{"id":187,"date":"2012-04-19T02:41:00","date_gmt":"2012-04-18T17:41:00","guid":{"rendered":"\/sawamura\/wp\/?p=187"},"modified":"2025-01-31T16:44:10","modified_gmt":"2025-01-31T07:44:10","slug":"medullo","status":"publish","type":"post","link":"https:\/\/plaza.umin.ac.jp\/sawamura\/pediattumor\/medullo\/","title":{"rendered":"\u9ac4\u82bd\u816b medulloblastoma"},"content":{"rendered":"<div class=\"setumei\">\n<ul>\n<li>\u65e5\u672c\u3067\u306e\u9ac4\u82bd\u816b\u306e\u5e74\u9593\u767a\u751f\u4f8b\u306f50\u4f8b\u304f\u3089\u3044\u3067\u3059\u304b\u3089\u73cd\u3057\u3044\u3082\u306e\u3067\u3059<\/li>\n<li>\u51fa\u751f\u6570\u306e\u6e1b\u5c11\u306b\u6bd4\u4f8b\u3057\u3066\uff0c\u767a\u751f\u6570\u304c\u6e1b\u5c11\u3057\u3066\u3044\u307e\u3059<\/li>\n<li>\u4e73\u5150\u304b\u3089\u5e7c\u3044<span style=\"color: #000080;\"><strong>\u5b50\u4f9b\u305f\u3061\uff08\u4e2d\u592e\u5024\uff15\u6b73\uff09\u306e\u5c0f\u8133<\/strong><\/span>\u306b\u3067\u304d\u307e\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>\u60aa\u6027\u816b\u760d<\/strong><\/span>\u3067\u3059\u304c\uff0c\u6cbb\u308b\u898b\u8fbc\u307f\u306f\u5341\u5206\u3042\u308a\u307e\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>\u982d\u75db\u3084\u5614\u5410\uff0c\u6b69\u884c\u6642\u306e\u3075\u3089\u3064\u304d<\/strong><\/span>\u304c\u521d\u767a\u75c7\u72b6\u3067\u3059<\/li>\n<li><strong><span style=\"color: #000080;\">\u3068\u3066\u3082\u65e9\u304f\u5927\u304d\u304f\u306a\u308a\u6025\u306b\u75c7\u72b6\u304c\u9032\u884c\u3059\u308b<\/span><\/strong>\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>\u9ac4\u6db2\u306e\u51fa\u53e3\uff08\u7b2c\uff14\u8133\u5ba4\uff09\u3092\u3075\u3055\u3050\u305f\u3081\u306b\u982d\u306e\u4e2d\u306b\u6c34\u304c\u305f\u307e\u3063\u3066\u3057\u307e\u3044\u307e\u3059<\/li>\n<li><a href=\"\/sawamura\/pediattumor\/gliomachemo-2\/\"><strong><span style=\"color: #000080;\">\u6c34\u982d\u75c7<\/span><\/strong><\/a>\u3068\u3044\u3046\u306e\u3067\u3059\u304c\uff0c\u982d\u75db\u304c\u6025\u6fc0\u306b\u60aa\u5316\u3057\u3066\u5614\u5410\u3057\u307e\u3059<\/li>\n<li>\u3050\u3063\u305f\u308a\u3057\u3066\u610f\u8b58\u304c\u60aa\u304f\u306a\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>\u305d\u306e\u305f\u3081\u306b<strong><span style=\"color: #000080;\">\u7dca\u6025\u5165\u9662\u3057\u305f\u308a\uff0c\u81e8\u6642\u624b\u8853<\/span><\/strong>\u3092\u53d7\u3051\u308b\u5b50\u3069\u3082\u304c\u591a\u3044\u3067\u3059<\/li>\n<li>\u5c0f\u8133\u306b\u3067\u304d\u308b\u306e\u3067\u3059\u304c\uff0c\u9ac4\u6db2\u306b\u306e\u3063\u3066<span style=\"color: #000080;\"><strong>\u8133\u3068\u304b\u810a\u9ac4\u306b\u8ee2\u79fb\uff08\u64ad\u7a2e \u306f\u3057\u3085\uff09<\/strong><\/span>\u3057\u307e\u3059<\/li>\n<li>\u9ac4\u82bd\u816b\u306e\u5b50\u3069\u3082\u305f\u3061\u306e<span style=\"color: #000080;\"><strong>\u6b7b\u4ea1\u539f\u56e0\u306f\u64ad\u7a2e<\/strong><\/span>\u3067\u3059<\/li>\n<li>\u3067\u3059\u304b\u3089\uff0c<strong><span style=\"color: #ff0000;\">\u6cbb\u7642\u306e\u4e3b\u76ee\u7684\u306f\u64ad\u7a2e\u3092\u9632\u3050<\/span><\/strong>\u3053\u3068\u306b\u306a\u308a\u307e\u3059<\/li>\n<li>\u64ad\u7a2e\u8ee2\u79fb\u306e\u3042\u308a\u306a\u3057\u3067\uff0c\u75c5\u671f\u00a0<span style=\"color: #000080;\"><strong>M0, M\uff13<\/strong><\/span>\u306b\u5206\u985e\u3057\u307e\u3059<\/li>\n<li>\u624b\u8853\u3057\u3066\u304b\u3089\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3068\u5316\u5b66\u7642\u6cd5\uff08\u5236\u304c\u3093\u5264\uff09\u3092\u3057\u307e\u3059<\/li>\n<li>\u624b\u8853\u3067\u6492\u304d\u6563\u3089\u3057\u305f\u816b\u760d\u7d30\u80de\u304b\u3089\u306e\u8ee2\u79fb\u3092<span style=\"color: #000080;\"><strong>\u624b\u8853\u8a98\u767a\u64ad\u7a2e<\/strong><\/span>\u3068\u8a00\u3044\u307e\u3059<\/li>\n<li>\u8853\u5f8c\u64ad\u7a2e\u3092\u9632\u3050\u305f\u3081\u306b\uff0c<span style=\"color: #ff0000;\"><strong>\u624b\u8853\u5f8c\u306e\u5316\u5b66\u7642\u6cd5\u3068\u653e\u5c04\u7dda\u6cbb\u7642\u306f3\u9031\u9593\u4ee5\u5185\u306b\u30b9\u30bf\u30fc\u30c8<\/strong><\/span>\u3057\u307e\u3059<\/li>\n<li>\u5168\u3066\u306e\u75c7\u4f8b\u3092\u5bfe\u8c61\u306b\u3059\u308c\u3070\u73fe\u5728\u3067\u3082\u6b7b\u4ea1\u7387\u306f30-40%\u304f\u3089\u3044\u3067\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>\uff13\u6b73\u672a\u6e80\u306e\u60a3\u5150\u306e\u6b7b\u4ea1\u7387\u306f\u9ad8\u3044<\/strong><\/span>\u3067\u3059<br \/>\n<hr \/>\n<h4><span style=\"color: #000080;\"><strong>\u75c5\u7406\u8a3a\u65ad\u306f\uff0c2021\u5e74\u306bWHO\u306e4\u3064\u306e\u65b0\u5206\u985e\u304c\u3067\u307e\u3057\u305f\u304c\uff0c\u4e16\u754c\u4e2d\u3067\u5927\u6df7\u4e71\u4e2d<\/strong><\/span><\/h4>\n<\/li>\n<\/ul>\n<\/div>\n<ul>\n<li><span style=\"color: #000080;\"><strong>WNT activated<br \/>\n<span style=\"color: #333333; font-weight: normal;\"><strong><span style=\"color: #ff0000;\">\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u6d3b\u6027\u578b<\/span><\/strong>\uff0c\u514d\u75ab\u7d44\u7e54\u67d3\u8272\u3067\u00a0<\/span><span style=\"font-weight: normal;\">DKK1 (WNT)<\/span><br \/>\n<\/strong><\/span><\/li>\n<li><strong><span style=\"color: #000080;\">SHH activated and\u00a0<em>TP53<\/em>\u00a0wildtype<br \/>\n<\/span><\/strong><span style=\"color: #000080;\"><span style=\"color: #ff0000;\"><span style=\"color: #333333;\"><span style=\"color: #ff0000;\"><strong>\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u6d3b\u6027\u578b<\/strong><\/span>\uff0c<em>TP53<\/em>\u907a\u4f1d\u5b50\u91ce\u751f\u578b<\/span><\/span><\/span><strong><span style=\"color: #000080;\"><br \/>\n<\/span><\/strong><\/li>\n<li><strong><span style=\"color: #000080;\">SHH activated and\u00a0<em>TP53<\/em> mutant<br \/>\n<\/span><span style=\"color: #ff0000;\">\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u6d3b\u6027\u578b\uff0c<em>TP53<\/em>\u907a\u4f1d\u5b50\u5909\u7570\u578b<\/span><span style=\"color: #000080;\"><br \/>\n<\/span><\/strong><\/li>\n<li><span style=\"color: #000080;\"><strong>non-WNT\/non-SHH<br \/>\n<\/strong><\/span><span style=\"color: #ff0000;\"><strong>\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u3067\u3082\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u3067\u3082\u306a\u3044\u3082\u306e<\/strong><\/span><\/li>\n<\/ul>\n<div class=\"setumei\">\n<hr \/>\n<p>\u81e8\u5e8a\u77e5\u898b\u3068\u81e8\u5e8a\u533b\u306e\u7d4c\u9a13\u5024\u304c\u751f\u7269\u5b66\u306e\u9032\u6b69\u3068\u6df7\u4e71\u306b\u8ffd\u3044\u3064\u3044\u3066\u3044\u307e\u305b\u3093<\/p>\n<ul>\n<li>\u6cbb\u7642\u6cd5\u306f\uff0c\u81e8\u5e8a\u6240\u898b\u30fb\u7d44\u7e54\u8a3a\u65ad\u30fb\u5206\u5b50\u8a3a\u65ad\u3092\u7d44\u307f\u5408\u308f\u305b\u3066\uff0c<span style=\"color: #ff0000;\"><strong>\u4f4e\u30ea\u30b9\u30af\u7fa4\uff0c\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4<\/strong><\/span>\u306e\uff13\u3064\u306b\u5206\u3051\u3066\u9078\u629e\u3057\u307e\u3059<\/li>\n<li>\u4f4e\u30ea\u30b9\u30af\u7fa4\u306f10%\uff0c\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306f50-60%\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u306f30-40%\u304f\u3089\u3044\u306e\u983b\u5ea6\u3067\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u306e\u4e2d\u3067\u3082DNMB\u30bf\u30a4\u30d7\u3067\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u3057\u306a\u304f\u3066\u3082\u6cbb\u308b<\/strong><\/span>\u3053\u3068\u304c\u308f\u304b\u3063\u3066\u304d\u307e\u3057\u305f<\/li>\n<li>\u3067\u3082\u305d\u306e\u907a\u4f1d\u5b50\u8a3a\u65ad\u3092\u307e\u3063\u3066\u6570\u9031\u9593\u3082\u6cbb\u7642\u5f85\u6a5f\u3057\u3066\u3044\u308b\u3068\uff0c\u4ed6\u306e\u30bf\u30a4\u30d7\u3067\u306f\u81f4\u547d\u7684\u306a\u816b\u760d\u5897\u60aa\u304c\u751f\u3058\u3066\u3057\u307e\u3046\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>\u9006\u306b\uff0c<strong><span style=\"color: #000080;\">non-WNT\/non-SHH\uff08\u30b0\u30eb\u30fc\u30d73\uff09<\/span><\/strong>\u306f\uff0c<span style=\"color: #000080;\"><strong>\u9032\u884c\u304c\u65e9\u304f\u9ad8\u7387\u306b\u9ac4\u6db2\u64ad\u7a2e\u3092\u3057\u307e\u3059<\/strong><\/span>\u304b\u3089\uff0c\u6b7b\u4ea1\u5272\u5408\u304c\u6700\u3082\u9ad8\u3044\u3067\u3059<\/li>\n<li>\u907a\u4f1d\u5b50\u8a3a\u65ad\u3068\u4e2d\u592e\u75c5\u7406\u8a3a\u65ad\u306f\u6025\u304c\u306a\u3044\u3068\uff0c\u60a3\u5150\u3092\u6551\u3046\u3068\u3044\u3046\u89b3\u70b9\u304b\u3089\u306f\u610f\u5473\u304c\u3042\u308a\u307e\u305b\u3093\uff0c\u5b66\u554f\u7684\u8208\u5473\u306e\u305f\u3081\u306b\u4e2d\u592e\u75c5\u7406\u8a3a\u65ad\u3092\u3057\u3066\u3044\u308b\u308f\u3051\u3067\u306f\u306a\u3044\u304b\u3089\u3067\u3059<\/li>\n<li>\u7d50\u679c\u7684\u306b\u306f\uff0c\u500b\u3005\u306e\u5b50\u4f9b\u3067\u7570\u306a\u308b\u6cbb\u7642\u65b9\u6cd5\u3092\u8003\u3048\u308b\u3068\u3044\u3046\u300c\u30c6\u30a4\u30e9\u30fc\u30e1\u30a4\u30c9\u300d\u306e\u65b9\u5411\u6027\u306b\u3042\u308a\u307e\u3059\uff0c\u5f93\u6765\u306e\u591a\u304f\u306e\u60a3\u5150\u3092\u4e00\u5b9a\u306e\u65b9\u91dd\u3067\u6cbb\u7642\u3059\u308b\u306b\u300c\u6a19\u6e96\u6cbb\u7642\u300d\u3068\u306f\u9006\u884c\u3059\u308b\u8003\u3048\u3067\u3059<\/li>\n<\/ul>\n<\/div>\n<h5><strong>\u9ac4\u82bd\u816b\u306e\u3067\u304d\u308b\u5834\u6240<\/strong><\/h5>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/07\/medullo\/medulloschem.png\"><img loading=\"lazy\" decoding=\"async\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/07\/medullo\/medulloschem.png\" alt=\"\" width=\"464\" height=\"338\" \/><\/a><\/p>\n<p>\u8d64\u304f\u5857\u3063\u3066\u3042\u308b\u306e\u304c\u9ac4\u82bd\u816b\u306e\u6700\u3082\u591a\u3044\u5834\u6240\u3067\u3059\u3002<span style=\"color: #333333;\">\u5c0f\u8133\u866b\u90e8\u304b\u3089\u767a\u751f\u3057\u3066\u7b2c\uff14\u8133\u5ba4\u3092\u57cb\u3081\u308b\u3088\u3046\u306b\u5927\u304d\u304f\u306a\u308a\u307e\u3059\u3002\u524d\u306e\u65b9\u306b\u3042\u308b\u8133\u5e79\u90e8\u3092\u5727\u8feb\u3057\u307e\u3059<\/span>\u304c\uff0c\u591a\u304f\u306e\u5834\u5408\u306f\u8133\u5e79\u90e8\u306b\u6d78\u6f64\uff08\u5165\u308a\u8fbc\u3080\u3053\u3068\uff09\u3057\u307e\u305b\u3093\u3002\u767a\u751f\u90e8\u4f4d\u306f\uff0c\u5c0f\u8133\u866b\u90e8\u304c8\u5272\u304f\u3089\u3044\uff0c\u5c0f\u8133\u534a\u7403\u304c2\u5272\u304f\u3089\u3044\u3067\u3059\u3002<span style=\"color: #000080;\"><a style=\"color: #000080;\" title=\"\u5c0f\u8133\u306e\u89e3\u5256\u56f3\" href=\"\/sawamura\/anatomys\/erebellum\/\">\u5c0f\u8133<\/a><\/span>\uff0c<a style=\"color: #000080;\" href=\"..\/anatomys\/brainstem\/\">\u8133\u5e79\u90e8<\/a>\uff0c<span style=\"color: #000080;\"><a style=\"color: #000080;\" title=\"\u8133\u5ba4\u306e\u89e3\u5256\u56f3\" href=\"\/sawamura\/anatomys\/temporal-2\/\">\u8133\u5ba4<\/a><\/span>\u306e\u8aac\u660e\u306f\u3053\u3053\u3092\u30af\u30ea\u30c3\u30af\u3059\u308b\u3068\u8a73\u3057\u304f\u51fa\u307e\u3059\u3002<\/p>\n<h4>\u8a3a\u65ad\u306f<\/h4>\n<ul>\n<li>MRI\u3067\u8a3a\u65ad\u3057\u307e\u3059<\/li>\n<li>\u5883\u754c\u304c\u306f\u3063\u304d\u308a\u3057\u305f\u816b\u760d\u3067\u3059\uff0c\u304f\u308a\u3093\u3068\u3057\u3066\u3044\u307e\u3059<\/li>\n<li>\u30ac\u30c9\u30ea\u30cb\u30a6\u30e0\u9020\u5f71\u5264\u3067\u767d\u304f\u6620\u308a\u307e\u3059\uff08\u5897\u5f37\u3055\u308c\u308b\uff09<\/li>\n<li>\u3067\u3082\uff0c\u30ac\u30c9\u30ea\u30cb\u30a6\u30e0\u9020\u5f71\u5264\u304c\u5165\u3089\u306a\u304f\u3066\u767d\u304f\u6620\u3089\u306a\u3044\u3082\u306e\u3082\u3042\u308a\u307e\u3059<\/li>\n<li>\u5468\u56f2\u306e\u5c0f\u8133\u304c\u816b\u308c\u308b\u3053\u3068\u304c\u591a\u3044\u3067\u3059\uff08\u8133\u6d6e\u816b\uff09<\/li>\n<li>CT\u3067\u306f\u77f3\u7070\u5316\u304c\u307f\u3089\u308c\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>CT\u3067\u306f\u5c0f\u8133\u3088\u308a\u767d\u3063\u307d\u3044\u7070\u8272\uff08\u9ad8\u5bc6\u5ea6\uff09\u306b\u5199\u308a\u307e\u3059<\/li>\n<li>\u4ed6\u306e\u816b\u760d\u3068\u306e\u9451\u5225\u306f\uff0c<span style=\"color: #000080;\"><a style=\"color: #000080;\" href=\"\/sawamura\/pediattumor\/fourthventricletumo\/\">\u7b2c\uff14\u8133\u5ba4\u816b\u760d\u306e\u3068\u3053\u308d\u3092\u8aad\u3093\u3067\u307f\u3066\u304f\u3060\u3055\u3044<\/a><\/span><\/li>\n<li>\u9ac4\u82bd\u816b\u3092\u7591\u3063\u305f\u3089\u3059\u3050\u306b\u810a\u9ac4\u306e\u9020\u5f71MRI\u3092\u3057\u307e\u3059\uff0c\u8ee2\u79fb\u304c\u3042\u308b\u304b\u3069\u3046\u304b\u63a2\u308b\u305f\u3081\u3067\u3059<\/li>\n<li>\u8a3a\u65ad\u5f8c\u306b\u3059\u3050\u306b<span style=\"color: #000080;\"><strong>\u5c0f\u5150\u6162\u6027\u75be\u60a3\u306e\u624b\u7d9a\u304d\u3092\u3059\u308c\u3070\u533b\u7642\u8cbb\u304c\u88dc\u52a9<\/strong><\/span>\u3055\u308c\u307e\u3059<\/li>\n<\/ul>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-9140 size-medium\" src=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm2-300x281.jpg\" alt=\"medullokm2\" width=\"300\" height=\"281\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm2-300x281.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm2-768x718.jpg 768w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm2-550x514.jpg 550w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm2.jpg 945w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-9141 size-medium\" src=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm1-300x295.jpg\" alt=\"medullokm1\" width=\"300\" height=\"295\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm1-300x295.