d4c\u81a0\u816b\u3068\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9<\/h2>\n

\u3000\u4e4f\u7a81\u8d77\u81a0\u816b\u7cfb\u816b\u760d\u306b\u5bfe\u3059\u308bPCV\u7642\u6cd5\u3092\u9664\u3051\u3070\uff0cgrade 3-4\u306b\u76f8\u5f53\u3059\u308b\u60aa\u6027\u795e\u7d4c\u81a0\u816b\u306b\u5bfe\u3059\u308b\u6709\u52b9\u306a\u5316\u5b66\u7642\u6cd5\u306f\u307b\u3068\u3093\u3069\u306a\u3044\u3068\u8a00\u3063\u3066\u3082\u904e\u8a00\u3067\u306f\u306a\u304b\u3063\u305f\u3002\u8fd1\u5e74\u958b\u767a\u3055\u308c\u305f\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306f\u7b2c\uff12\u4e16\u4ee3\u306e\u7d4c\u53e3\u30a2\u30eb\u30ad\u30eb\u5316\u5264\u3067\u3042\u308a\uff0c\u4e4f\u7a81\u8d77\u81a0\u816b\u306e\u307f\u306a\u3089\u305a\u6210\u4eba\u306e\u9000\u5f62\u6210\u6027\u661f\u7d30\u80de\u816b\u3068\u81a0\u82bd\u816b\u306b\u5bfe\u3057\u3066\u6709\u52b9\u6027\u304c\u8a8d\u3081\u3089\u308c\uff0c\u5c0f\u5150\u306e\u60aa\u6027\u795e\u7d4c\u81a0\u816b\u306e\u6cbb\u7642\u306b\u3082\u671f\u5f85\u304c\u6301\u305f\u308c\u305f\u3002<\/p>\n

\u3000\u5f93\u6765\u6700\u3082\u591a\u7528\u3055\u308c\u305f\u30cb\u30c8\u30ed\u30bd\u30a6\u30ec\u30a2\u5264\u306b\u5bfe\u3059\u308b\u60aa\u6027\u795e\u7d4c\u81a0\u816b\u306e\u85ac\u5264\u62b5\u6297\u6027\u306fDNA repair protein 06 methylguanine DNA methyl transferase (MGMT)\u306e\u767a\u73fe\u306e\u7a0b\u5ea6\u306b\u4f9d\u5b58\u3059\u308b\u3068\u3055\u308c\u308b\u304c\uff0c\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306b\u304a\u3044\u3066\u3082\u3053\u308c\u306f\u540c\u69d8\u3067\u3042\u308b\u3002<\/p>\n

\u3000\u5c0f\u5150\u306e\u6cbb\u7642\u62b5\u6297\u6027high-grade glioma\u3068\u8133\u5e79\u90e8\u795e\u7d4c\u81a0\u816b\u306b\u5bfe\u3059\u308b\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u7b2c\uff12\u76f8\u8a66\u9a13\u304c\u6b27\u5dde\u3067\u884c\u308f\u308c\u305f\u3002200mg\/m2<\/sup>\u3092\uff15\u65e5\u9593\u9023\u7d9a\u6295\u4e0e\u3057\u305f\u3082\u306e\u3067\u3042\u3063\u305f\u304c\uff0c\u767b\u9332\u3055\u308c\u305f55\u4f8b\u306b\u304a\u3044\u3066\u306e\u5ba2\u89b3\u7684\u306a\u594f\u52b9\u7387\u306f\u6975\u3081\u3066\u4f4e\u304f\u6709\u52b9\u6027\u306f\u8a8d\u3081\u3089\u308c\u306a\u3044\u3068\u7d50\u8ad6\u3055\u308c\u305f\u3002(14)<\/sup> \u3055\u3089\u306b\u521d\u767a\u4f8b\u306e\u3073\u307e\u3093\u6027\u8133\u5e79\u90e8\u81a0\u816b29\u4f8b\uff08\u5e74\u9f62\u4e2d\u592e\u50246\u6b73\uff09\u306b\u5bfe\u3057\u653e\u5c04\u7dda\u6cbb\u7642\u5f8c\u306b\u540c\u69d8\u306a\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u6295\u4e0e\u3092\u884c\u3063\u305f\u5831\u544a\u3067\u306f\uff0c\u751f\u5b58\u671f\u9593\u4e2d\u592e\u502412\u30f6\u6708\u3067\u5168\u4f8b\u304c\u6b7b\u4ea1\u3057\u8133\u5e79\u90e8\u795e\u7d4c\u81a0\u816b\u306e\u4e88\u5f8c\u3092\u6539\u5584\u3059\u308b\u3053\u3068\u306f\u3067\u304d\u306a\u3044\u3068\u3055\u308c\u305f\u3002(15)<\/sup><\/p>\n

\u3000<\/sup>\u73fe\u5728\uff0c\u6210\u4eba\u3068\u540c\u69d8\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u671f\u9593\u4e2d\u306b75-90mg\/m2<\/sup>\u309242\u65e5\u9593\u9023\u7d9a\u6295\u4e0e\u3057\u3066\u7528\u3044\u308b\u65b9\u6cd5\u304c\u691c\u8a0e\u3055\u308c\u3066\u3044\u308b\u304c\u660e\u3089\u304b\u306a\u6709\u52b9\u6027\u3092\u793a\u5506\u3059\u308b\u5831\u544a\u306f\u3044\u307e\u3060\u898b\u3089\u308c\u306a\u3044\u3002\u672c\u90a6\u3067\u3082\u8fd1\u3044\u5c06\u6765\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u4fdd\u967a\u8a3a\u7642\u304c\u8a8d\u3081\u3089\u308c\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u304c\uff0c\u5c0f\u5150\u795e\u7d4c\u81a0\u816b\u306b\u5bfe\u3059\u308b\u6709\u52b9\u6027\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u306a\u304f\u307e\u305f\u6b27\u7c73\u306e\u81e8\u5e8a\u8a66\u9a13\u3067\u306f\u671f\u5f85\u3055\u308c\u3066\u3044\u305f\u3088\u3046\u306a\u52b9\u679c\u304c\u5426\u5b9a\u3055\u308c\u3064\u3064\u3042\u308b\u50be\u5411\u306b\u7559\u610f\u3059\u308b\u5fc5\u8981\u304c\u3042\u308b\u3002<\/p>\n

6. \u6587\u732e<\/h2>\n
    \n
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  7. Chi SN, Gardner SL, Levy AS, et al: Feasibility and response to induction chemotherapy intensified with high-dose methotrexate for young children with newly diagnosed high-risk disseminated medulloblastoma. J Clin Oncol 22:4881-4887, 2004<\/li>\n
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  11. \u6fa4\u6751\u3000\u8c4a\uff0c\u52a0\u85e4\u3000\u529f\uff0c\u9edb\u3000\u8c6a\u606d\u307b\u304b\uff1a\u4e73\u5e7c\u5150 hypothalamic\/chiasmatic pilocytic astrocytoma \u306b\u5bfe\u3059\u308b\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u30fb\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u306e\u52b9\u679c\u3000\u5c0f\u5150\u304c\u3093 39: 187-191, 2002<\/li>\n
  12. Stege EM, Kros JM, de Bruin HG, et al: Successful treatment of low-grade oligodendroglial tumors with a chemotherapy regimen of procarbazine, lomustine, and vincristine. Cancer 103:802-809, 2005<\/li>\n
  13. Hoang-Xuan K et al: Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions. J Clin Oncol 22:3133-3138, 2004<\/li>\n
  14. Lashford LS, Thiesse P, Jouvet A, et al: Temozolomide in malignant gliomas of childhood: a United Kingdom Children’s Cancer Study Group and French Society for Pediatric Oncology Intergroup Study. J Clin Oncol 20:4684-4691, 2002<\/li>\n
  15. Broniscer A, Iacono L, Chintagumpala M, et al: Role of temozolomide after radiotherapy for newly diagnosed diffuse brainstem glioma in children: results of a multiinstitutional study (SJHG-98). Cancer 103:133-139, 2005<\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    \u5c0f\u5150\u30b0\u30ea\u30aa\u30fc\u30de\u306e\u5316\u5b66\u7642\u6cd5 \u65b0\u3057\u3044\u60c5\u5831\uff1a\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u795e\u7d4c\u82bd\u7d30\u80de\u816b\u3078\u306e\u52b9\u679c\u306b\u3064\u3044\u3066 \u8133\u816b\u760d\u3067\u306f\u306a\u3044\u5c0f\u5150\u60aa\u6027\u816b\u760d\u306b\u5bfe\u3059\u308b\u52b9\u679c\u3092\u898b\u305f\u3082\u306e\u3067\u3059\u3002 Rubie H, et al: Pahse II study of temozo […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-181","post","type-post","status-publish","format-standard","hentry","category-pediattumor"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/posts\/181","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/comments?post=181"}],"version-history":[{"count":3,"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/posts\/181\/revisions"}],"predecessor-version":[{"id":1694,"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/posts\/181\/revisions\/1694"}],"wp:attachment":[{"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/media?parent=181"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/categories?post=181"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/plaza.umin.ac.jp\/sawamura\/wp-json\/wp\/v2\/tags?post=181"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}