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm1-768x755.jpg 768w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm1-550x541.jpg 550w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullokm1.jpg 945w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>\u5178\u578b\u7684\u306a\u5c0f\u8133\u866b\u90e8\uff08\u5c0f\u8133\u306e\u771f\u3093\u4e2d\uff09\u306e\u9ac4\u82bd\u816b\u3067\u3059\u3002\u6a2a\u306e\u65b9\uff0c\u30eb\u30b7\u30e5\u30ab\u5b54\u3078\u4f38\u3073\u3066\u3044\u306a\u3044\u306e\u3067\u4e0a\u8863\u816b\u3068\u533a\u5225\u3067\u304d\u307e\u3059\u3002\u30ac\u30c9\u30ea\u30cb\u30a6\u30e0\u3068\u3044\u3046\u9020\u5f71\u5264\u3067\u767d\u304f\u5199\u3063\u3066\u3044\u307e\u3059\u3002<\/p>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-9142\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot1-200x200.jpg\" alt=\"medulloot1\" width=\"200\" height=\"200\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot1-200x200.jpg 200w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot1-144x144.jpg 144w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot3.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-9143\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot3-200x200.jpg\" alt=\"medulloot3\" width=\"200\" height=\"200\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot3-200x200.jpg 200w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot3-144x144.jpg 144w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-9144\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot2-200x200.jpg\" alt=\"medulloot2\" width=\"200\" height=\"200\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot2-200x200.jpg 200w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulloot2-144x144.jpg 144w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><\/p>\n<p>\u3053\u306e\u4f8b\u306f\uff0c\u5c0f\u8133\u534a\u7403\u306b\u3067\u304d\u305f\u3082\u306e\u3067\u3059\u3002\u306e\u3046\u80de\uff08\u6c34\u305f\u307e\u308a\uff09\u3092\u5f62\u6210\u3057\u3066\u3044\u307e\u3059\u3002\u9ac4\u82bd\u816b\u306e\u5927\u304d\u306a\u7279\u5fb4\u306f\uff0c\u9020\u5f71\u5264\u3092\u5165\u308c\u306a\u3044CT\uff08\u5de6\u5074\uff09\u3067\u816b\u760d\u304c\u5c11\u3057\u767d\u304f\u898b\u3048\u308b\u3053\u3068\u3067\u3059\uff08\u7070\u767d\u8cea\u3088\u308a\u9ad8\u5bc6\u5ea6\u3068\u3044\u3044\u307e\u3059\uff09\u3002\u7d30\u80de\u5bc6\u5ea6\u304c\u9ad8\u3044\u306e\u3067\u9ad8\u5bc6\u5ea6\u306b\u306a\u308a\u307e\u3059\u3002\u3053\u306e\u4f8b\u306fclassic medulloblastoma\u3067\u3059\u304c\uff0cMIB-1\u306f45%\u306b\u9054\u3059\u308b\u3082\u306e\u3067\uff0c\u6025\u6fc0\u306a\u816b\u760d\u767a\u80b2\u3092\u793a\u3057\u307e\u3059\u3002<\/p>\n<h1><span style=\"color: #000080;\">\u76ee\u6a19\u306f\u751f\u5b58\u7387\u304b\u3089QOL\u3078\uff0c\u3044\u304b\u306b\u5f8c\u907a\u75c7\u3092\u5c11\u306a\u304f\u3057\u3066\u751f\u304d\u5ef6\u3073\u308b\u304b\u3068\u3044\u3046\u65b9\u5411\u3078\u3068\u5411\u304b\u3063\u3066\u3044\u307e\u3059<\/span><\/h1>\n<h1><span style=\"color: #000080;\">\u5206\u5b50\u751f\u7269\u5b66\u306e\u77e5\u8b58\u3084\u5171\u540c\u7814\u7a76\u3084\u65b0\u3057\u3044\u6cbb\u9a13\u3082\u5927\u5207\u3067\u3059\u304c\uff0c\u305d\u308c\u4ee5\u4e0a\u306b\u5c0f\u5150\u306e\u60aa\u6027\u8133\u816b\u760d\u3092\u7ba1\u7406\u3059\u308b\u81e8\u5e8a\u7684\u80fd\u529b\u304c\u62c5\u5f53\u306e\u533b\u5e2b\u306b\u306a\u3044\u3068\u52a9\u304b\u308a\u307e\u305b\u3093\u3057\uff0c\u5927\u304d\u306a\u5f8c\u907a\u75c7\u3092\u304b\u304b\u3048\u308b\u3053\u3068\u306b\u306a\u308a\u307e\u3059<\/span><\/h1>\n<h1><span style=\"color: #000080;\">\u624b\u8853\u5f8c\u306e\u907a\u4f1d\u5b50\u8a3a\u65ad\u306b\u6642\u9593\u304c\u304b\u304b\u3063\u3066\uff0c\u6cbb\u7642\u958b\u59cb\u304c\u9045\u308c\u308b\u3068\u624b\u9045\u308c\u306b\u306a\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/span><\/h1>\n<h5>2024\u5e74\u6642\u70b9\u3067\u5206\u5b50\u8a3a\u65ad\u306b\u57fa\u3065\u3044\u305f\u65b0\u305f\u306a\u6cbb\u7642\u65b9\u6cd5\u306f\u958b\u767a\u3055\u308c\u3066\u3044\u307e\u305b\u3093<\/h5>\n<div class=\"setumei\">\n<h4>\u6cbb\u7642\u306f\u307e\u305a\u624b\u8853<\/h4>\n<ul>\n<li>\u3069\u3053\u3067\u3082\u6cbb\u7642\u3067\u304d\u308b\u75c5\u6c17\u3067\u306f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li>\u624b\u8853\u3067<span style=\"color: #000080;\"><strong>\u5168\u6458\u51fa\u3057\u305f\u65b9\u304c\u751f\u5b58\u306e\u30c1\u30e3\u30f3\u30b9\u304c\u5897\u3059\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u307e\u3057\u305f<\/strong><\/span><\/li>\n<li>\u3067\u3082\u6700\u8fd1\u306f\uff0c<span style=\"color: #000080;\"><strong>\u5f8c\u907a\u75c7\u3092\u51fa\u3057\u3066\u307e\u3067\u7121\u7406\u3057\u3066\u5168\u6458\u51fa\u3057\u306a\u3044<\/strong><\/span>\u3068\u3044\u3046\u65b9\u5411\u6027\u306b\u3042\u308a\u307e\u3059<\/li>\n<li>\u624b\u8853\u3067\u75c5\u7406\u7d44\u7e54\u8a3a\u65ad\u3068\u5206\u5b50\u8a3a\u65ad\u3092\u3057\u3066\uff0c\u3069\u3093\u306a\u30bf\u30a4\u30d7\u306e\u9ac4\u82bd\u816b\u304b\u6c7a\u3081\u308b\u3053\u3068\u304c\u91cd\u8981\u306b\u306a\u308a\u307e\u3057\u305f<\/li>\n<li>\u624b\u8853\u306f\u3080\u305a\u304b\u3057\u3044\u306e\u3067\u7d4c\u9a13\u306e\u3042\u308b\u8133\u5916\u79d1\u533b\u3068\u65bd\u8a2d\u3092\u9078\u3093\u3067\u4e0b\u3055\u3044<\/li>\n<li>\u624b\u8853\u6458\u51fa\u3057\u306a\u304f\u3066\u3082\u6cbb\u308b\u30bf\u30a4\u30d7\u306e\u9ac4\u82bd\u816b\u304c\u3042\u308a\u307e\u3059\u304c\uff0c\u305d\u306e\u5224\u65ad\u306f\u3082\u306e\u3059\u3054\u304f\u96e3\u3057\u3044\u3067\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>\u9ac4\u82bd\u816b\u3068\u753b\u50cf\u8a3a\u65ad\u3055\u308c\u3066\u3082\u305d\u306e\u65bd\u8a2d\u306b\u9ac4\u82bd\u816b\u306e\u7d4c\u9a13\u304c\u5c11\u306a\u3044\u306a\u3089\uff0c\u624b\u8853\u3092\u53d7\u3051\u308b\u524d\u306b\u7dca\u6025\u3067\u6cbb\u7642\u7d4c\u9a13\u306e\u591a\u3044\u65bd\u8a2d\u3078\u79fb\u3057\u3066\u3044\u305f\u3060\u304f<\/strong><\/span>\u3053\u3068\u304c\u5927\u5207\u3067\u3059<\/li>\n<li>\u624b\u8853\u5f8c\u306e\u6cbb\u7642\u306e\u9078\u629e\u306b\u8ff7\u3063\u305f\u5834\u5408\u306b\u306f\uff0c\u60c5\u5831\u3092\u96c6\u3081\u3066\u30bb\u30ab\u30f3\u30c9\u30aa\u30d4\u30cb\u30aa\u30f3\u3092\u805e\u304f\u3053\u3068\u3092\u3057\u307e\u3057\u3087\u3046\uff0c\u3067\u3082\u6642\u9593\u306f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li>\u9ac4\u82bd\u816b\u9577\u671f\u751f\u5b58\u8005\u3067\u306e\u624b\u8853\u5f8c\u907a\u75c7\u306f\u3068\u3066\u3082\u591a\u3044\u3067\u3059<\/li>\n<li>\u624b\u8853\u3067\u306f\uff0c\u9ac4\u82bd\u816b\u7d30\u80de\u3092\u3070\u3089\u6492\u3044\u3066\uff0c<span style=\"color: #ff0000;\"><strong>\u624b\u8853\u8a98\u767a\u64ad\u7a2e\u3092\u751f\u3058\u306a\u3044<\/strong><\/span>\u3088\u3046\u306b\u52aa\u3081\u307e\u3059<\/li>\n<li>\u907f\u3051\u3048\u306a\u3044\u3068\u3044\u3046\u5074\u9762\u3082\u3042\u308a\u307e\u3059\u304c\uff0c\u305d\u3093\u306a\u3053\u3068\u3092\u3057\u3066\u306f\u5143\u3082\u5b50\u3082\u306a\u3044\u624b\u8853\u3068\u306a\u308a\u307e\u3059<\/li>\n<\/ul>\n<h5>\u624b\u8853\u5f8c\u306b\u306f\u75c5\u7406\u8a3a\u65ad\u3092\u30c0\u30e9\u30c0\u30e9\u3057\u306a\u3044\u3067\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u304b\u5316\u5b66\u7642\u6cd5\u306e\u6e96\u5099\u3068\u958b\u59cb\u3092\u5c11\u3057\u3067\u3082\u6025\u304e\u307e\u3059\uff0c\u305d\u3046\u3057\u306a\u3044\u3068\u65e9\u671f\u64ad\u7a2e\u518d\u767a\u306a\u3069\u306b\u906d\u9047\u3057\u3066\u52a9\u304b\u308a\u307e\u305b\u3093<\/h5>\n<h4>\u624b\u8853\u5f8c\u306e\u653e\u5c04\u7dda\u6cbb\u7642<\/h4>\n<ul>\n<li>\u624b\u8853\u5f8c\u306e<strong><span style=\"color: #ff0000;\">\u57fa\u672c\u7684\u306a\u6cbb\u7642\u306f\u653e\u5c04\u7dda\u6cbb\u7642\uff08\u8133\u810a\u9ac4\u7167\u5c04 CSI\uff09<\/span><\/strong>\u3067\u3059<\/li>\n<li>\u653e\u5c04\u7dda\u306f\u5168\u90e8\u306e\u8133\u3068\u810a\u9ac4\u306b\u304b\u3051\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u304c\uff0c<span style=\"color: #000080;\"><strong>\u5e74\u9f62\u3067\u8133\u810a\u9ac4\u7167\u5c04\u306e\u7dda\u91cf\u3092\u8abf\u7bc0<\/strong><\/span>\u3057\u307e\u3059<\/li>\n<li>\u8133\u810a\u9ac4\u7167\u5c04\u306b\u52a0\u3048\u3066\u816b\u760d\u306e\u3042\u308b\u90e8\u4f4d\u306b\u5c40\u6240\u7167\u5c04\u3092\u3057\u307e\u3059<\/li>\n<li>\u304b\u3064\u3066\u306f\u5f8c\u982d\u7aa9\u7167\u5c0454\u30b0\u30ec\u30a4\u304c\u7528\u3044\u3089\u308c\u307e\u3057\u305f\u304c\uff0c\u5c0f\u8133\u3068\u8133\u5e79\u90e8\u306e\u88ab\u7206\u3067\u8a8d\u77e5\u6a5f\u80fd\u4f4e\u4e0b\u304c\u751f\u3058\u308b\u306e\u3067\uff0c<strong><span style=\"color: #000080;\">\u816b\u760d\u5c40\u6240\u7167\u5c04\uff08\u816b\u760d\u5e8a tumor bed, involved field\uff09<\/span><\/strong>\u3078\u3068\u5909\u308f\u308a\u307e\u3057\u305f<\/li>\n<li>\u5e74\u9f62\u304c\u4f4e\u3044\u3068\uff0c\u653e\u5c04\u7dda\u5f8c\u907a\u75c7\u306f\u5f37\u304f\u51fa\u307e\u3059<\/li>\n<li>\u554f\u984c\u306f\uff0c\u6cbb\u7642\u5f8c\u306b\u4f55\u5e74\u3082\u304b\u304b\u3063\u3066\u60aa\u5316\u3059\u308b\u5b66\u7fd2\u969c\u5bb3\u3042\u308b\u3044\u306f<strong><span style=\"color: #000080;\">\u8a8d\u77e5\u969c\u5bb3<\/span><\/strong>\uff08\u77e5\u80fd\u306e\u4f4e\u4e0b\uff09\u3067\u3059<\/li>\n<li><strong><span style=\"color: #ff0000;\">\u5f8c\u907a\u75c7\u306f\u624b\u8853\u3068\u653e\u5c04\u7dda\u3067\u6c7a\u307e\u308a\u307e\u3059<\/span><\/strong>\u304b\u3089\uff0c\u305d\u308c\u3092\u3067\u304d\u308b\u9650\u308a\u4f4e\u4fb5\u8972\u306b\u6291\u3048\u308b\u306e\u304c\u6cbb\u7642\u306e\u30b3\u30c4\u3067\u3059<\/li>\n<li><strong><span style=\"color: #000080;\">\u8133\u810a\u9ac4\u7167\u5c04<\/span><\/strong>\u306f\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u3067\u306f36\u30b0\u30ec\u30a4\u304f\u3089\u3044\uff0c\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u306f23.4\u30b0\u30ec\u30a4\u304f\u3089\u3044\uff0c\u4f4e\u30ea\u30b9\u30af\u7fa4\u306f\u884c\u308f\u306a\u3044\u3068\u3044\u3046\u9078\u629e\u80a2\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>8\u6b73\u672a\u6e80\u306e\u5e74\u5c11\u5150\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u306f\uff0c\u8a8d\u77e5\u6a5f\u80fd\u306e\u4f4e\u4e0b\u3092\u907f\u3051\u308b\u305f\u3081\u306b\u4f4e\u7dda\u91cf\u8133\u810a\u9ac4\u7167\u5c04 18\u30b0\u30ec\u30a4 low-dose CSI \u304c\u4e00\u822c\u7684\u306b\u306a\u3063\u3066\u304d\u307e\u3057\u305f<\/li>\n<li>\u3057\u304b\u3057\uff0c\u4f4e\u7dda\u91cf\u8133\u810a\u9ac4\u7167\u5c04\u3067\u306f\u308f\u305a\u304b\u306a\u304c\u3089\u751f\u5b58\u5272\u5408\u304c\u4f4e\u4e0b\u3057\u307e\u3059<\/li>\n<li>\u653e\u5c04\u7dda\u6cbb\u7642\u3082\u6280\u8853\u7684\u306b\u96e3\u3057\u3044\u306e\u3067\u304d\u3061\u3093\u3068\u7167\u5c04\u3067\u304d\u308b\u65bd\u8a2d\u306f\u591a\u304f\u306f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li>\u8133\u3068\u810a\u9ac4\u3092\u4e00\u7dd2\u306b\u7167\u5c04\u3059\u308b\uff081\u65e5\u3067\u8133\u3078\u3082\u810a\u9ac4\u3078\u3082\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u3067\u304d\u308b\uff09\u3053\u3068\u304c\u6700\u4f4e\u6761\u4ef6\u3067\u3057\u3087\u3046<\/li>\n<li>\u9650\u3089\u308c\u305f\u65bd\u8a2d\u3067\u306f\uff0c\u967d\u5b50\u7dda\u6cbb\u7642\u3082\u7528\u3044\u308b\u3053\u3068\u304c\u3067\u304d\u308b\u306e\u3067\u3059\u304c\uff0c\u901a\u5e38\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u3068\u6bd4\u3079\u3066\u306e\u9577\u671f\u751f\u5b58\u5272\u5408\u306e\u5dee\u306f\u8a3c\u660e\u3055\u308c\u3066\u3044\u307e\u305b\u3093<\/li>\n<li>\u967d\u5b50\u7dda\u6cbb\u7642\u3092\u5f85\u3063\u3066\u3044\u3066\uff0c\u305d\u306e\u9593\u306b\u9ac4\u82bd\u816b\u304c\u64ad\u7a2e\u3057\u3066\u3057\u307e\u3048\u3070\u5143\u3082\u5b50\u3082\u3042\u308a\u307e\u305b\u3093<\/li>\n<\/ul>\n<h4>\u624b\u8853\u5f8c\u306e\u5316\u5b66\u7642\u6cd5<\/h4>\n<ul>\n<li><span style=\"color: #000080;\"><strong>\u5316\u5b66\u7642\u6cd5\uff08\u5236\u304c\u3093\u5264\uff09\u3082\u4f7f\u3063\u3066\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u8ca0\u62c5\u3092\u4e0b\u3052\u3088\u3046\u3068\u3059\u308b<\/strong><\/span>\u306e\u304c\u73fe\u5728\u306e\u8003\u3048\u65b9\u3067\u3059<\/li>\n<li>\u3067\u3082\u3057\u304b\u3057\uff0c\u5316\u5b66\u7642\u6cd5\u3060\u3051\u3067\u306f\u6cbb\u308b\u306e\u306f\u9650\u3089\u308c\u305f\u4e00\u90e8\u306e\u9ac4\u82bd\u816b\u3060\u3051\u3067\u3059<\/li>\n<li>\u5b8c\u5168\u306b\u6cbb\u3059\u305f\u3081\u306b\u306f\u4eca\u3067\u3082\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u6700\u3082\u52b9\u679c\u304c\u3042\u308b\u3053\u3068\u3092\u5fd8\u308c\u3066\u306f\u3044\u3051\u307e\u305b\u3093<\/li>\n<li>\u5316\u5b66\u7642\u6cd5\u306f\u5c0f\u5150\u79d1\u306e\u5148\u751f\u304c\u884c\u3044\u307e\u3059<\/li>\n<li><strong><span style=\"color: #ff0000;\">\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4<\/span><\/strong>\u3068\u3044\u3046\u6cbb\u308a\u3084\u3059\u3044\u72b6\u614b\u306e\u9ac4\u82bd\u816b\u3067\u306e\u6700\u3082\u4fe1\u983c\u306e\u304a\u3051\u308b\u6210\u7e3e\u306f\uff0c<strong><span style=\"color: #ff0000;\">23.4\u30b0\u30ec\u30a4\u8133\u810a\u9ac4\u7167\u5c04\u306854\u30b0\u30ec\u30a4\u816b\u760d\u5e8a\u7167\u5c04\uff0c<\/span><\/strong><span style=\"color: #ff0000;\"><span style=\"color: #333333;\">\u305d\u306e\u5f8c\u306b<\/span><\/span><strong><span style=\"color: #ff0000;\">\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u3092\u4f7f\u3046\u5316\u5b66\u7642\u6cd5<\/span><\/strong>\u30924\u30b3\u30fc\u30b9\u52a0\u3048\u308b\u3082\u306e\u3067\u3059<\/li>\n<li>2021\u5e74\u306eSJMB03\u3068\u3044\u3046\u5927\u898f\u6a21\u81e8\u5e8a\u8a66\u9a13\u3067\u3082\u3053\u306e\u5316\u5b66\u7642\u6cd5\u304c\u7528\u3044\u3089\u308c\u3066\u3044\u307e\u3059\u3002<\/li>\n<li>\u3068\u3066\u3082\u305f\u304f\u3055\u3093\u306e\u91cf\u306e\u5236\u304c\u3093\u5264\u3092\u4f7f\u3046\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u6cbb\u308b\u3068\u3044\u3046\u8a3c\u62e0\u306f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li><span style=\"color: #000080;\"><strong>\uff13\u6b73\u672a\u6e80\u306e\u5b50\u4f9b\u305f\u3061\u306b\u653e\u5c04\u7dda\u3092\u304b\u3051\u308b\u3068\u3066\u3082\u3064\u3089\u3044\u7cbe\u795e\u767a\u9054\u9045\u6ede\u304c\u304a\u3053\u308a\u307e\u3059\u304b\u3089\uff0c\u5316\u5b66\u7642\u6cd5\u3060\u3051\u3067\u307e\u305a\u6cbb\u7642<\/strong><\/span>\u3092\u3059\u308b\u3053\u3068\u306b\u3057\u305f\u65b9\u304c\u3044\u3044\u3067\u3059<\/li>\n<li>\u7279\u306b\uff0c<span style=\"color: #000080;\"><strong>\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u4f7f\u3048\u306a\u3044\u5e74\u5c11\u306e\u304a\u5b50\u3055\u3093\uff0c\u64ad\u7a2e\u3057\u3066\u3057\u307e\u3063\u305f\u9ac4\u82bd\u816b\uff0c\u75c5\u7406\u5b66\u7684\u306b\u6cbb\u308a\u306b\u304f\u3044<span style=\"color: #000080;\">(\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b\u306a\u3069)<\/span>\u00a0<\/strong><\/span>\u3068\u5224\u65ad\u3055\u308c\u305f\u6642\u306b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u304c\u8003\u616e\u3055\u308c\u307e\u3059<\/li>\n<li>\u9006\u8aac\u7684\u3067\u3059\u304c\uff0c\u75c5\u7406\u5b66\u7684\u306b<span style=\"color: #000080;\"><strong>\u3068\u3066\u3082\u6cbb\u308a\u3084\u3059\u3044\u30bf\u30a4\u30d7 (MBEN, DPM, \u30a6\u30a4\u30f3\u30b0\u30ec\u30b9)\u00a0<\/strong><\/span><span style=\"color: #ff0000;\"><span style=\"color: #000080;\"><strong>\u3067\u8133\u810a\u9ac4\u7167\u5c04\u3092\u7701\u3051\u308b\u3068\u5224\u65ad\u3057\u305f\u6642<\/strong><\/span><\/span>\u3082\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3092\u8003\u3048\u307e\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>MBEN\u3067\u306f\uff0cgerman HIT trial\u3068\u3044\u3046\u81e8\u5e8a\u8a66\u9a13\u304c\u6700\u3082\u826f\u3044\u6210\u7e3e<\/strong><\/span>\u3092\u3042\u3052\u3066\u3044\u3066\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u7701\u304f\u5316\u5b66\u7642\u6cd5\u306e\u307f\u306e\u6cbb\u7642\u65b9\u91dd\u3067\u3059\uff08\u5f8c\u8ff0\u306e\u6587\u732e\u306b\u3042\u308a\u307e\u3059\uff09<\/li>\n<li>\u64ad\u7a2e\u518d\u767a\u306e\u78ba\u7387\u304c\u9ad8\u3044<span style=\"color: #000080;\"><strong>\u30b0\u30eb\u30fc\u30d73\u9ac4\u82bd\u816b\u3067\u306f\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306b\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u3092\u4f75\u7528<\/strong><\/span>\u3059\u308b\u3068\u751f\u5b58\u5272\u5408\u304c\u6539\u5584\u3057\u307e\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong>\u5316\u5b66\u7642\u6cd5\u3067\u3082\uff0c\u5316\u5b66\u7642\u6cd5\u6b7b\u3084\u4e8c\u6b21\u764c<\/strong><\/span>\u306a\u3069\u306e\u526f\u4f5c\u7528\u306f\u3042\u308b\u306e\u3067\u305f\u304f\u3055\u3093\u306e\u91cf\u3092\u4f7f\u3048\u3070\u3044\u3044\u3068\u3044\u3046\u3082\u306e\u3067\u306f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li><span style=\"color: #000080;\"><strong>\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\uff08\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8, MTX\uff09\u306e\u968f\u8154\u5185\u6295\u4e0e\u3092\u884c\u3046\u3068\u8133\u767d\u8cea\u969c\u5bb3<\/strong><\/span>\u306e\u305f\u3081\u306b\u6cbb\u7642\u5f8c\u306e\u77e5\u80fd\u4f4e\u4e0b\u304c\u3072\u3069\u304f\u306a\u308a\u307e\u3059\u304b\u3089\u4f7f\u7528\u306f\u52e7\u3081\u3089\u308c\u307e\u305b\u3093<\/li>\n<\/ul>\n<h4>2019\u5e74\u304b\u3089<span style=\"color: #000080;\"><strong>\u30c1\u30aa\u30c6\u30d1\uff08\u30ea\u30b5\u30a4\u30aa\uff09<\/strong><\/span>\u304c\u4fdd\u967a\u8a3a\u7642\u3067\u4f7f\u7528\u3067\u304d\u307e\u3059<\/h4>\n<ul>\n<li>\u7279\u306b\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u907f\u3051\u305f\u3044\u4e73\u5e7c\u5150\u3084\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u6cbb\u308b\u898b\u8fbc\u307f\u306e\u3042\u308b\u30bf\u30a4\u30d7\u306e\u9ac4\u82bd\u816b\u306b\u4f7f\u7528\u3055\u308c\u307e\u3059<\/li>\n<li>\u9069\u5fdc\u306f\u300c\u5c0f\u5150\u60aa\u6027\u56fa\u5f62\u816b\u760d\u306b\u304a\u3051\u308b<span style=\"color: #000080;\"><strong>\u81ea\u5bb6\u9020\u8840\u5e79\u7d30\u80de\u79fb\u690d\u306e\u524d\u6cbb\u7642<\/strong><\/span>\u300d\u3067\u3059<\/li>\n<li>\u30e1\u30eb\u30d5\u30a1\u30e9\u30f3\u3068\u306e\u4f75\u7528\u3067\uff0c1\u65e5\u4e00\u56de 200mg\/m2\u3092\u4f7f\u7528\u3059\u308b\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u306e\u307f\u306e\u8a8d\u53ef\u3067\u3059\u304b\u3089\uff0c\u4f7f\u7528\u5236\u9650\u306f\u53b3\u3057\u3044\u3067\u3059<\/li>\n<\/ul>\n<h4><a href=\"\/sawamura\/pediattumor\/gliomachemo-2\/\">\u6c34\u982d\u75c7\uff08\u30af\u30ea\u30c3\u30af\u3059\u308b\u3068\u8a73\u3057\u304f\u8aad\u3081\u307e\u3059\uff09<\/a><\/h4>\n<ul>\n<li>\u958b\u982d\u624b\u8853\u3067\u816b\u760d\u3092\u5341\u5206\u3068\u308c\u3066\u7b2c\uff14\u8133\u5ba4\u306e\u8a70\u307e\u308a\u304c\u306a\u304a\u308b\u3068\u6cbb\u308a\u307e\u3059<\/li>\n<li>\u6c34\u982d\u75c7\u306b\u30b7\u30e3\u30f3\u30c8\u3092\u3059\u308b\u3068\u304a\u8179\u306e\u4e2d\u306b\u9ac4\u82bd\u816b\u304c\u8ee2\u79fb\u3057\u307e\u3059\u304b\u3089\uff0c\u30b7\u30e3\u30f3\u30c8\u306f\u3057\u307e\u305b\u3093<\/li>\n<li>\u816b\u760d\u6458\u51fa\u3067\u3082\u6c34\u982d\u75c7\u304c\u6cbb\u3089\u306a\u3044\u6642\u306b\u306f\uff0c\u5185\u8996\u93e1\u3067\u7b2c\uff13\u8133\u5ba4\u958b\u7a93\u8853\u3092\u3057\u307e\u3059<\/li>\n<\/ul>\n<\/div>\n<div class=\"setumei\">\n<h4><a href=\"\/sawamura\/pediattumor\/ccs\/\">\u6cbb\u7642\u5f8c\u306e\u3053\u3068\uff08\u30af\u30ea\u30c3\u30af\u3059\u308b\u3068\u8a73\u3057\u304f\u8aad\u3081\u307e\u3059\uff09<\/a><\/h4>\n<ul>\n<li>\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u5e74\u9577\u5150\u306e\uff15\u5e74\u751f\u5b58\u5272\u5408\u306f80\uff05\u307b\u3069\u306b\u9054\u3059\u308b\u306e\u3067\u3059\u304c\uff0c\u6b8b\u5ff5\u306a\u304c\u30893\u6b73\u672a\u6e80\u306e\u5b50\u3069\u3082\u305f\u3061\u306f50%\u304f\u3089\u3044\u3067\u3059<\/li>\n<li>\u6cbb\u7642\u5f8c\u306b<span style=\"color: #000080;\"><strong>\u5185\u5206\u6ccc\uff08\u30db\u30eb\u30e2\u30f3\uff09\u969c\u5bb3<\/strong><\/span>\u304c\u51fa\u308b\u3053\u3068\u304c\u591a\u3044\u306e\u3067\u5c0f\u5150\u5185\u5206\u6ccc\u306e\u5c02\u9580\u5bb6\u306b\u8a3a\u3066\u3082\u3089\u3046\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>\u6cbb\u7642\u5f8c\u306e\u8a8d\u77e5\u969c\u5bb3\uff08\u77e5\u80fd\u306e\u4f4e\u4e0b\uff09\u306f\u4f55\u5e74\u3082\u304b\u304b\u3063\u3066\u3086\u3063\u304f\u308a\u9032\u884c\u3057\u307e\u3059<\/li>\n<\/ul>\n<\/div>\n<h1 class=\"style1\"><span style=\"color: #000080;\"><strong><span class=\"style2\">\u9ac4\u82bd\u816b\u306e<span style=\"color: #ff0000;\">2021\u5e74 WHO\u306e\u5206\u985e <\/span><\/span><\/strong><span class=\"style2\">\u5168\u3066\u30b0\u30ec\u30fc\u30c94<\/span><\/span><\/h1>\n<h4><strong><span style=\"color: #000080;\">Medulloblastomas, molecularly defined<br \/>\n\u907a\u4f1d\u5b50\u8a3a\u65ad\u304c\u306a\u3055\u308c\u305f\u3082\u306e<\/span><\/strong><\/h4>\n<ul>\n<li><span style=\"color: #000080;\"><strong>Medulloblastoma, WNT activated<br \/>\n<span style=\"color: #333333; font-weight: normal;\">\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u6d3b\u6027\u578b\uff0c\u514d\u75ab\u7d44\u7e54\u67d3\u8272\u3067\u00a0<\/span><span style=\"font-weight: normal;\"><strong>DKK1 (WNT)<\/strong><\/span><br \/>\n<\/strong><\/span><\/li>\n<li><strong><span style=\"color: #000080;\">Medulloblastoma, SHH activated and\u00a0<em>TP53<\/em>\u00a0wildtype<br \/>\n<\/span><\/strong><span style=\"color: #000080;\"><span style=\"color: #ff0000;\"><span style=\"color: #333333;\">\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u6d3b\u6027\u578b\uff0c<em>TP53<\/em>\u907a\u4f1d\u5b50\u91ce\u751f\u578b<\/span><\/span><\/span><strong><span style=\"color: #000080;\"><br \/>\n<\/span><\/strong><\/li>\n<li><strong><span style=\"color: #000080;\">Medulloblastoma, SHH activated and\u00a0<em>TP53<\/em> mutant<br \/>\n<\/span><\/strong><span style=\"color: #000080;\"><span style=\"color: #ff0000;\"><span style=\"color: #333333;\">\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u6d3b\u6027\u578b\uff0c<em>TP53<\/em>\u907a\u4f1d\u5b50\u5909\u7570\u578b<\/span><\/span><\/span><strong><span style=\"color: #000080;\"><br \/>\n<\/span><\/strong><\/li>\n<li><span style=\"color: #000080;\"><strong>Medulloblastoma,\u00a0non-WNT\/non-SHH<br \/>\n<\/strong><\/span>\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u3067\u3082\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u3067\u3082\u306a\u3044\u3082\u306e<\/li>\n<\/ul>\n<h4><strong><span style=\"color: #000080;\">Medulloblastoma histologicaly defined (grade IV)<br \/>\n\u7d44\u7e54\u8a3a\u65ad\u306e\u307f\u306b\u3088\u308b\u3082\u306e<\/span><\/strong><\/h4>\n<p>\u907a\u4f1d\u5b50\u8a3a\u65ad\u304c\u3067\u304d\u306a\u3044\u30b1\u30fc\u30b9\u3067\u9ac4\u82bd\u816b\u3068\u7d44\u7e54\u8a3a\u65ad\u3057\u305f\u6642\u3067\u3059<\/p>\n<hr \/>\n<h5>\u3053\u306e\u57fa\u672c\u7684\u306a4\u3064\u306e\u5206\u5b50\u8a3a\u65ad\u3068\uff0c\u4e0b\u306e\u65b9\u306b\u66f8\u3044\u3066\u3042\u308b\u7d44\u7e54\u8a3a\u65ad\u3092\u7d44\u307f\u5408\u308f\u305b\u3066\uff0cWHO\u8a3a\u65ad\u540d\u3068\u75c5\u7406\u5b66\u7684\u306a\u30ea\u30b9\u30af\u8a3a\u65ad\u3068\u3057\u307e\u3059<\/h5>\n<p>SHH activated\u306f\uff0cSHH\u6d3b\u6027\u578b\uff0cSHH\u578b\uff0cSHH\u30bf\u30a4\u30d7\u306a\u3069\u3068\u65e5\u672c\u8a9e\u8a33\u3055\u308c\u3066\u3044\u307e\u3059\u304c\u7d71\u4e00\u3055\u308c\u3066\u3044\u307e\u305b\u3093\u3002\u65e5\u5e38\u7684\u306b\u306f\u5358\u306b\uff0c\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30b0\u3068\u3044\u3046\u3053\u3068\u304c\u591a\u3044\u3067\u3059\u3002<\/p>\n<h5><span style=\"color: #000080;\"><strong>WNT activated<\/strong><\/span><\/h5>\n<ul>\n<li>\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u306e\u7d44\u7e54\u8a3a\u65ad\u306f\u30af\u30e9\u30b7\u30c3\u30af\u30bf\u30a4\u30d7\u3067\u3042\u308a\uff0c\u4f4e\u30ea\u30b9\u30af\u816b\u760d<\/li>\n<li>\u6cbb\u7642\u304c\u3088\u304f\u52b9\u3044\u3066\u307b\u307c\u5168\u54e1\u304c\u9577\u671f\u751f\u5b58\u3067\u304d\u307e\u3059\uff0c\u4e00\u756a\u6cbb\u308a\u3084\u3059\u3044\uff0c\u3067\u3082\u30b0\u30ec\u30fc\u30c94\u3067\u3059<\/li>\n<\/ul>\n<h5><span style=\"color: #000080;\"><strong>SHH activated,\u00a0<em>TP53 mutated<\/em><\/strong><\/span><\/h5>\n<ul>\n<li>\u5927\u7d30\u80de\uff0f\u9000\u5f62\u6210\u6027\u3067\u9ad8\u30ea\u30b9\u30af\uff0c\uff17\u6b73\u221217\u6b73\u306b\u591a\u3044<\/li>\n<li>desmoplastic\/nodular DNMB \u3067\u306f\u4f4e\u30ea\u30b9\u30af<\/li>\n<li>\u30d5\u30a1\u30f3\u30b3\u30cb\u8ca7\u8840\uff0c\u30b4\u30fc\u30ea\u30f3\u75c7\u5019\u7fa4\uff0c\u30ea\u30fb\u30d5\u30e9\u30a6\u30e1\u30ea\u75c7\u5019\u7fa4\u306b\u5408\u4f75\u3059\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/li>\n<\/ul>\n<h5><span style=\"color: #000080;\"><strong>SHH activated,\u00a0<em>TP53 wildtype<\/em><\/strong><\/span><\/h5>\n<ul>\n<li>\u30af\u30e9\u30b7\u30c3\u30af\u3067\u306f\uff0c\u6a19\u6e96\u30ea\u30b9\u30af<\/li>\n<li>\u5927\u7d30\u80de\uff0f\u9000\u5f62\u6210\u6027\u3067\u306f\uff0c\u81e8\u5e8a\u50cf\u3068\u306e\u95a2\u9023\u4e0d\u660e<\/li>\n<li>desmoplastic\/nodular DNMB \u3067\u306f\uff0c\u4e73\u5150\u3067\u306f\u4f4e\u30ea\u30b9\u30af\uff0c\u6210\u4eba\u306b\u3082\u898b\u3089\u308c\u308b<\/li>\n<li>extensive nodularity\u306f\uff0c\u4e73\u5150\u306e\u4f4e\u30ea\u30b9\u30af\u816b\u760d<\/li>\n<\/ul>\n<h5><span style=\"color: #000080;\"><strong>non-WNT\/non-SHH<\/strong><\/span><\/h5>\n<ul>\n<li>\u30af\u30e9\u30b7\u30c3\u30af\u3067\u306f\uff0c\u6a19\u6e96\u30ea\u30b9\u30af<\/li>\n<li>\u5927\u7d30\u80de\uff0f\u9000\u5f62\u6210\u6027\u3067\u306f\uff0c\u9ad8\u30ea\u30b9\u30af<\/li>\n<li>\u3053\u306e\u4e2d\u306b\u30b0\u30eb\u30fc\u30d73\u304c\u542b\u307e\u308c\u3066\u3044\u307e\u3059\uff0cgroup 3\u306f\u9ac4\u82bd\u816b\u306e25%\u307b\u3069\u3092\u5360\u3081\u308b\u3082\u306e\u3067\u4e73\u5e7c\u5150\uff0c\u7537\u5150\u306b\u767a\u751f\u7387\u304c\u9ad8\u3044\u3067\u3059\u3002\u9ac4\u82bd\u816b\u306e\u4e2d\u3067\u3082\u6700\u3082\u6b7b\u4ea1\u7387\u304c\u9ad8\u3044\u3082\u306e\u3067\u3059\u3002\u7d44\u7e54\u8a3a\u65ad\u306fclassic\u3042\u308b\u3044\u306fanaplastic\u3067\uff0c\u9ad8\u983b\u5ea6\u306b<span style=\"color: #000080;\">MYC\u5897\u5e45\u3042\u308b\u3044\u306fisodicentric 17q<\/span>\u304c\u3042\u308a\u307e\u3059\u3002MRI\u3067\u306f\u5c0f\u8133\u866b\u90e8\u767a\u751f\u3067\u816b\u760d\u5883\u754c\u304c\u306f\u3063\u304d\u308a\u3057\u306a\u3044\u3053\u3068\u304c\u3042\u308a\uff0c\u30ac\u30c9\u30ea\u30cb\u30a6\u30e0\u3067\u5f37\u304f\u5897\u5f37\u3055\u308c\u307e\u3059\u3002\u767a\u75c7\u6642\u304b\u3089\uff13\u5272\u304f\u3089\u3044\u306e\u4f8b\u3067\u64ad\u7a2e\u304c\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002<\/li>\n<\/ul>\n<h5><strong>\u907a\u4f1d\u5b50\u8a3a\u65ad\u306e\u306a\u3044\u9ac4\u82bd\u816b\uff1a\u7d44\u7e54\u8a3a\u65ad\u3060\u3051\u306b\u3088\u308b\u3082\u306e<br \/>\n<\/strong><strong>Classic medulloblastoma CMB<br \/>\nDesmoplastic\/nodular medulloblastoma DNMB<br \/>\nMedulloblastoma with extensive nodularity MBEN<br \/>\nAnaplastic\/large cell medulloblastoma<\/strong><\/h5>\n<p>\u907a\u4f1d\u5b50\u8a3a\u65ad\u3057\u306a\u304b\u3063\u305f\u5834\u5408\u306f\uff0c\u5f93\u6765\u306e\u7d44\u7e54\u8a3a\u65ad\u3060\u3051\u3067\u75c5\u540d\u3092\u3064\u3051\u3066\u304a\u304d\u307e\u3059<\/p>\n<h5>2021\u5e747\u6708\u6642\u70b9\u3067\uff0c\u4e0a\u8a18\u306e 4 molecular subgroups \u3068\u3055\u3089\u306b\u4e88\u5f8c\u306e\u5dee\u7570\u304c\u3042\u308b 12 subtypes \u304c\u3042\u308a\u307e\u3059<\/h5>\n<h4>\u81e8\u5e8a\u6240\u898b\u3092\u52a0\u3048\u308b\u3068\u3082\u3063\u3068\u8907\u96d1\u306a\u30ea\u30b9\u30af\u5206\u985e\u306b\u306a\u308a\u307e\u3059<br \/>\n\u3053\u308c\u306b\u3088\u3063\u3066\u6cbb\u7642\u65b9\u91dd\u304c\u6c7a\u3081\u3089\u308c\u308b\u65b9\u5411\u306b\u3042\u308a\u307e\u3059\u304c\uff0c\u8907\u96d1\u3067<strong><span style=\"color: #ff0000;\">\u884c\u304d\u5148\u4e0d\u660e\uff1f<\/span><\/strong><\/h4>\n<ul>\n<li>\u907a\u4f1d\u5b50\u8a3a\u65ad\u304c\u306a\u3055\u308c\u306a\u3044\u3068\u4e0a\u8a18\u306e\u5206\u985e\u304c\u3067\u304d\u307e\u305b\u3093<\/li>\n<li>2021\u5e747\u6708\u6642\u70b9\u3067\uff0c\u4e0a\u8a18\u306e<span style=\"color: #000080;\"><strong>4 molecular subgroups<\/strong><\/span>\u3068\u3055\u3089\u306b<strong><span style=\"color: #000080;\">12 subtypes<\/span><\/strong>\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>\u7d76\u5bfe\u7684\u8a3a\u65ad\u3068\u4fe1\u3058\u3089\u308c\u3066\u3044\u307e\u3059\u304c\uff0c<span style=\"color: #000080;\"><strong>\u907a\u4f1d\u5b50\u8a3a\u65ad\u306e\u8aa4\u8a3a\u3068\u3044\u3046\u3082\u306e\u3082\u610f\u5916\u306b\u591a\u3044<\/strong><\/span>\u3067\u3059<\/li>\n<li>\u307e\u305f\u907a\u4f1d\u5b50\u8a3a\u65ad\u3057\u3066\u3082\u4f8b\u5916\u3068\u306a\u308b\u3082\u306e\u306f\u5c11\u306a\u304f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li>\u5f53\u3066\u306f\u307e\u3089\u306a\u3044\u3082\u306e\u3092\uff0cmedulloblastoma NOS\u3068\u8868\u73fe\u3057\u307e\u3059<\/li>\n<li><span style=\"color: #000080;\"><strong><em>MYC<\/em>\u907a\u4f1d\u5b50<\/strong><\/span>\u5897\u5e45\u3067\u3082\u30ea\u30b9\u30af\u304c\u9ad8\u307e\u308a\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u306a\u308a\u307e\u3059<\/li>\n<li><strong><span style=\"color: #000080;\">\u907a\u4f1d\u5b50\u8a3a\u65ad\u306b\u304b\u304b\u308f\u3089\u305a\uff0c\u521d\u56de\u5316\u5b66\u7642\u6cd5\u306b\u53cd\u5fdc\u304c\u826f\u3044\u3082\u306e\u306f\u4f4e\u30ea\u30b9\u30af<\/span><\/strong>\u3068\u3044\u3046\u4e8b\u5b9f\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>2021\u5e74\u6642\u70b9\u3067\uff0c\u3053\u306e\u907a\u4f1d\u5b50\u8a3a\u65ad\u3067\u3069\u306e\u6cbb\u7642\u304c\u30d9\u30b9\u30c8\u3068\u3044\u3046\u306f\u3063\u304d\u308a\u3057\u305f\u9078\u629e\u80a2\u306f\u3042\u308a\u307e\u305b\u3093<\/li>\n<li><span style=\"color: #000080;\"><strong>\u5f93\u6765\u306e\u75c5\u7406\u7d44\u7e54\u8a3a\u65ad\u3067\uff0c<span style=\"color: #ff0000;\">\u5927\u7d30\u80de\u6027\uff0f\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b\u3068\u3055\u308c\u305f\u3082\u306e\u306f\u5168\u90e8\uff0c\u9ad8\u30ea\u30b9\u30af<\/span>\u3067\u3059\uff0c\u907a\u4f1d\u5b50\u8a3a\u65ad\u3057\u306a\u304f\u3066\u3082\u540c\u3058<\/strong><\/span><\/li>\n<\/ul>\n<hr \/>\n<h4><strong><span style=\"color: #ff0000;\"><span style=\"color: #000080;\"><span style=\"color: #ff0000;\">\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306e\u6a19\u6e96\u6cbb\u7642<\/span>\uff08Dr. \u30d1\u30c3\u30ab\u30fc\u306e\u6cbb\u7642\u6cd5\uff09<br \/>\n<\/span><\/span><\/strong><strong>CCNU\/\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3<\/strong><\/h4>\n<div class=\"setumei\">\n<p><span style=\"color: #000080;\"><strong>Packer RJ<\/strong><\/span>, et al.: Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol 24: 4202-4208, 2006<br \/>\n379\u4eba\u3082\u306e\u60a3\u8005\u3055\u3093\u304c\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u5927\u898f\u6a21\u81e8\u5e8a\u8a66\u9a13\uff08\u304d\u3061\u3093\u3068\u3057\u305f\u81e8\u5e8a\u7814\u7a76\uff09\u3067\u6cbb\u7642\u3055\u308c\u3066\u305d\u306e\u5206\u6790\u7d50\u679c\u304c\u3067\u307e\u3057\u305f\u3002\u5bfe\u8c61\u306f\uff0c<span style=\"color: #000080;\"><strong>\u64ad\u7a2e\u306e\u306a\u3044\u9ac4\u82bd\u816b\u3067\uff0c\u304b\u3064\u624b\u8853\u3067\u307b\u3068\u3093\u3069\u3068\u308c\u3066\u3044\u3066\uff0c3\u6b73\u304b\u308921\u6b73\u307e\u3067\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u5165\u308b\u9ac4\u82bd\u816b<\/strong><\/span>\u3067\u3059\u3002<br \/>\n\u57fa\u672c\u306b\u306a\u308b\u306e\u306f\uff0c<span style=\"color: #ff0000;\"><strong>23.4\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3068\u7dcf\u7dda\u91cf55.8\u30b0\u30ec\u30a4\u306e\u5f8c\u982d\u7aa9\u7167\u5c04<\/strong><\/span>\u3067\u3059\u3002\u305d\u306e\u5f8c\u306b\uff0c<span style=\"color: #ff0000;\"><strong>CCNU\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3<\/strong><\/span>\u3092\u4f7f\u3046\u5316\u5b66\u7642\u6cd5\u304b<span style=\"color: #ff0000;\"><strong>\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3<\/strong><\/span>\u3092\u4f7f\u3046\u5316\u5b66\u7642\u6cd5\u306e\u3044\u305a\u308c\u304b\u304c\u52a0\u3048\u3089\u308c\u307e\u3057\u305f\u3002MTX\u306e\u9ac4\u6ce8\u306f\u7528\u3044\u307e\u305b\u3093\u3002<br \/>\n\u624b\u8853\u5f8c31\u65e5\u4ee5\u5185\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u958b\u59cb\u3055\u308c\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306f\uff11\u9031\u9593\u306b\uff11\u5ea6\u306e\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3(1.5mg\/m2)\u306e\u6295\u4e0e\u304c\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u591a\u5264\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u306f\u8133\u810a\u9ac4\u7167\u5c04\u306e\uff16\u9031\u9593\u5f8c\u306b\u958b\u59cb\u3055\u308c\u3066\uff0c<span style=\"color: #000080;\"><strong>\u5408\u8a08\uff18\u30b3\u30fc\u30b9<\/strong><\/span>\u304c\u6295\u4e0e\u3055\u308c\u307e\u3057\u305f\u3002<br \/>\n\u300c\u7d50\u679c\u300d<span style=\"color: #000080;\"><strong>\u7121\u5897\u60aa\uff15\u5e74\u751f\u5b58\u5272\u5408\uff08\u518d\u767a\u306a\u3069\u304c\u306a\u304b\u3063\u305f\uff09\u306f81%<\/strong><\/span>\uff0c\u5168\uff15\u5e74\u751f\u5b58\u5272\u5408\u306f86%\u3067\u3057\u305f\u3002\u7d04\uff15\u5e74\u306e\u89b3\u5bdf\u671f\u9593\u3067\uff17\u4eba\u306e\u751f\u5b58\u8005\u306b2\u6b21\u764c\u304c\u767a\u751f\u3057\u307e\u3057\u305f\u3002\u5316\u5b66\u7642\u6cd5\u306e\u9055\u3044\uff08CCNU\u304b\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff09\u3067\u306f\u751f\u5b58\u5272\u5408\u306b\u5dee\u306f\u3042\u308a\u307e\u305b\u3093\u3067\u3057\u305f\u3002\u6700\u5f8c\u306b\uff0c<span style=\"color: #ff0000;\"><strong>\u5916\u79d1\u624b\u8853\u3067\u306e\u5408\u4f75\u75c7\u306b\u3088\u308b\u5f8c\u907a\u75c7\u304c\u591a\u3044<\/strong><\/span>\u3053\u3068\u304c\u89e6\u308c\u3089\u308c\u3066\u3044\u307e\u3059\u3002<br \/>\n2021\u5e74\u306b\u5831\u544a\u3055\u308c\u305f330\u540d\u3092\u5bfe\u8c61\u3068\u3057\u305f\u5927\u898f\u6a21\u81e8\u5e8a\u8a66\u9a13 SJMB03 phaseIII\u3067\u306f\uff0c\u540c\u3058\u5316\u5b66\u7642\u6cd5\u304c\uff14\u30b3\u30fc\u30b9\u4f7f\u7528\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<h5>\u89e3\u8aac<\/h5>\n<ul>\n<li>\u3053\u306e\u5831\u544a\u306f\u9ac4\u82bd\u816b\u306e\u7121\u4f5c\u70ba\u6bd4\u8f03\u8a66\u9a13\u3067\u306f\u6700\u3082\u5927\u898f\u6a21\u306a\u3082\u306e\u3067\u3059<\/li>\n<li>\u3068\u3066\u3082\u3044\u3044\u6210\u7e3e\u3067\u3059\u304b\u3089\uff0c\u3053\u306e\u5831\u544a\u3092\u3082\u3063\u3066\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306e\u9ac4\u82bd\u816b\u3067\u306f<span style=\"color: #000080;\"><strong>\u6a19\u6e96\u6cbb\u7642\u3068\u547c\u3079\u308b\u3082\u306e\u304c\u78ba\u7acb<\/strong><\/span>\u3055\u308c\u307e\u3057\u305f<\/li>\n<li>\u6700\u3082\u6ce8\u610f\u3059\u3079\u304d\u3053\u3068\u306f\u3053\u306e\u6210\u7e3e\u304c\u7a81\u51fa\u3057\u3066\u826f\u3044\u3053\u3068\u3067\u3059<\/li>\n<li>\u65e5\u672c\u3067\u540c\u3058\u3053\u3068\u3092\u3057\u3066\u540c\u3058\u6210\u7e3e\u304c\u5f97\u3089\u308c\u308b\u3068\u306f\u601d\u3048\u307e\u305b\u3093<\/li>\n<li>\u624b\u8853\u5f8c\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u958b\u59cb\u306f31\u65e5\u4ee5\u5185\u3068\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u304c\uff0c\u73fe\u5728\u3067\u306f\u3082\u3063\u3068\u65e9\u671f\u306b\u958b\u59cb\u3059\u308b\u3079\u304d\u3067\u3042\u308b\u3068\u3055\u308c\u3066\u3044\u307e\u3059<\/li>\n<li>\u3053\u306e\u8ad6\u6587\u3067\u306f\u5f8c\u982d\u7aa9\u7167\u5c04 55.8\u30b0\u30ec\u30a4\u304c\u4f7f\u7528\u3055\u308c\u3066\u3044\u307e\u3059\u304c\uff0c\u3053\u306e\u7dda\u91cf\u306e\u5f8c\u982d\u7aa9\u7167\u5c04\u306f\u77e5\u80fd\u4f4e\u4e0b\u3092\u751f\u3058\u307e\u3059<\/li>\n<li>\u8fd1\u5e74\u3067\u306f<span style=\"color: #ff0000;\"><strong>\u816b\u760d\u5e8a\u306b54\u30b0\u30ec\u30a4\u306e\u539f\u4f53\u7167\u5c04 conformal tumor bed boost<\/strong><\/span>\u304c\u4e00\u822c\u7684\u3067\u3059<\/li>\n<li>CCNU\u306f\u65e5\u672c\u3067\u624b\u306b\u5165\u308a\u307e\u305b\u3093\u304c\uff0c\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u306e\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u306f\u884c\u3046\u3053\u3068\u304c\u3067\u304d\u307e\u3059<\/li>\n<li>\u305f\u3060\u3057\uff0c<span style=\"color: #000080;\"><strong>\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306e\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u306e\u4f7f\u7528\u306b\u95a2\u3057\u3066\u306f\u7c73\u56fd\u3067\u3082\u5426\u5b9a\u7684\u306a\u610f\u898b<\/strong><\/span>\u304c\u591a\u304f\uff0c\u7701\u304f\u3053\u3068\u304c\u3067\u304d\u308b\u304b\u3082\u3057\u308c\u307e\u305b\u3093<\/li>\n<li>\u4f4e\u30ea\u30b9\u30af\u306e\u75c5\u7406\u50cf\u3092\u793a\u3059\u9ac4\u82bd\u816b\u306b8\u30b3\u30fc\u30b9\u307e\u3067\u306e\u5316\u5b66\u7642\u6cd5\u304c\u5fc5\u8981\u304b\u3068\u3044\u3046\u3053\u3068\u306b\u3082\u8b70\u8ad6\u304c\u3042\u308a\u307e\u3059<\/li>\n<li>\u307e\u305f\uff0c\u6b8b\u5b58\u816b\u760d1.5cm<sup>3<\/sup>\u3068\u3044\u3046\u306e\u306f\u7d76\u5bfe\u7684\u6570\u5024\u3068\u3057\u3066\u306e\u6839\u62e0\u304c\u3042\u3044\u307e\u3044\u3067\uff0c\u307b\u3068\u3093\u3093\u3069\u6458\u51fa\u3067\u304d\u305f\u304b\uff0c\u3042\u308b\u3044\u306f\u5927\u304d\u306a\u6b8b\u5b58\u816b\u760d\u304c\u3042\u308b\u304b\u3068\u3044\u3046\u5224\u65ad\u3092\u3057\u305f\u65b9\u304c\u73fe\u5b9f\u7684\u3067\u3059<\/li>\n<li>\u3053\u306e\u8ad6\u6587\u306e\u9ad8\u3044\u751f\u5b58\u7387\u306f\uff0c<span style=\"color: #333333;\">\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u306e\u4f53\u5236\u304c\u6574\u3063\u305f\u65bd\u8a2d\u3067\uff0c\u624b\u8853\u3067\u9ac4\u82bd\u816b\u304c\u5168\u6458\u3067\u304d\u3066\u3044\u3066\uff0c\u8853\u5f8c\u306e\u5408\u4f75\u75c7\u3092\u4e57\u308a\u5207\u308a\uff0c\u8853\u5f8c\u306b\u3082\u64ad\u7a2e\u304c\u306a\u304f\u3066\uff0c\u3042\u308b\u671f\u9593\u307e\u3067\u306b\u8133\u810a\u9ac4\u7167\u5c04\u304c\u958b\u59cb\u3067\u304d\u305f\uff0c\uff13\u6b73\u4ee5\u4e0a\u306e\u9ac4\u82bd\u816b\u3067\uff0c\u5316\u5b66\u7642\u6cd5\u304c\u5b8c\u9042\u3067\u304d\u305f\u75c7\u4f8b\u306e\u6210\u7e3e\u3067\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059<\/span><\/li>\n<li>\u3053\u308c\u3089\u306e\u6761\u4ef6\u3092\u5168\u3066\u6e80\u305f\u3055\u306a\u3051\u308c\u3070\uff0c\u540c\u3058\u6cbb\u7642\u3067\u3053\u306e\u9ad8\u3044\u6210\u7e3e\u306f\u51fa\u307e\u305b\u3093<\/li>\n<li>\u3053\u306e\u8ad6\u6587\u306e\u6761\u4ef6\u3068\u3057\u3066\uff0c\u624b\u8853\u3067\u5341\u5206\u306a\u6458\u51fa\u304c\u3067\u304d\u3066\u3044\u306a\u3044\u5834\u5408\u306f\u3053\u306e\u6cbb\u7642\u6cd5\u3092\u305d\u306e\u307e\u307e\u9069\u5fdc\u3059\u308b\u3053\u3068\u306f\u3067\u304d\u307e\u305b\u3093\u304c\uff0c\u5b9f\u969b\u306b\u306f\u6b8b\u5b58\u816b\u760d\u304c\u5927\u304d\u304f\u3066\u3082\u540c\u3058\u6cbb\u7642\u304c\u5fdc\u7528\u3067\u304d\u307e\u3059<\/li>\n<li>\u3057\u304b\u3057\uff0c\u3069\u3053\u304b\u306e\u30bf\u30a4\u30df\u30f3\u30b0\u3067\u6b8b\u5b58\u816b\u760d\u3092\u6458\u51fa\u3059\u308b<strong><span style=\"color: #000080;\">\u518d\u624b\u8853 second-look surgery<\/span><\/strong> \u3042\u308b\u3044\u306f\u5b9a\u4f4d\u653e\u5c04\u7dda\u6cbb\u7642\u306b\u3088\u308b\u9ad8\u7dda\u91cfboost\u304c\u5fc5\u8981\u3068\u306a\u308b\u3053\u3068\u3082\u3042\u308a\u307e\u3059<\/li>\n<\/ul>\n<h5 align=\"left\">\u5e74\u5c11\u5150\u3067\u3053\u306e\u5316\u5b66\u7642\u6cd5\u306e\u6295\u4e0e\u91cf\u3092\u591a\u304f\u3057\u305f\u3089\u3069\u3046\u306a\u308b\u304b\uff1f<\/h5>\n<p align=\"left\">Strother DR, et al.: Benefit from prolonged dose-intensive chemotherapy for infants with malignant brain tumors is restricted to patients with ependymoma: a report of the Pediatric Oncology Group randomized controlled trial 9233\/34. Neuro Oncol 16: 457-65, 2014<br \/>\n\uff13\u6b73\u672a\u6e80\u3067\uff0c112\u4eba\u306e\u9ac4\u82bd\u816b\u304c\u767b\u9332\u3055\u308c\u305fPOG 9233\u306e\u7d50\u679c\u3067\u3059\u3002\u6a19\u6e96\u7684\u6cbb\u7642\u306e\u304a\u3088\u305d1.8\u500d\u306e\u5316\u5b66\u7642\u6cd5\u5264\u304c\u6295\u4e0e\u3055\u308c\u307e\u3057\u305f\u304c\uff0c\u3053\u306e\u5e74\u9f62\u5c64\u3067\u306f\u5316\u5b66\u7642\u6cd5\u5264\u306e\u91cf\u3092\u5897\u3084\u3059\u3060\u3051\u3067\u306f\uff0c\u7121\u5897\u60aa\u751f\u5b58\u671f\u9593\u3082\u5168\u751f\u5b58\u671f\u9593\u3082\u6539\u5584\u3057\u307e\u305b\u3093\u3067\u3057\u305f\u3002<\/p>\n<h4>\u9ac4\u82bd\u816b\u306e\u624b\u8853\u306b\u3064\u3044\u3066\uff08\u60a3\u8005\u3055\u3093\u306e\u4e21\u89aa\u3068\u8133\u5916\u79d1\u306e\u5148\u751f\u3078\uff09<\/h4>\n<h5>\u9ac4\u82bd\u816b\u306e\u624b\u8853\u306f\u96e3\u3057\u304f\u3066\uff0c\u3053\u306e\u624b\u8853\u3092\u7684\u78ba\u306b\u3067\u304d\u308b\u8133\u5916\u79d1\u533b\u306f\u65e5\u672c\u306b\u307b\u3068\u3093\u3069\u3044\u307e\u305b\u3093<\/h5>\n<p>\u6fa4\u6751\u81ea\u8eab\u306b\u3068\u3063\u3066\u3082\u9ac4\u82bd\u816b\u306e\u624b\u8853\u304c\u3068\u3066\u3082\u96e3\u3057\u3044\u3068\u8003\u3048\u3066\u3044\u307e\u3059\u3057\uff0c\u601d\u308f\u306c\u3064\u3089\u3044\u5408\u4f75\u75c7\u306b\u51fa\u4f1a\u3063\u305f\u3053\u3068\u306f\u3042\u308a\u307e\u3059\u3002\u9ac4\u82bd\u816b\u306e\u624b\u8853\u306f\u7c21\u5358\u306a\u3082\u306e\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u304c\uff0c\u624b\u8853\u6210\u7e3e\u304c\u9577\u671f\u751f\u5b58\u5272\u5408\u306b\u5927\u304d\u306a\u5f71\u97ff\u3092\u4e0e\u3048\u307e\u3059\u3002\u3067\u3059\u304b\u3089\uff0c\u9ac4\u82bd\u816b\u306e\u624b\u8853\u7d4c\u9a13\u306e\u3042\u308b\u8133\u5916\u79d1\u533b\u304c\u3044\u3066\uff0c\u9ac4\u82bd\u816b\u3092\u6cbb\u7642\u3067\u304d\u308b\u8a2d\u5099\u306e\u3042\u308b\u65bd\u8a2d\u3067\u6cbb\u7642\u3092\u958b\u59cb\u3057\u305f\u307b\u3046\u304c\u3044\u3044\u3067\u3059\u3002\u305d\u306e\u3088\u3046\u306a\u7d4c\u9a13\u306e\u3042\u308b\u8133\u5916\u79d1\u533b\u304c\u3044\u306a\u3044\u5834\u5408\u3084\u65bd\u8a2d\u3067\u306f\uff0c\u60a3\u5150\u3092\u306a\u308b\u3079\u304f\u65e9\u304f\u9069\u5207\u306a\u65bd\u8a2d\u306b\u8ee2\u9001\u3059\u308b\u3088\u3046\u306a\u30b7\u30b9\u30c6\u30e0\u304c\u5fc5\u8981\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u624b\u8853\u3060\u3051\u3057\u3066\u304b\u3089\u8ee2\u9662\u3057\u3066\u306f\u304d\u3061\u3093\u3068\u3057\u305f\u6cbb\u7642\u304c\u3067\u304d\u306a\u3044\u3053\u3068\u3082\u3042\u308a\u307e\u3059\u3002<\/p>\n<p>\u624b\u8853\u3067\u6700\u3082\u3057\u3066\u3044\u3051\u306a\u3044\u3053\u3068\u306f\uff0c\u53d6\u308c\u308b\u306f\u305a\u306e\u90e8\u5206\u306e\u816b\u760d\u3092\u53d6\u308a\u6b8b\u3059\u3053\u3068\u3067\u3059\u3002\u5f53\u305f\u308a\u524d\u306e\u3053\u3068\u3067\u3059\u304c\uff0c\u53d6\u308a\u6b8b\u3057\u304c\u591a\u3044\u307b\u3069\u6b7b\u4ea1\u7387\u306f\u9ad8\u304f\u306a\u308a\u307e\u3059\u3002\u624b\u8853\u306e\u5408\u4f75\u75c7\u3067\u983b\u5ea6\u304c\u9ad8\u3044\u306e\u306f\uff0c\u5c0f\u8133\u5931\u8abf\u3068\u8133\u795e\u7d4c\u9ebb\u75fa\u3067\u3059\u3002\u624b\u8853\u5f8c\u907a\u75c7\u3068\u3057\u3066\uff0c\u4f53\u5e79\u5931\u8abf\uff0c\u5916\u8ee2\u795e\u7d4c\u9ebb\u75fa\uff0c\u9854\u9762\u795e\u7d4c\u9ebb\u75fa\uff0c\u773c\u7403\u904b\u52d5\u969c\u5bb3\uff0c\u56a5\u4e0b\u969c\u5bb3\u3092\u3082\u3063\u3066\u3044\u308b\u5b50\u4f9b\u305f\u3061\u3092\u305f\u304f\u3055\u3093\u898b\u307e\u3057\u305f\u3002\u3067\u3082\u60a3\u8005\u3055\u3093\u5074\u304b\u3089\u306f\uff0c\u7a4d\u6975\u7684\u306a\u6458\u51fa\u304c\u5f8c\u907a\u75c7\u306e\u5371\u967a\u3068\u88cf\u8179\u306a\u3053\u3068\u306f\u7406\u89e3\u3057\u3066\u304f\u3060\u3055\u3044\u3002\u4e00\u6642\u7684\u306b\u8853\u5f8c\u306b\u51fa\u308b\u75c7\u72b6\u3068\u3057\u3066\u6709\u540d\u306a\u306e\u304c<span style=\"color: #ff0000;\"><strong>\u5c0f\u8133\u6027\u7121\u8a00\u75c7<\/strong><\/span>\uff08\u5f8c\u982d\u7aa9\u75c7\u5019\u7fa4\uff09\u8a00\u8449\u304c\u51fa\u306a\u3044\u7121\u8a00\uff09\u3067\u3059\u304c\uff0c\u591a\u304f\u306e\u5834\u5408\u306f\u6570\u65e5\u304b\u3089\u6570\u9031\u9593\u3067\u6539\u5584\u3057\u3066\u3044\u304d\u307e\u3059\u3002\u3057\u304b\u3057\uff0c<span style=\"color: #000080;\"><strong>\u3053\u306e\u75c7\u72b6\u304c\u51fa\u308b\u3068\u305d\u306e\u5f8c\u306e\u77e5\u80fd\u767a\u9054\u3068\u8a00\u8a9e\u767a\u9054\u306b\u5f71\u97ff\u304c\u53ca\u3076\u3053\u3068\u304c\u3042\u308a\u307e\u3059<\/strong><\/span>\u3002<\/p>\n<p>MRI\u3067\u9ac4\u82bd\u816b\u3092\u307f\u308b\u3068\u4e00\u898b\u3057\u3066\u5883\u754c\u304c\u306f\u3063\u304d\u308a\u3057\u3066\u3044\u308b\u3088\u3046\u306b\u898b\u3048\u307e\u3059\u304c\uff0c\u5b9f\u969b\u306b\u958b\u3051\u3066\u307f\u308b\u3068\u5c0f\u8133\u3084\u8133\u5e79\u90e8\u306b\u30d9\u30c8\u30d9\u30c8\u304f\u3063\u3064\u3044\u3066\u3044\u3066\uff0c\u8133\u7d44\u7e54\u304b\u3089\u306f\u304c\u308c\u3066\u304f\u308c\u307e\u305b\u3093\u3002 \u3067\u3082\uff0c\u898b\u3048\u308b\u9650\u308a\u306e\u816b\u760d\u306f\u6458\u51fa\u3057\u305f\u307b\u3046\u304c\u52a9\u304b\u308b\u78ba\u7387\u306f\u9ad8\u304f\u306a\u308a\u307e\u3059\u3057\uff0c\u9006\u306b\u3001\u7121\u7406\u306a\u6458\u51fa\u306f\u8133\u5e79\u3084\u8133\u795e\u7d4c\u306e\u640d\u50b7\u3092\u62db\u304d\u307e\u3059\u3002\u3068\u3066\u3082\u96e3\u3057\u3044\u306e\u3067\u6163\u308c\u3066\u3044\u3066\u3082\u307b\u3068\u307b\u3068\u56f0\u3063\u305f\u5834\u9762\u306b\u306a\u3063\u3066\u3057\u307e\u3046\u3053\u3068\u3082\u591a\u3044\u3067\u3059\u3002\u8133\u795e\u7d4c\u5916\u79d1\u533b\u306b\u3068\u3063\u3066\u3082\u9ac4\u82bd\u816b\u306e\u624b\u8853\u306f\u6016\u3044\u3082\u306e\u3067\u3059\u3002\u3082\u3061\u308d\u3093\u9ac4\u82bd\u816b\u306e\u4e2d\u306b\u306f\u653e\u5c04\u7dda\u3084\u5316\u5b66\u7642\u6cd5\u304c\u3088\u304f\u52b9\u304f\u30bf\u30a4\u30d7\u3082\u3042\u308a\u307e\u3059\u304b\u3089\uff0c\u3072\u3069\u3044\u5f8c\u907a\u75c7\u304c\u51fa\u305d\u3046\u306a\u3089\u816b\u760d\u3092\u6b8b\u3057\u305f\u307e\u307e\u624b\u8853\u3092\u7d42\u4e86\u3057\u307e\u3059\u3002<\/p>\n<p>\u9ac4\u82bd\u816b\u306f\uff0c\u64ad\u7a2e\u518d\u767a\u3057\u3066\u6b7b\u4ea1\u3059\u308b\u3053\u3068\u304c\u591a\u3044\u816b\u760d\u3067\u3059\u3002\u624b\u8853\u306e\u524d\u306b\u64ad\u7a2e\uff08\u8ee2\u79fb\uff09\u304c\u306a\u304f\u3066\u3082\uff0c\u64ad\u7a2e\u518d\u767a\u3057\u3066\u6b7b\u4ea1\u3059\u308b\u4f8b\u306f\u305f\u304f\u3055\u3093\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u3088\u3046\u306a\u4f8b\u3067\u306f\uff0c\u624b\u8853\u3067\u816b\u760d\u7d30\u80de\u3092\u307e\u304d\u6563\u3089\u3057\u3066\u3057\u307e\u3063\u305f\u53ef\u80fd\u6027\u304c\u3042\u308b\u3068\u8133\u5916\u79d1\u533b\u306f\u8003\u3048\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002\u9ac4\u82bd\u816b\u7d30\u80de\u306f\u9ac4\u6db2\u306e\u4e2d\u3067\u751f\u304d\u6b8b\u308c\u308b\u306e\u3067\uff0c\u30c9\u30ed\u30c9\u30ed\u306b\u67d4\u3089\u304b\u3044\u90e8\u5206\u306e\u9ac4\u82bd\u816b\u3092\u53d6\u3063\u3066\u3044\u308b\u6642\u306b\uff0c\u305f\u304f\u3055\u3093\u306e\u816b\u760d\u7d30\u80de\u3092\u9ac4\u6db2\u306e\u4e2d\u306b\u307e\u304d\u6563\u3089\u3057\u3066\u3044\u308b\u53ef\u80fd\u6027\u306f\u9ad8\u3044\u3068\u601d\u3063\u3066\u304f\u3060\u3055\u3044\u3002\u3053\u308c\u3092\u907f\u3051\u308b\u305f\u3081\u306b\u306f\u3044\u308d\u3044\u308d\u5de5\u592b\u304c\u5fc5\u8981\u3067\u3059\u3002\u4f8b\u3048\u3070\uff0c\u8d85\u97f3\u6ce2\u5438\u5f15\u5668\u306f\u6d17\u6d44\u6c34\u3067\u7d30\u80de\u3092\u307e\u304d\u6563\u3089\u3059\u306e\u3067\u4f7f\u308f\u306a\u3044\u3068\u304b\u3067\u3059\u3002\u9ac4\u82bd\u816b\u3092\u6cbb\u7642\u3059\u308b\u533b\u5e2b\u306f\uff0c<span style=\"color: #ff0000;\"><strong>\u624b\u8853\u8a98\u767a\u64ad\u7a2e<\/strong><\/span>\u3068\u3044\u3046\u3053\u3068\u3070\u3092\u77e5\u3089\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3057\uff0c\u305d\u3046\u3057\u306a\u3044\u3088\u3046\u306b\u6700\u5927\u9650\u306e\u52aa\u529b\u3092\u3057\u307e\u3059\u3002<\/p>\n<p>\u8853\u76f4\u5f8c\u306e\u5408\u4f75\u75c7\u3068\u3057\u3066\u907f\u3051\u308b\u3079\u304d\u306a\u306e\u306f<span style=\"color: #ff0000;\"><strong>\u9ac4\u6db2\u306e\u554f\u984c<\/strong><\/span>\u3067\u3059\u3002\u6c34\u982d\u75c7\u3084\u9ac4\u6db2\u6f0f\u304c\u3042\u308b\u3068\u5316\u5b66\u7642\u6cd5\u3084\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u958b\u59cb\u306e\u6642\u671f\u304c\u9045\u308c\u307e\u3059\u3002\u5f8c\u982d\u90e8\u306b\u76ae\u4e0b\u9ac4\u6db2\u8caf\u7559\u304c\u3042\u308b\u3068\u539f\u56e0\u4e0d\u660e\u306e\u767a\u71b1\u304c\u9577\u304f\u7d9a\u304f\u3053\u3068\u304c\u3042\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u5c40\u6240\u306e\u611f\u67d3\u3067\u3059\u304c\u3001CRP\u306a\u3069\u306e\u708e\u75c7\u6240\u898b\u3092\u793a\u3059\u30c7\u30fc\u30bf\u304c\u9670\u6027\u306b\u306a\u308b\u305f\u3081\u306b\u8a3a\u65ad\u3092\u8aa4\u308b\u3053\u3068\u304c\u591a\u3044\u3067\u3059\u3002\u5bfe\u7b56\u3068\u3057\u3066\u3001\u6e1b\u5727\u958b\u982d\u306e\u3088\u3046\u306a\u5fc5\u8981\u4ee5\u4e0a\u306b\u5927\u304d\u306a\u958b\u982d\u3092\u3057\u306a\u3044\u3068\u304b\uff0ccraniectomy\u3092\u3057\u306a\u3044\u3068\u304b\uff0c\u786c\u819c\u3092\u713c\u304b\u306a\u3044\u3068\u304b\uff0c\u4eba\u5de5\u786c\u819c\u3092\u4f7f\u308f\u306a\u3044\u3068\u304b\uff0c\u8853\u5f8c\u51fa\u8840\u3092\u8d77\u3053\u3055\u306a\u3044\u3068\u304b\uff0c\u4e2d\u8133\u6c34\u9053\u3092\u3057\u3063\u304b\u308a\u958b\u3051\u308b\u3068\u304b\uff0c\u50e7\u5e3d\u7b4b\u306e\u6df1\u90e8\u306e\u7e2b\u5408\u3092\u7dca\u5bc6\u306b\u3059\u308b\u3068\u304b\uff0c\u624b\u8853\u306e\u64cd\u4f5c\u304c\u3057\u3063\u304b\u308a\u3057\u3066\u3044\u308c\u3070\u3053\u306e\u3088\u3046\u306a\u554f\u984c\u306f\u56de\u907f\u3067\u304d\u308b\u3053\u3068\u3082\u591a\u3044\u306e\u3067\u3059\u3002\u75c5\u7406\u8a3a\u65ad\u3092\u6025\u3052\u3070\u958b\u982d\u8853\u5f8c\u306e\uff11\u9031\u9593\u4ee5\u5185\u306b\u5316\u5b66\u7642\u6cd5\u3092\u958b\u59cb\u3059\u308b\u3053\u3068\u306f\u53ef\u80fd\u3067\u3059\u3002\u3057\u304b\u3057\uff0c\u5168\u6458\u51fa\u306e\u5371\u967a\u304c\u9ad8\u3059\u304e\u308b\u6642\u306a\u3069\uff0c\u9ac4\u6db2\u30c9\u30ec\u30ca\u30fc\u30b8\u3092\u3057\u306a\u3051\u308c\u3070\u6c34\u982d\u75c7\u304c\u6539\u5584\u3067\u304d\u306a\u3044\u5834\u5408\u3082\u3042\u308a\u307e\u3059\u3002<\/p>\n<\/div>\n<div class=\"setumei\">\n<h5><strong><span style=\"color: #ff0000;\">\u751f\u5b58\u306e\u8cea\u3092\u4fdd\u3063\u3066\u751f\u304d\u6b8b\u308b\u305f\u3081\u306e\u6700\u3082\u5927\u5207\u306a\u7b2c\uff11\u6b69\u306f\uff0c\u5316\u5b66\u7642\u6cd5\u3067\u3082\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u3082\u306a\u304f\uff0c\u5b89\u5168\u306a\u624b\u8853\u3067\u3059<\/span><\/strong><\/h5>\n<p><span style=\"color: #ff0000;\"><span style=\"color: #000000;\">\u4e00\u65b9\u3067\uff0c<span style=\"color: #000080;\"><strong>\u6458\u51fa\u624b\u8853\u3092\u3057\u306a\u3044\u3067\u6cbb\u7642\u3059\u308b\u3068\u3044\u3046\u9078\u629e\u80a2\u306f\u3042\u308a\u307e\u3059<\/strong><\/span>\u3002\u306a<span style=\"color: #333333;\">\u305c\u306a\u3089<\/span><\/span><\/span><span style=\"color: #333333;\">\uff0c\u4e16\u754c\u6a19\u6e96\u6cbb\u7642\u306f\uff0c \u307e\u305a\u624b\u8853\uff0c\u3067\u3082\uff0c\u75c7\u4f8b\u5206\u6563\u306e\u305f\u3081\u306b\uff0c\u65e5\u672c\u306e\u8133\u5916\u79d1\u533b\u306b\u306f\u9ac4\u82bd\u816b\u306e\u624b\u8853\u7d4c\u9a13\u304c\u307b\u3068\u3093\u3069\u306a\u3044\uff0c\u304b\u3064\uff0c \u719f\u7df4\u3057\u3066\u3044\u308b\u8853\u8005\u304c\u5b58\u5728\u3057\u306a\u3044\u304b\u3082\u3057\u308c\u306a\u3044\u304b\u3089\u3067\u3059\u3002<\/span><\/p>\n<h4><strong>\u5c0f\u8133\u6027\u7121\u8a00\u75c7 cerebellar mutism<\/strong><\/h4>\n<p>\u4e3b\u3068\u3057\u3066\u5c0f\u8133\u866b\u90e8\u767a\u751f\u306e\u816b\u760d\u306e\u8853\u5f8c\u306b\u51fa\u308b\u75c7\u72b6\u3068\u3057\u3066<span style=\"color: #000080;\"><strong>\u5c0f\u8133\u6027\u7121\u8a00\u75c7\uff08cerebellar mutism) \u3068\u5f8c\u982d\u4e0b\u75c7\u5019\u7fa4 (posterior fossa syndrome\uff09<\/strong><\/span>\u304c\u3042\u308a\u307e\u3059\u3002\u610f\u8b58\u306f\u3042\u3063\u3066\u666e\u901a\u306b\u53cd\u5fdc\u3059\u308b\u306e\u306b\u8a00\u8449\u304c\u5168\u304f\u51fa\u306a\u3044\u3068\u3044\u3046\u75c7\u72b6\u3067\u3059\u3002\u3053\u308c\u306f\u901a\u5e38\uff0c\u6570\u65e5\u304b\u3089\u6570\u9031\u9593\u3067\u6539\u5584\u3057\u307e\u305a\u304c\uff0c\u5c0f\u5150\u3067\u3053\u306e\u75c7\u72b6\u304c\u3067\u308b\u3068\u5c06\u6765\u306e\u8a8d\u77e5\u6a5f\u80fd\u3068\u8a00\u8a9e\u306e\u767a\u9054\u306b\u9045\u308c\u304c\u3067\u307e\u3059\u3002\u5c0f\u8133\u6df1\u90e8\u767d\u8cea\u3042\u308b\u3044\u306f\u866b\u90e8\u306e\u5927\u304d\u306a\u624b\u8853\u640d\u50b7\u304c\u306a\u3051\u308c\u3070\u3053\u306e\u5c0f\u8133\u6027\u7121\u8a00\u75c7\u306f\u751f\u3058\u307e\u305b\u3093\u3002<span style=\"color: #000080;\"><strong>50%\u306e\u60a3\u5150\u3067\u306f\uff0c\u8853\u5f8c16\u65e5\u4ee5\u5185\u306b\u7121\u8a00\u75c7\u304b\u3089\u8a00\u8a9e\u767a\u51fa\u4f4e\u4e0b\u306b\u79fb\u884c\u3057\u307e\u3059<\/strong><\/span>\u3002\u3053\u306e\u6642\u70b9\u3067\u3082\u56de\u5fa9\u3057\u306a\u3044\u5834\u5408\u306b\u306f\u8a8d\u77e5\u6a5f\u80fd\u969c\u5bb3\u304c\u6b8b\u308b\u3053\u3068\u304c\u591a\u3044\u3067\u3057\u3087\u3046\u3002<\/p>\n<h4><strong>cerebellar fits, cerebellar seizures \u5c0f\u8133\u767a\u4f5c\uff0c\u5c0f\u8133\u3066\u3093\u304b\u3093<\/strong><\/h4>\n<p>\u5c0f\u8133\u3066\u3093\u304b\u3093\uff0c\u5c0f\u8133\u767a\u4f5c\u3068\u547c\u3070\u308c\u307e\u3059\u3002\u5c0f\u8133\u6241\u6843\u30d8\u30eb\u30cb\u30a2\u3042\u308b\u3044\u306f\u8133\u5e79\u90e8\u3078\u306e\u5f37\u3044\u5727\u8feb\u304c\u3042\u308b\u72b6\u614b\u3067\u751f\u3058\u308b\u75c7\u72b6\u3067\u3059\u3002\u75c7\u72b6\u306f\uff0c\u982d\u75db\u304b\u3089\u610f\u8b58\u969c\u5bb3\uff0c\u3066\u3093\u304b\u3093\u985e\u4f3c\u767a\u4f5c\u3067\u3059\u3002\u5f37\u76f4\u6027\u767a\u4f5c\u3084\u8ef8\u525b\u6027 axial rigidity \u3068\u904b\u52d5\u6027\u81ea\u52d5\u75c7\u304c\u307f\u3089\u308c\u307e\u3059\u3002\u5927\u304d\u306a\u5c0f\u8133\u640d\u50b7\uff08\u816b\u760d\u3084\u51fa\u8840\uff09\u3067\u3082\u307f\u3089\u308c\u307e\u3059\u3002\u7a81\u7136\u306e\u8ee2\u5012 drop attack\u3084\u547c\u5438\u4e0d\u5168\u3092\u4f34\u3046\u3053\u3068\u3082\u3042\u308a\u307e\u3059\u3002\u5927\u8133\u8d77\u6e90\u306e\u3066\u3093\u304b\u3093\u767a\u4f5c\u3068\u8aa4\u8a3a\u3055\u308c\u308b\u3053\u3068\u304c\u3042\u308b\u306e\u3067\u6ce8\u610f\u3057\u307e\u3059\u3002<\/p>\n<\/div>\n<h5>\u6700\u8fd1\u306e\u624b\u8853\u306e\u8003\u3048\u65b9<\/h5>\n<p>Thompson EM, et al.: Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis. Lancet Oncol 2016 Mar 11<br \/>\n787\u4f8b\u306e\u9ac4\u82bd\u816b\u306e\u624b\u8853\u6210\u7e3e\u304c\u89e3\u6790\u3055\u308c\u307e\u3057\u305f\u3002\u5168\u6458\u51fa\uff0c\u4e9c\u5168\u6458\u51fa(\u6b8b\u5b58\u816b\u760d&lt;1.5ml)\uff0c\u90e8\u5206\u6458\u51fa\u3067\u8a55\u4fa1\u304c\u884c\u308f\u308c\u307e\u3057\u305f\u3002\u5168\u6458\u51fa\u3068\u4e9c\u5168\u6458\u51fa\u3067\u6bd4\u8f03\u3057\u305f\u5834\u5408\uff0c\u5168\u751f\u5b58\u5272\u5408\u306e\u9055\u3044\u306f\u306a\u304b\u3063\u305f\u3068\u3044\u3046\u30c7\u30fc\u30bf\u3067\u3059\u3002WNT, SHH, group 3\u3067\u816b\u760d\u3092\u5168\u6458\u51fa\u3057\u3066\u3082\u751f\u5b58\u5272\u5408\u306b\u5bfe\u3059\u308bbenefit\u306f\u3042\u308a\u307e\u305b\u3093\u3067\u3057\u305f\u3002<br \/>\n\u300c\u89e3\u8aac\u300d<span style=\"color: #ff0000;\"><strong>\u7121\u7406\u3057\u3066\u5168\u6458\u3057\u306a\u304f\u3066\u3082\u3088\u304f\u3066\uff0c\u3060\u3044\u305f\u3044\u5168\u90e8\u53d6\u308c\u3070\u826f\u3044<\/strong><\/span>\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u5b89\u5168\u3067\u3088\u308a\u591a\u304f\u306e\u816b\u760d\u3092\u6458\u51fa\u3059\u308b\u3053\u3068\u306f\uff0c\u4eca\u3082\u6a19\u6e96\u6cbb\u7642 standard care\u306a\u306e\u3067\u3059\u304c\uff0c<span style=\"color: #000080;\"><strong>\u5f8c\u907a\u75c7 neurological morbidity\u3092\u51fa\u3057\u3066\u307e\u3067\u7121\u7406\u3057\u3066\u6458\u51fa\u3057\u3066\u306f\u3044\u3051\u306a\u3044<\/strong><\/span>\u3068\u3044\u3046\u7d50\u8ad6\u3067\u3059\u3002\u5c0f\u3055\u306a\u6b8b\u5b58\u816b\u760d\u304c\u96e3\u3057\u3044\u5834\u6240\u306b\u3042\u308b\u5834\u5408\u306f\uff0csecond-look surgery\u306f\u3057\u306a\u3044\u3002<\/p>\n<h4>\u6cbb\u7642\u5f8c\u306e\u518d\u767a\u306f\uff1f<\/h4>\n<p>2021\u5e74\u6642\u70b9\u3067\uff0c\u9ac4\u82bd\u816b\u5168\u4f53\u3067\u306e\u6cbb\u7642\u5f8c\u306e\u518d\u767a\u306f30\uff05\u307b\u3069\uff0c\u307b\u3068\u3093\u3069\u306e\u518d\u767a\u306f5\u5e74\u4ee5\u5185\u306b\u751f\u3058\u308b\u3068\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u518d\u6cbb\u7642\u3067\u306f\u8133\u810a\u9ac4\u7167\u5c04\u304c\u4f7f\u7528\u3067\u304d\u306a\u3044\u306e\u3067\u6709\u52b9\u6027\u306f\u4f4e\u304f\uff0c\u305d\u306e\u4e2d\u3067\u306e10%\u304f\u3089\u3044\u306e\u5b50\u4f9b\u305f\u3061\u304c5\u5e74\u3092\u8d85\u3048\u3066\u751f\u5b58\u3057\u307e\u3059\u3002<br \/>\n\u6b8b\u5ff5\u306a\u304c\u3089\uff0c\u518d\u767a\u306f\u64ad\u7a2e\u518d\u767a\u304c\u591a\u3044\u306e\u3067\u6cbb\u7642\u65b9\u6cd5\u306f\u3042\u308a\u307e\u305b\u3093\u3002PBSCT\u3068\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3092\u7528\u3044\u3066\u3082\u816b\u760d\u3092\u6d88\u3059\u3053\u3068\u304c\u3067\u304d\u305a\uff0c\u8133\u810a\u9ac4\u7167\u5c04\u3082\u5341\u5206\u306a\u7dda\u91cf\u3092\u7528\u3044\u308b\u3053\u3068\u306f\u3067\u304d\u307e\u305b\u3093\u3002\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u3084\u30a8\u30c8\u30dd\u30b7\u30c9\u306a\u3069\u306e\u7d4c\u53e3\u6297\u304c\u3093\u5264\u3092\u670d\u7528\u3057\u3066\u9032\u884c\u3092\u5c11\u3057\u9045\u3089\u305b\u308b\u3068\u3044\u3046\u3088\u3046\u306a\uff0c\u7de9\u548c\u7684\u306a\u7642\u6cd5\u304c\u7528\u3044\u3089\u308c\u308b\u3053\u3068\u304c\u591a\u3044\u3067\u3059\u3002<\/p>\n<div class=\"setumei\">\n<h4>\u751f\u5b58\u7387\u306f\uff1f<\/h4>\n<p>\u6b63\u78ba\u306b\u306f\u751f\u5b58\u5272\u5408\u3068\u3044\u3044\u307e\u3059\u3002\u5c02\u9580\u7528\u8a9e\u3067\u306f\uff0c\u6cbb\u7642\u5f8c\uff15\u5e74\u306e\u6642\u70b9\u306e\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 PFS \u3068\u304b\u5168\u751f\u5b58\u5272\u5408 OS \u3068\u304b\u3044\u3046\u7528\u8a9e\u3092\u4f7f\u3044\u307e\u3059\u3002\u3067\u3082\u3053\u308c\u3089\u306f\uff0c\u78ba\u5b9f\u306b\u6cbb\u7652\u3059\u308b\u3068\u3044\u3046\u610f\u5473\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u3069\u306e\u3088\u3046\u306a\u6cbb\u7642\u3067\u3042\u308c\uff0c\u521d\u671f\u6cbb\u7642\u306e\u5f8c\u3067\u518d\u767a\u3059\u308c\u3070\u52a9\u304b\u308b\u30c1\u30e3\u30f3\u30b9\u306f\u4f4e\u304f\uff0c\u6cbb\u7642\u306e\uff18\u5e74\u5f8c\u306b\u518d\u767a\u6b7b\u4ea1\u3059\u308b\u4f8b\u3082\u3042\u308b\u306e\u3067\u3059\u304b\u3089\u3002\uff15\u5e74\u306e\u6642\u70b9\u3067\u518d\u767a\u3092\u62b1\u3048\u3066\u3044\u3066\u306f\u6cbb\u7652\u3078\u306e\u671f\u5f85\u306f\u8584\u304f\u306a\u308a\u307e\u3059\u3002\u3068\u306b\u304b\u304f\u6700\u521d\u306e\u6cbb\u7642\u3067\u6cbb\u3057\u3066\u3057\u307e\u3048\u308b\u304b\u3069\u3046\u304b\u304c\u9375\u3067\u3059\u3002<\/p>\n<p>2005\u5e74\u306e10\u6708\u306e\u8ad6\u6587\u3067\u6709\u540d\u306a\u7c73\u56fd\u306ePaker RJ\u3068\u3044\u3046\u5148\u751f\u304c\uff0c<strong><span style=\"color: #ff0000;\"> <span class=\"style1\">\u6a19\u6e96\u30ea\u30b9\u30af\u306e\u9ac4\u82bd\u816b\u60a3\u8005\u3055\u3093\u3067\u306e5\u5e74\u751f\u5b58\u7387\u306f80%\u304f\u3089\u3044<\/span><\/span><\/strong>\u3067\uff0c\u64ad\u7a2e\u304c\u3042\u3063\u305f\u308a\uff13\u6b73\u672a\u6e80\u306a\u3069\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u60a3\u8005\u3055\u3093\u3067\u308210\u4eba\u306b7\u4eba\u304f\u3089\u3044\u306f\u751f\u5b58\u3067\u304d\u308b\u3068\u3057\u3066\u3044\u307e\u3059\u3002\u3067\u3082\uff0c\u73fe\u5b9f\u306b\u306f\uff13\u6b73\u672a\u6e80\u306e\u5b50\u3069\u3082\u305f\u3061\u306f50%\u4ee5\u4e0b\u3068\u63a8\u5b9a\u3055\u308c\u307e\u3059\u3002\u6b27\u5dde\u304b\u3089\u306e\u5831\u544a\u3067\u306f\u3055\u3089\u306b10%\u304f\u3089\u3044\u4f4e\u304f\u306a\u308a\u307e\u3059\u3002\u3053\u306e\u826f\u3044\u6210\u7e3e\u3092\u65e5\u672c\u306b\u5f53\u3066\u306f\u3081\u308b\u3053\u3068\u306f\u3067\u304d\u307e\u305b\u3093\u3002\u66f4\u306b\uff0c\u65e5\u672c\u3067\u306e\u9ac4\u82bd\u816b\u306e\u751f\u5b58\u7387\u306f\u3053\u308c\u3088\u308a10\uff05\u304f\u3089\u3044\u4f4e\u3044\u3068\u898b\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3067\u3059\u3002\u7406\u7531\u306f\u6cbb\u7642\u306e\u5e73\u5747\u6c34\u6e96\u304c\u4f4e\u3044\u304b\u3089\u3002<\/p>\n<p>2021\u5e74\u6642\u70b9\u3067\u3082\u5168\u4f53\u3092\u898b\u308c\u3070\uff0c<span style=\"color: #000080;\"><strong>\u3068\u3066\u3082\u6cbb\u308a\u3084\u3059\u3044\u30bf\u30a4\u30d7\u30678\u5272\u304f\u3089\u3044\uff0c\u6cbb\u308a\u306b\u304f\u3044\u30bf\u30a4\u30d7\u3067\u306f\uff13\u5272\u304f\u3089\u3044\u306e\u5b50\u3069\u3082\u304c\u9577\u671f\u751f\u5b58\u3067\u304d\u308b<\/strong><\/span>\u3068\u8003\u3048\u3089\u308c\u307e\u3059\u3002<span style=\"color: #000080;\"><strong>\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\uff15\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f75-80%<\/strong><\/span>\u3067\u3059\u3002<\/p>\n<h1>\u3053\u3053\u304b\u3089\u4e0b\u306f\u96e3\u3057\u3044<\/h1>\n<h4><span class=\"style2\">\u75c5\u6c17\u306e\u9032\u884c\u5177\u5408\u306e\u5206\u985e\uff08<span style=\"color: #ff0000;\">\u30c1\u30e3\u30f3\u306e<\/span><\/span><strong><span class=\"style1\" style=\"color: #ff0000;\">\u75c5\u671f\u5206\u985e<\/span><\/strong>\uff09<\/h4>\n<p>\u3082\u3068\u3082\u3068\u306fChang\u3068\u3044\u3046\u533b\u5e2b\u304c40\u5e74\u304f\u3089\u3044\u524d\u306b\u8a18\u8f09\u3057\u305f\u5206\u985e staging \u3067\u3059\u304c\u6539\u8a02\u3055\u308c\u3066\u4eca\u3082\u4f7f\u308f\u308c\u3066\u3044\u307e\u3059\u3002M0\u306e\u65b9\u304cM3 \u3088\u308a\u6cbb\u308a\u3084\u3059\u3044\u306e\u3067\uff0c\u6cbb\u7642\u306e\u65b9\u6cd5\u3082\u5909\u308f\u308a\u307e\u3059\u304b\u3089\u91cd\u8981\u3067\u3059\u3002M1\u3068\u3044\u3046\u306e\u306f\u4e88\u5f8c\u306b\u95a2\u4fc2\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u3063\u3066\u3044\u307e\u3059 (Shih DJ, 2014)\u3002<\/p>\n<ul>\n<li><strong><span style=\"color: #ff0000;\">M0<\/span><\/strong>\uff1a \u8ee2\u79fb\u304c\u306a\u3044\uff0c\u9ac4\u6db2\u306e\u4e2d\u306b\u7d30\u80de\u304c\u6563\u3089\u3070\u3063\u3066\u3044\u306a\u3044\uff0c\u3053\u308c\u304c\u4e00\u756a\u591a\u3044\u3067\u3059<\/li>\n<li><span style=\"color: #000000;\">M1\uff1a<\/span> \u9ac4\u6db2\u3092\u3068\u3063\u3066\u9855\u5fae\u93e1\u3067\u898b\u308b\uff08\u9ac4\u6db2\u7d30\u80de\u8a3a\uff09\u3068\u816b\u760d\u7d30\u80de\u304c\u898b\u3048\u308b\u3053\u3068\u3067\u3059\u304c\uff0c\u7d30\u80de\u8a3a\u3067\u306e\u8aa4\u8a3a\uff08\u507d\u967d\u6027\uff09\u304c\u3088\u304f\u3042\u308a\u307e\u3059\u3057\uff0c\u4e88\u5f8c\u306b\u306f\u3042\u307e\u308a\u95a2\u4fc2\u3042\u308a\u307e\u305b\u3093<\/li>\n<li><strong><span style=\"color: #ff0000;\">M2<\/span><\/strong>\uff1a MRI\u3067\u982d\u306e\u4e2d\u306e\u8133\u5ba4\u3084\u8133\u69fd\u306b\u816b\u760d\u306e\u8ee2\u79fb\u304c\u3042\u308b<\/li>\n<li><strong><span style=\"color: #ff0000;\">M3<\/span><\/strong>\uff1a MRI\u3067\u810a\u9ac4\u306b\u816b\u760d\u306e\u8ee2\u79fb\u304c\u3042\u308b<\/li>\n<\/ul>\n<p><span style=\"color: #333333;\">M1\u3092\u5206\u985e\u3059\u308b\u3053\u3068\u306f\u610f\u7fa9\u304c\u3042\u308a\u307e\u305b\u3093\u3002<\/span><strong><span style=\"color: #ff0000;\">M2\u3068M3\u306f\u4f34\u306b\u6cbb\u308a\u306b\u304f\u3044\u9ac4\u6db2\u64ad\u7a2e<\/span><\/strong>\u3067\u3059\u304b\u3089\u9055\u3044\u306f\u3042\u308a\u307e\u305b\u3093\u3057\uff0c\u4e21\u65b9\u3068\u3082\u307e\u3068\u3081\u3066M3\u3068\u8003\u3048\u305f\u307b\u3046\u304c\u3044\u3044\u3067\u3059\u3002M2\u3068M3\u3092\u4f75\u305b\u3066<strong><span style=\"color: #000080;\">macroscopic metastasis<\/span><\/strong>\uff08\u8089\u773c\u7684\u306b\u898b\u3048\u308b\u8ee2\u79fb\uff09\u3068\u3044\u3046\u3068\u4fbf\u5229\u3067\u3059\u3002M4\u306f\u5185\u8535\u3084\u9aa8\u306b\u8ee2\u79fb\u3059\u308b\u3082\u306e\u3092\u3044\u3044\u307e\u3059\u304c\uff0c\u73fe\u5b9f\u306b\u306f\u307b\u3068\u3093\u3069\u306a\u3044\u306e\u3067\u610f\u5473\u304c\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<h4><span class=\"style1\"><span class=\"style2\">\u6cbb\u7642\u9078\u629e\u306e\u305f\u3081\u306e<\/span><strong><span style=\"color: #ff0000;\">\u30ea\u30b9\u30af\u5206\u985e<\/span><\/strong><\/span><\/h4>\n<p>\u30ea\u30b9\u30af\u5206\u985e\u3068\u306f\u3001\u6cbb\u308a\u3084\u3059\u3044\u9ac4\u82bd\u816b\u304b\u3069\u3046\u304b\u3092\u898b\u5206\u3051\u308b\u305f\u3081\u306e\u3082\u306e\u3067\u3059\u3002\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3068\u3044\u3046\u306e\u306f\u6cbb\u308a\u3084\u3059\u3044\u30bf\u30a4\u30d7\u3068\u3044\u3048\u307e\u3059\u3002\u6cbb\u7642\u65b9\u6cd5\u3092\u8003\u3048\u308b\u6642\u306e\u5927\u5206\u985e\u3068\u306a\u308a\u307e\u3059\u3002\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306e\u6cbb\u7642\u6cd5\u306b\u306f\u6a19\u6e96\u6cbb\u7642\uff08\u3053\u308c\u3092\u3059\u308c\u3070\u826f\u3044\u3068\u3044\u3046\u6cbb\u7642\u6cd5\uff09\u304c\u3042\u308b\u3068\u8003\u3048\u3066\u3088\u3044\u306e\u3067\u3059\u304c\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u306f\u5b9a\u8aac\u304c\u306a\u3044\u3068\u601d\u3044\u307e\u3059\u3002\u7cbe\u5ea6\u306e\u9ad8\u3044MRI\u304c\u64ae\u50cf\u3067\u304d\u308b\u73fe\u5728\u3067\u306fM1\u306f\u9650\u308a\u306a\u304f\u7070\u8272\u3067\u3059\u3002\uff13\u6b73\u672a\u6e80\u306e\u5c0f\u5150\u306b\u306f\u7a4d\u6975\u7684\u306a\u8133\u810a\u9ac4\u7167\u5c04\u304c\u4f7f\u3048\u306a\u3044\u304b\u3089\u9ad8\u30ea\u30b9\u30af\u306b\u306a\u308b\u3068\u6349\u3048\u308b\u898b\u65b9\u3082\u3042\u308a\u307e\u3059\u3002<\/p>\n<ul>\n<li><strong><span style=\"color: #ff0000;\">\u4f4e\u30ea\u30b9\u30af\u7fa4\uff08low-risk tumor)<\/span><\/strong>\uff1aWNT activated (classic)\uff0c\u3082\u3057\u304f\u306f\uff0cSHH-activated TP-53 wild type (desmoplastic\/nodular in infant\/adult or extensive nodularity in infant)<\/li>\n<li><strong><span style=\"color: #ff0000;\">\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4 (standard-risk disease)<\/span><\/strong>\uff1a \u307e\u305a\uff0c\u7d44\u7e54\u5206\u5b50\u8a3a\u65ad\u3067\u4f4e\u30ea\u30b9\u30af\u3068\u9ad8\u30ea\u30b9\u30af\u816b\u760d\u3092\u6392\u9664\u3057\u307e\u3059\u3002\u52a0\u3048\u3066\uff0c\uff13\u6b73\u4ee5\u4e0a\u306e\u5c0f\u5150\uff0c\u9ac4\u8154\u5185\u8ee2\u79fb\u304c\u306a\u3044\uff0c\u624b\u8853\u3067\u816b\u760d\u304c\u307b\u3068\u3093\u3069\u6458\u51fa\u3055\u308c\u3066\u3044\u308b(gross total or subtotal resection)\u306e\u5168\u3066\u3092\u6e80\u305f\u3059\u3082\u306e\u3067\u3059\u3002<\/li>\n<li><strong><span style=\"color: #ff0000;\">\u9ad8\u30ea\u30b9\u30af\u7fa4 (high-risk disease, poor-prognosis group)<\/span><\/strong> \uff1a \uff13\u6b73\u672a\u6e80\u306e\u4e73\u5e7c\u5150\uff0c<span style=\"color: #000080;\"><strong>\u9ac4\u8154\u5185\u8ee2\u79fb\u306e\u5b58\u5728 (M2, M3)<\/strong><\/span>\uff0c\u8853\u5f8c\u306e\u6b8b\u5b58\u816b\u760d\u306e\u5b58\u5728\u306e\u4e00\u3064\u3092\u542b\u3080\u3082\u306e\u3068\u7406\u89e3\u3055\u308c\u307e\u3059\u3002\u6b8b\u5b58\u816b\u760d\u306b\u95a2\u3057\u3066\u306f\uff0c\u304b\u3064\u3066\u306f1.5cm<sup>3<\/sup>\u4ee5\u4e0a\u306e\u6b8b\u5b58\u816b\u760d\u3068\u3055\u305f\u307e\u3057\u304c\u3053\u306e\u6570\u5b57\u306f\u8efd\u8996\u3055\u308c\u308b\u50be\u5411\u306b\u3042\u308a\u307e\u3059\u30022018\u5e74\u6642\u70b9\u3067\u306f\uff0c\u300c\u304b\u306a\u308a\u306f\u3063\u304d\u308a\u3057\u305f\u5927\u304d\u306a\u6b8b\u5b58\u304c\u3042\u308b\u6642\u306e\u307f\uff0c\u3042\u308b\u3044\u306f\u6b8b\u5b58\u816b\u760d\u306e\u6709\u7121\u306f\u7121\u8996\u3059\u308b\u300d\u3068\u89e3\u91c8\u3057\u305f\u65b9\u304c\u3044\u3044\u3067\u3057\u3087\u3046\uff0c\u305d\u3046\u3057\u306a\u3044\u3068\u3084\u304a\u3089\u8133\u810a\u9ac4\u7167\u5c04\u306e\u7dda\u91cf\u304c\u591a\u304f\u306a\u308a\u91cd\u7be4\u306a\u8a8d\u77e5\u969c\u5bb3\u3092\u751f\u3058\u308b\u5b50\u3069\u3082\u306e\u5272\u5408\u304c\u9ad8\u304f\u306a\u308a\u307e\u3059\u3002M1\u30b9\u30c6\u30fc\u30b8\u3067\u3082\u540c\u69d8\u3067\u3059\u3002\u7d44\u7e54\u8a3a\u65ad\u3067<strong><span style=\"color: #000080;\">\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b large cell \/ anaplastic medulloblastoma<\/span><\/strong> \u3068\u3044\u308f\u308c\u308b\u3082\u306e\u3068\uff0c\u5206\u5b50\u8a3a\u65ad\u3067<span style=\"color: #000080;\"><strong>MYC\u5897\u5e45<\/strong><\/span>\u306e\u3042\u308b\u3082\u306e\u306f\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u3067\u3059\u3002<\/li>\n<\/ul>\n<\/div>\n<div class=\"setumei\">\n<h5><strong>\u6a19\u6e96\u30ea\u30b9\u30af\u306e\u9ac4\u82bd\u816b<\/strong><\/h5>\n<div class=\"Wrapper clearFix\">\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulsag.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-5368\" title=\"medulsag\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulsag.png\" alt=\"\" width=\"283\" height=\"286\" \/><\/a>10\u4ee3\u306e\u5b50\u3069\u3082\u306b\u3067\u304d\u305f\uff0c\u5178\u578b\u7684\u306a\u7b2c\uff14\u8133\u5ba4\u3092\u5145\u6e80\u3059\u308b\u5c0f\u8133\u866b\u90e8\u306e\u9ac4\u82bd\u816b\u306eMRI\u77e2\u72b6\u65ad\u5c64\u3067\u3059\u3002\u9020\u5f71\u5264\u3092\u5165\u308c\u3066\u3068\u3063\u305f\u5199\u771f\u3067\u3059\u304b\u3089\uff0c\u816b\u760d\u304c\u767d\u304f\u76ee\u7acb\u3064\u3088\u3046\u306b\u6620\u3063\u3066\u3044\u307e\u3059\u3002\u6c34\u982d\u75c7\u306b\u306a\u3063\u3066\u3044\u308b\u305f\u3081\u306b\u7b2c\uff13\u8133\u5ba4\u306e\u62e1\u5927\u304c\u898b\u3089\u308c\u307e\u3059\u3002\u5c0f\u8133\u866b\u90e8\u304b\u3089\u767a\u751f\u3057\u305f\u3082\u306e\u3067\u3057\u305f\u304c\uff0c\u8133\u5e79\u90e8\u306e\u80cc\u9762\u306b\u304f\u3063\u3064\u3044\u3066\u3044\u307e\u3057\u305f\u3002\u9ac4\u6db2\u64ad\u7a2e\u306e\u6240\u898b\u306f\u3042\u308a\u307e\u305b\u3093\u3057\u5e74\u9577\u5150\u3067\u3059\u304b\u3089\uff0c\u3053\u308c\u304c\u624b\u8853\u3067\u307b\u3068\u3093\u3069\u53d6\u308c\u308c\u3070\uff0c\u6a19\u6e96\u7684\u30ea\u30b9\u30af\u7fa4\u306b\u5165\u308b\u4f8b\u3067\u3059\u3002<\/p>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulhemis.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" title=\"medulhemis\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulhemis.png\" alt=\"\" width=\"283\" height=\"257\" \/><\/a>\u5c0f\u5150\u306e\u53f3\u5c0f\u8133\u534a\u7403\u306b\u767a\u751f\u3057\u305f\u300c\u306e\u3046\u80de\u5f62\u6210\u300d\u3092\u4f34\u3046\u9ac4\u82bd\u816b\u3067\u3059\u3002\u7b2c\uff14\u8133\u5ba4\u306f\u9589\u585e\u3057\u6c34\u982d\u75c7\u3092\u4f34\u3063\u3066\u3044\u308b\u305f\u3081\uff0c\u982d\u75db\uff0c\u5614\u5410\uff0c\u4e0d\u5b89\u5b9a\u6b69\u884c\u3067\u767a\u75c7\u3057\u307e\u3057\u305f\u3002\u6bdb\u69d8\u7d30\u80de\u6027\u661f\u7d30\u80de\u816b\u3068\u306e\u9451\u5225\u304c\u5c11\u3005\u96e3\u3057\u3044\u4f8b\u3067\u3059\u3002<\/p>\n<\/div>\n<\/div>\n<div class=\"setumei\">\n<div class=\"Wrapper clearFix\">\n<h3><span style=\"color: #000080;\">\u65e7\u6765\u306e\u75c5\u7406\u8a3a\u65ad\u306b\u3088\u308b\u30ea\u30b9\u30af\u5206\u985e<\/span><\/h3>\n<div><span style=\"color: #ff0000;\"><strong>\u4f4e\u30ea\u30b9\u30af\u578b<\/strong><\/span><\/div>\n<div>\n<ul>\n<li><span style=\"color: #000080;\"><strong>medulloblastoma with extensive nodularity (MBEN)<\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong><strong>desmoplastic\/nodular medulloblastoma\u3000(DMB)<\/strong><\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong>ordinary (classic) medulloblastoma (WNT-activated\uff09<\/strong><\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<div><span style=\"color: #ff0000;\"><strong>\u6a19\u6e96\u30ea\u30b9\u30af\u578b<\/strong><\/span><\/div>\n<div class=\"setumei\">\n<div class=\"Wrapper clearFix\">\n<div>\n<ul>\n<li><span style=\"color: #000080;\"><strong>ordinary (classic) medulloblastoma (WNT\u3092\u9664\u304f\uff09<\/strong><\/span><\/li>\n<\/ul>\n<div><strong><span style=\"color: #ff0000;\">\u9ad8\u30ea\u30b9\u30af\u578b<\/span><\/strong><\/div>\n<ul>\n<li><span style=\"color: #000080;\"><strong>anaplastic medulloblastoma (AMB)<\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong>large cell medulloblastoma (LCMB)<\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong>(medulloblastoma with myogenic differentiation)<\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong>(medulloblastoma with melanotic differentiation)<\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong>(medulloblastoma with rhabdoid differentiation)<\/strong><\/span><\/li>\n<li><span style=\"color: #000080;\"><strong>(large cell\/melanotic\/myogenic mixed etc.)<\/strong><\/span><\/li>\n<\/ul>\n<\/div>\n<div>\u4e0a\u306e\u65b9\u304b\u3089\u6cbb\u308a\u3084\u3059\u3044\u9806\u306b\u306a\u3063\u3066\u3044\u307e\u3059\u3002\u3068\u304f\u306bMBEN\u3068DMB\u306f\u5316\u5b66\u7642\u6cd5\u3060\u3051\u3067\u6cbb\u7652\u304c\u671f\u5f85\u3055\u308c\u308b\u7d44\u7e54\u578b\u3067\u3059\u304b\u3089\uff0c\u7279\u306b\uff14\u6b73\u672a\u6e80\u306e\u5e7c\u5150\u3067\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u907f\u3051\u3066\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3059\u308b\u3079\u304d\u3060\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u9ad8\u30ea\u30b9\u30af\u578b\u306e\u75c5\u7406\u8a3a\u65ad\u3067\u306f\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u3068\u3057\u3066\u3067\u304d\u308b\u9650\u308a\u306e\u6cbb\u7642\u3092\u3057\u306a\u3044\u3068\u52a9\u304b\u308a\u307e\u305b\u3093\u3002<\/div>\n<div>WHO 2007\u5e74\u7248\u3067\u306f\uff0cmedullomyoblastoma\u3068melanotic medulloblastoma\u306f\u72ec\u7acb\u3057\u305fentity\u3067\u306f\u306a\u3044\u3068\u3055\u308c\u307e\u3057\u305f\u3002\u3057\u304b\u3057\u306a\u304c\u3089\uff0c\u4e88\u5f8c\u304c\u7570\u306a\u308b\u306e\u3067 medulloblastoma with melanotic differentiation\u306a\u3069\u3068\u6b63\u78ba\u306b\u8a18\u8f09\u3059\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002medulloblastoma\u306f\u4e00\u62ec\u3057\u3066 WHO grade IV\u3067\u3059\u304c\uff0cdesmoplastic\/nodular type, medulloblastoma with extensive nodularity type\u306f\u4e88\u5f8c\u304c\u826f\u304f\uff0canaplastic, large cell, melanotic type\u306a\u3069\u306f\u3055\u3089\u306b\u4e88\u5f8c\u304c\u60aa\u3044\u96e3\u6cbb\u6027\u816b\u760d\u3067\u3059\u3002<\/div>\n<div><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anaplmedullo1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3086 alignleft\" title=\"anaplmedullo\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anaplmedullo1-300x252.jpg\" alt=\"\" width=\"300\" height=\"252\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anaplmedullo1-300x252.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anaplmedullo1-550x463.jpg 550w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anaplmedullo1.jpg 567w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><br \/>\nanaplastic\/large cell type: \u3053\u306e\u9ac4\u82bd\u816b\u306f\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b\u3068\u3082\u5927\u7d30\u80de\u6027\u9ac4\u82bd\u816b\u3068\u3082\u8a3a\u65ad\u3067\u304d\u308b\u3082\u306e\u3067\u3059\u3002\u6cbb\u7642\u306b\u62b5\u6297\u6027\u3067\u3042\u308a\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u884c\u306a\u3063\u3066\u3082\u816b\u760d\u306f\u7e2e\u5c0f\u3057\u307e\u305b\u3093\u3067\u3057\u305f\u3002\u305f\u3068\u3048\u9ad8\u30ea\u30b9\u30af\u7fa4\u3068\u3057\u3066\u8133\u810a\u9ac4\u7167\u5c04\u306e\u7dda\u91cf\u3092\u4e0a\u3052\u3066\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3092\u884c\u306a\u3063\u3066\u3082\u5c40\u6240\u5236\u5fa1\u3055\u3048\u3082\u96e3\u3057\u3044\u3082\u306e\u3067\u3059\u3002<\/div>\n<\/div>\n<div><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullodesmo1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-5385\" title=\"medullodesmo\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullodesmo1-300x272.jpg\" alt=\"\" width=\"300\" height=\"272\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullodesmo1-300x272.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullodesmo1.jpg 429w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><br \/>\ndesmoplastic\/nodullar type: \u7d30\u80de\u5bc6\u5ea6\u306e\u4f4e\u3044\u5cf6\u72b6\uff08\u7d50\u7bc0\u72b6\uff09\u306e\u90e8\u5206\u3092\uff0c\u7d30\u80de\u6838\u5bc6\u5ea6\u306e\u9ad8\u3044\u9818\u57df\u304c\u53d6\u308a\u56f2\u3093\u3067\u3044\u307e\u3059\u3002\u6cbb\u308a\u3084\u3059\u3044\u30bf\u30a4\u30d7\u306e\u9ac4\u82bd\u816b\u3068\u8003\u3048\u3089\u308c\u307e\u3059\u3002<\/div>\n<div>\n<h3><span style=\"color: #000080;\">\u9ac4\u82bd\u816b\u306e\u5206\u5b50\u8a3a\u65ad<\/span><\/h3>\n<\/div>\n<\/div>\n<h4>2017\u5e74\u306e\u5206\u5b50\u5206\u985e\uff0c<strong><span style=\"color: #ff0000;\">\u884c\u304d\u5148\u3055\u3089\u306b\u4e0d\u660e\uff01<\/span><\/strong><\/h4>\n<p>Schwalbe EC, et al.: Novel molecular subgroups for clinical classification and outcome prediction in childhood\u00a0medulloblastoma: a cohort study. <strong><span style=\"color: #000080;\">Lancet Oncol\u00a02017<\/span><\/strong><br \/>\n\u4ee5\u4e0b\u306e\u3088\u3046\u306b\u306a\u308a\uff0c\u3053\u306e\u8a3a\u65ad\u3067\u6cbb\u7642\u306e\u4fb5\u8972\u5ea6\u3092\u5909\u3048\u307e\u3059\u3002<br \/>\n<strong>MB<\/strong><sub><strong>WNT<\/strong>\u00a0<\/sub>remained unchanged and each remaining consensus subgroup was split in two. MB<sub>SHH<\/sub> was split into age-dependent subgroups corresponding to infant (&lt;4\u00b73 years; <strong>MB<sub>SHH-Infant<\/sub><\/strong>; n=65) and childhood patients (\u22654\u00b73 years; <strong>MB<sub>SHH-Child<\/sub><\/strong>; n=38). MB<sub>Grp3<\/sub> and MB<sub>Grp4<\/sub> were each split into high-risk (<strong>MB<sub>Grp3-HR<\/sub><\/strong> [n=65] and <strong>MB<sub>Grp4-HR<\/sub><\/strong> [n=85]) and low-risk (<strong>MB<sub>Grp3-LR<\/sub><\/strong> [n=50] and <strong>MB<sub>Grp4-LR<\/sub><\/strong>[n=73]) subgroups.<\/p>\n<p>Northcott PA, et al.: The whole-genome\u00a0landscape of\u00a0medulloblastoma\u00a0subtypes. <span style=\"color: #000080;\"><strong>Nature 547, 2017<\/strong><\/span><br \/>\n\u5168\u30b2\u30ce\u30e0\u89e3\u6790\u304c\u306a\u3055\u308c\u307e\u3057\u305f\u3002\u7279\u306b\u4eca\u307e\u3067\u4e0d\u660e\u3067\u3042\u3063\u305f\u30b0\u30eb\u30fc\u30d73\u3068\u30b0\u30eb\u30fc\u30d7\uff14\u306edriver gene\u304c\u660e\u3089\u304b\u306b\u3055\u308c\u307e\u3057\u305f\u3002<br \/>\nDriver mutations were confidently assigned to most patients belonging to Group 3 and Group 4 medulloblastoma subgroups. New molecular subtypes were differentially enriched for specific driver events, including hotspot in-frame insertions that target <i>KBTBD4<\/i> and \u2018enhancer hijacking\u2019 events that activate <i>PRDM6<\/i>.<\/p>\n<h4>2016\u5e74\u307e\u3067\u306e\u5206\u5b50\u8a3a\u65ad\u306e\u77e5\u898b<\/h4>\n<p>Northcott PA, et al.: Medulloblastoma comprises four distinct molecular variants. J Clin Oncol, 2010<br \/>\nRemke M, et al.: Adult medulloblastoma comprises three major molecular variants. J Clin Oncol, 2011<br \/>\nNorthcott PA, et al.:\u00a0Subgroup-specific structural variation across 1,000 medulloblastoma genomes Nature, 2012<br \/>\nShih DJ, et al.: Cytogenetic prognostication within medulloblastoma subgroups. J Clin Oncol, 2014<\/p>\n<div class=\"setumei\">\n<div>\n<ul>\n<li><span style=\"color: #ff0000;\"><strong><span style=\"color: #000080;\">\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9 WNT\u3067\u306f\uff0c\u64ad\u7a2e\u304c\u3042\u308d\u3046\u3068\u3069\u306e\u3088\u3046\u306a\u6cbb\u7642\u6cd5\u3067\u3042\u308d\u3046\u306895%\u304f\u3089\u3044\u3067\u6cbb\u7652\u304c\u671f\u5f85\u3067\u304d\u307e\u3059<\/span>\u00a0<\/strong><\/span>(Shih DJ)<\/li>\n<li>\u3067\u3059\u304b\u3089\uff0c\u30c1\u30e3\u30f3\u306e\u75c5\u671f\u5206\u985e\u306fSHH, \u30b0\u30eb\u30fc\u30d73, \u30b0\u30eb\u30fc\u30d74\u3060\u3051\u3067\u6709\u7528\u306a\u5206\u985e\u3068\u306a\u308a\u307e\u3057\u305f<\/li>\n<li>SHH\u3067\u306f\uff0c\u6210\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u4e88\u5f8c\u304c\u826f\u304f\u5c0f\u5150\u3067\u306f\u60aa\u3044\u3067\u3059<\/li>\n<li>SHH\u3067\u306f\uff0cclassic type\u306e\u65b9\u304canaplastic histology\u3088\u308a\u4e88\u5f8c\u304c\u826f\u3044\u3067\u3059<\/li>\n<li><span style=\"color: #ff0000;\"><strong>\u30b0\u30eb\u30fc\u30d73\u3060\u3051\u3067\uff0c\u9ac4\u6db2\u64ad\u7a2e\u306e\u78ba\u7387\u304c\u7a81\u51fa\u3057\u3066\u9ad8\u304f<\/strong><\/span>\u3066\uff0c\u304b\u3064\u9577\u671f\u751f\u5b58\u5272\u5408\u3082\u6975\u3081\u3066\u4f4e\u3044\u3067\u3059<\/li>\n<li>\u30b0\u30eb\u30fc\u30d73\u3067\u306flarge-cell\/anaplastic histology\u306e\u4e88\u5f8c\u304c\u6709\u610f\u306b\u60aa\u3044\u3067\u3059<\/li>\n<li><span style=\"color: #ff0000;\"><strong>\u30b0\u30eb\u30fc\u30d73\u306e\u9577\u671f\u751f\u5b58\u5272\u5408\u306f40%\u4ee5\u4e0b<\/strong><\/span>\u3068\u307f\u306a\u3055\u308c\u3066\u3044\u307e\u3059\uff082016\u5e74\u6642\u70b9\uff09<\/li>\n<li>\u9006\u306b\u4ed6\u306e\u30b0\u30eb\u30fc\u30d7\u306f\u64ad\u7a2e\u8ee2\u79fb\u306e\u983b\u5ea6\u304c\u4f4e\u304f\u6cbb\u308b\u78ba\u7387\u304c\u9ad8\u304f\u306a\u308a\u307e\u3059<\/li>\n<li>\u6210\u4eba\u4f8b\u3067\u306f\u3053\u306e\u30b0\u30eb\u30fc\u30d73\u304c\u5c11\u306a\u3044\u306e\u3067\u3059\u304c\uff0c\u6210\u4eba\u3067\u306fWNT\u3068\u30b0\u30eb\u30fc\u30d74\u306e\u4e88\u5f8c\u304c\u60aa\u3044\u305d\u3046\u3067\u3059<\/li>\n<li>\u30b0\u30eb\u30fc\u30d7\uff14\u306e\u4e73\u5150\u306f\u7279\u306b\u4e88\u5f8c\u304c\u60aa\u3044\u306e\u3067\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u5fc5\u9808 critical \u306e\u3088\u3046\u3067\u3059<\/li>\n<li>\u30b0\u30eb\u30fc\u30d7\uff14\u3067\u306f\uff0c\u7b2c10, 11, 17\u67d3\u8272\u4f53\u306e\u7570\u5e38\u306e\u6709\u7121\u304b\u3089\u4e88\u5f8c\u304c\u826f\u3044\u4f8b\u304c\u9078\u5225\u3067\u304d\u307e\u3059<\/li>\n<li>\u8981\u3059\u308b\u306b\u30b0\u30eb\u30fc\u30d73\u4ee5\u5916\u306f\u6cbb\u308a\u3084\u3059\u3044\u816b\u760d\u306a\u306e\u3067\u3042\u308d\u3046\u3068\u3044\u3046\u3053\u3068\u3067\u3059<\/li>\n<li>\u3053\u308c\u3089\u306e\u30b0\u30eb\u30fc\u30d7\u5206\u3051\u3092\u3057\u3066\u3082\u306a\u304a\uff0c<span style=\"color: #ff0000;\"><strong>\u8a3a\u65ad\u6642\u306e\u64ad\u7a2e\u8ee2\u79fb\u306e\u6709\u7121 (M2\/3)\u306f\u4e88\u5f8c\u306b\u5f37\u3044\u76f8\u95a2<\/strong><\/span>\u3092\u6709\u3057\u307e\u3059<\/li>\n<\/ul>\n<p>\u3053\u306e\u5206\u985e\u306b\u5f93\u3048\u3070\uff0cWNT\u3068SHH\u3068\u30b0\u30eb\u30fc\u30d74\u3067\u306f\u5316\u5b66\u7642\u6cd5\u3092\u4e3b\u3068\u3057\u305f\u6cbb\u7642\u306b\u3057\u3066\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u5c0f\u8133\u306e\u5c40\u62403\u6b21\u5143\u539f\u4f53\u7167\u5c04\u3067\u6e08\u3080\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u3057\u304b\u3057\uff0c\u30b0\u30eb\u30fc\u30d73\u306f\u5f93\u6765\u306e\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u6e96\u3058\u3066\uff0c\u9ad8\u7dda\u91cf\u5c40\u6240\u7167\u5c04\u3068\u8133\u810a\u9ac4\u7167\u5c04\u304c\u6b20\u304b\u305b\u305a\uff0c\u8840\u6db2\u5e79\u7d30\u80de\u6551\u63f4\u3082\u8996\u91ce\u306b\u5165\u308c\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002<\/p>\n<h4><strong>\u624b\u8853\u3092\u3057\u306a\u3044\u3067\u5316\u5b66\u7642\u6cd5\u304b\u3089\u6cbb\u7642\u3092\u958b\u59cb\u3059\u308b\u3068\u3044\u3046\u9078\u629e\u80a2<\/strong><\/h4>\n<p>\u9ac4\u82bd\u816b\u3092\u753b\u50cf\u8a3a\u65ad\u3057\u3066\u307e\u305a\u5316\u5b66\u7642\u6cd5\u3067\u816b\u760d\u306e\u7e2e\u5c0f\u3092\u8a08\u308b\u3068\u3044\u3046\u9078\u629e\u80a2\u306f\u3042\u308a\u307e\u3059\u3002<\/p>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm31.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-5802\" title=\"medullonm3\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm31-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm41.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-5803\" title=\"medullonm4\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm41-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><br \/>\n\uff13\u6b73\u767a\u75c7\u306e\u9ac4\u82bd\u816b\u3067\u3059\u3002M2\/M3\u3067\u3057\u305f\u304b\u3089\uff0c\u751f\u691c\u8853\u306a\u3069\u305b\u305a\u306b\uff0c\u8133\u5ba4\u30c9\u30ec\u30ca\u30fc\u30b8\u3092\u3057\u3066\uff0cICE\u5316\u5b66\u7642\u6cd5\u3067\u6cbb\u7642\u3092\u958b\u59cb\u3057\u307e\u3057\u305f\u3002<\/p>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm5.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-5804\" title=\"medullonm5\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm5-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm6.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-5805\" title=\"medullonm6\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullonm6-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><br \/>\n\u5316\u5b66\u7642\u6cd5\u3092\u958b\u59cb\u3057\u306621\u65e5\u76ee\u306eMRI\u3067\u3059\uff0c\u816b\u760d\u306f\u304b\u306a\u308a\u5c0f\u3055\u304f\u306a\u3063\u3066\u3044\u307e\u3059\u3002\u3053\u306e\u5f8c\u306b\uff0c\u624b\u8853\u6458\u51fa\uff08\u75c5\u7406\u78ba\u5b9a\uff09\u3084\u8133\u810a\u9ac4\u7167\u5c04\u306a\u3069\u3092\u3057\u307e\u3057\u305f\u3002\u3053\u306e\u4f8b\u306f\u3044\u305a\u308c\u306b\u3057\u3066\u3082\u5316\u5b66\u7642\u6cd5\u3092\u3059\u308b\u5fc5\u7528\u304c\u3042\u3063\u305f\u3082\u306e\u3067\u3059\u3002<\/p>\n<\/div>\n<h5>\u304a\u3088\u305d\u306e\u6cbb\u7642\u65b9\u91dd\uff08\u3061\u3087\u3063\u3068\u3080\u305a\u304b\u3057\u3044\u304b\u3082\uff09<\/h5>\n<p>\u9ac4\u82bd\u816b\u3067\u306f<strong><span style=\"color: #ff0000;\">\u9ad8\u30ea\u30b9\u30af\u7fa4<\/span><\/strong>\u3068<strong><span style=\"color: #ff0000;\">\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4<\/span><\/strong>\u3067\u3068\u3044\u3046\uff12\u3064\u306e\u30b0\u30eb\u30fc\u30d7\u306b\u5206\u3051\u3066\u6cbb\u7642\u6cd5\u304c\u9078\u629e\u3055\u308c\u3066\u304d\u307e\u3057\u305f\u3002\u4f4e\u30ea\u30b9\u30af\u3082\u52a0\u3048\u3066\uff0c3\u3064\u306e\u30b0\u30eb\u30fc\u30d7\u306b\u5206\u3051\u308b\u65b9\u6cd5\u8ad6\u306f\u3042\u308a\u307e\u3059\u304c\uff0c\u305d\u308c\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u6cd5\u306f\u307e\u3060\u78ba\u7acb\u3055\u308c\u3066\u3044\u307e\u305b\u3093\u3002\u9ad8\u30ea\u30b9\u30af\u7fa4\u3068\u3044\u3046\u306f\u300c\u6cbb\u3059\u306e\u304c\u96e3\u3057\u3044\u3068\u3044\u3046\u610f\u5473\u300d\u3067\u3059\u3002\u4f8b\u3048\u3070\uff12\u6b73\u306e\u9ac4\u82bd\u816b\u3067\u810a\u9ac4\u8ee2\u79fb\u3092\u3057\u3066\u3044\u308b\u306e\u3067\u3042\u308c\u3070\u6cbb\u7642\u304c\u3068\u3066\u3082\u53b3\u3057\u3044\u3068\u7406\u89e3\u3057\u3066\u4e0b\u3055\u3044\u3002<span style=\"color: #000080;\"><strong>\u75c5\u7406\u6240\u898b\u3067\u60aa\u6027\u5ea6\u304c\u9ad8\u3044\u9ac4\u82bd\u816b<\/strong><\/span>\uff08\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b\uff0c\u5927\u7d30\u80de\u6027\u9ac4\u82bd\u816b\uff0c\u30e1\u30e9\u30cb\u30f3\u6027\u9ac4\u82bd\u816b\uff09\u3082\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u5165\u308b\u3068\u8003\u3048\u3066\u3044\u3044\u3067\u3057\u3087\u3046\u3002<\/p>\n<h3><span style=\"color: #000080;\">\u653e\u5c04\u7dda\u6cbb\u7642<\/span><\/h3>\n<p><span style=\"color: #000080;\"><strong>\u8853\u5f8c\u3067\u304d\u308b\u9650\u308a\u65e9\u3044\u8133\u810a\u9ac4\u7167\u5c04<\/strong><\/span>\u306e\u958b\u59cb\u3092\u57fa\u672c\u3068\u3057\u307e\u3059\u30022018\u5e74\u306e\u8ad6\u6587\u3067\u3082\u624b\u8853\u5f8c31\u65e5\u4ee5\u5185\u306b\u958b\u59cb\u3059\u308b\u3053\u3068\u304c\u6761\u4ef6\u3068\u3057\u3066\u8a18\u8f09\u3055\u308c\u3066\u3044\u307e\u3059\u3002<span style=\"color: #000080;\"><strong>\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u5bfe\u3057\u3066\u57fa\u672c\u306b\u306a\u308b\u306e\u306f\uff0c23.4\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3068\u7dcf\u7dda\u91cf54\u30b0\u30ec\u30a4\u306e\u816b\u760d\u5e8a\u7167\u5c04<\/strong><\/span>\u3067\u3059\u3002\uff13\u6b73\u4ee5\u4e0a\u306e\u60a3\u5150\u306b\u5bfe\u3057\u3066\u306e\u7167\u5c04\u306f\uff11\u65e5\u7dda\u91cf1.8Gy\uff0c\u9031\uff15\u56de\u7167\u5c04\u304c\u6a19\u6e96\u7684\u3067\u3059\u3002\u4e00\u65b9\u3001\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u306f\u8133\u810a\u9ac4\u7167\u5c0424-36Gy\u304c\u7528\u3044\u3089\u308c\u307e\u3059\u304c\uff0c\u5e74\u4ee4\u306b\u3088\u3063\u3066\u306f\u3053\u306e\u7dda\u91cf\u306f\u4f7f\u3048\u307e\u305b\u3093\u3002\u64ad\u7a2e\u3057\u3066\u3044\u308b\u9ac4\u82bd\u816b\u3067\u306f\u8133\u810a\u9ac4\u7167\u5c04\u306e\u7dda\u91cf\u306f\u3088\u308a\u5927\u304d\u304f\u306a\u308a\u307e\u3059\u3002\u816b\u760d\u5e8a\u306e\u7167\u5c04\u3067\u306f\uff13\u6b21\u5143\u6cbb\u7642\u8a08\u753b 3D conformal technique \u3092\u7528\u3044\u307e\u3059\u3002<\/p>\n<p><span style=\"color: #333333;\"><a style=\"color: #333333;\" title=\"\u5168\u8133\u7167\u5c04\u5f8c\u306e\u8133\u58ca\u6b7b\u3068\u767d\u8cea\u8133\u75c7\" href=\"\/sawamura\/pediattumor\/csiradiationnecrosi\/\">\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<\/a><\/span>\u3067\uff0c<span style=\"color: #000080;\"><strong>\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<\/strong><\/span>\u3067\u3059\u3002\u3057\u304b\u3057\uff0c\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\uff0c\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<span style=\"color: #000080;\"><strong>\u4f4e\u5e74\u9f62\u5150\u307b\u3069\u7167\u5c04\u7dda\u91cf\u3092\u4e0b\u3052\u308b\u305f\u3081\u88dc\u52a9\u5316\u5b66\u7642\u6cd5\u306e\u5f79\u5272\u306f\u5927\u304d\u304f\u306a\u308a\u307e\u3059<\/strong><\/span>\u3002<\/p>\n<h4><strong>spinal junction<\/strong><\/h4>\n<p>\u8133\u810a\u9ac4\u7167\u5c04\u3092\u884c\u3046\u6642\u306b\u3053\u306e\u8a00\u8449\u304c\u308f\u304b\u3089\u306a\u3044\u3068\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u3046\u307e\u304f\u884c\u304d\u307e\u305b\u3093\u3002\u5168\u8133\u7167\u5c04\u3068\u5168\u810a\u9ac4\u7167\u5c04\u306e\u3064\u306a\u304e\u76ee\uff08\u30ae\u30e3\u30c3\u30d7\uff09\u306e\u3053\u3068\u3067\u3059\u3002\u3053\u306e\u3064\u306a\u304e\u76ee\u306b\u306f\u653e\u5c04\u7dda\u91cf\u304c\u5341\u5206\u306b\u5165\u3089\u306a\u3044\u306e\u3067\uff0c\u305d\u306e\u90e8\u5206\u304b\u3089\u306e\u518d\u767a\u304c\u591a\u3044\u3068\u8a00\u3048\u307e\u3059\u3002\u8133\u3068\u810a\u9ac4\u306f\u540c\u65e5\u306b\u7167\u5c04\u3057\u307e\u3059\u304b\u3089\uff0c\u305d\u306e\u3064\u306a\u304e\u76ee\u3092\u5c11\u3057\u305a\u3064\u305a\u3089\u3057\u306a\u304c\u3089\u6bce\u65e5\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3092\u52e7\u3081\u3066\u884c\u304d\u307e\u3059\u3002\u653e\u5c04\u7dda\u304c\u5165\u3089\u306a\u3044\u9818\u57df\u3092\u907f\u3051\u308b\u305f\u3081\u3067\u3059\u3002\u3053\u308c\u306f\u967d\u5b50\u7dda\u6cbb\u7642\uff0cIMRT\u3067\u3082\u540c\u3058\u3053\u3068\u3067\uff0c\u967d\u5b50\u7dda\u6cbb\u7642\u5f8c\u306e\u518d\u767a\u3082spinal junction\u306b\u751f\u3058\u308b\u3053\u3068\u304c\u77e5\u3089\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4><span style=\"color: #000080;\"><strong><a style=\"color: #000080;\" title=\"\u5168\u8133\u7167\u5c04\u5f8c\u306e\u8133\u58ca\u6b7b\u3068\u767d\u8cea\u8133\u75c7\" href=\"\/sawamura\/pediattumor\/csiradiationnecrosi\/\">\u8133\u810a\u9ac4\u7167\u5c04\u306e\u5f8c\u907a\u75c7\u306f\u4e00\u4eba\u4e00\u4eba\u3067\u304b\u306a\u308a\u9055\u3046<\/a><\/strong><\/span><\/h4>\n<p>\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u540c\u3058\u3088\u3046\u306b\u884c\u306a\u3063\u3066\u3082\uff0c\u7279\u306b\u5b50\u3069\u3082\u306e\u5834\u5408\u306f\uff0c\u500b\u4eba\u500b\u4eba\u3067\u6709\u5bb3\u4e8b\u8c61\uff08\u9045\u767a\u6027\u8a8d\u77e5\u6a5f\u80fd\u4f4e\u4e0b\uff0c\u5b66\u7fd2\u969c\u5bb3\uff0c\u8a8d\u77e5\u6a5f\u80fd\u969c\u5bb3\uff0c\u9ad8\u6b21\u8133\u6a5f\u80fd\u969c\u5bb3\uff0c\u7cbe\u795e\u767a\u9054\u9045\u6ede\u306a\u3069\u3068\u8868\u73fe\u3055\u308c\u307e\u3059\uff09\u304c\u304b\u306a\u308a\u9055\u3063\u3066\u51fa\u307e\u3059\u3002\u4f8b\u3048\u3070\uff0c\uff17\u6b73\u306e\u5b50\u3069\u3082\u3067\u8133\u810a\u9ac4\u7167\u5c04\u309223.4\u30b0\u30ec\u30a4\u3057\u3066\u3082\uff0c\u666e\u901a\u306b\u9ad8\u6821\u751f\u306b\u306a\u3063\u3066\u793e\u4f1a\u4eba\u306b\u306a\u308b\u5b50\u3069\u3082\u3082\u3044\u307e\u3059\u3057\uff0c\u5c0f\u5b66\u6821\u9ad8\u5b66\u5e74\u304f\u3089\u3044\u3067\u7279\u5225\u306a\u652f\u63f4\u304c\u306a\u3044\u3068\u5b66\u7fd2\u3067\u304d\u306a\u304f\u306a\u308b\u5b50\u3069\u3082\u3082\u3044\u307e\u3059\u3002\u3082\u3061\u308d\u309336\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3067\u306f\u307b\u307c\u78ba\u5b9f\u306b\u8a8d\u77e5\u6a5f\u80fd\u306e\u4f4e\u4e0b\u306f\u751f\u3058\u307e\u3059\u304b\u3089\uff0c\u4f55\u3068\u304b\u3067\u304d\u308c\u3070\u3053\u306e\u7dda\u91cf\u306f\u907f\u3051\u305f\u3044\u3067\u3059\u3002<span style=\"color: #333333;\"><a style=\"color: #333333;\" title=\"\u5168\u8133\u7167\u5c04\u5f8c\u306e\u8133\u58ca\u6b7b\u3068\u767d\u8cea\u8133\u75c7\" href=\"\/sawamura\/pediattumor\/csiradiationnecrosi\/\">\u3053\u3053\u3092\u30af\u30ea\u30c3\u30af\u3057\u3066\u3044\u305f\u3060\u304f\u3068\u53c2\u8003\u4f8b\u304c\u898b\u3048\u307e\u3059\u3002<\/a><\/span><\/p>\n<p><span style=\"color: #333333;\"><a style=\"color: #333333;\" title=\"\u30bd\u30d5\u30a3\u30fc\u306e\u9078\u629e\" href=\"\/sawamura\/pediattumor\/sophie\/\">\u3053\u306e\u7dda\u91cf\u3092\u9078\u629e\u3059\u308b\u304b\u3069\u3046\u304b\u306f\uff0c\u30bd\u30d5\u30a3\u30fc\u306e\u9078\u629e\u80a2\u3068\u306a\u308a\u307e\u3059\uff08\u3053\u3053\u3092\u30af\u30ea\u30c3\u30af\uff09<\/a><\/span><\/p>\n<h3><span style=\"color: #000080;\"><strong>\u5316\u5b66\u7642\u6cd5<\/strong><\/span><\/h3>\n<p>2006\u5e74\u306bPacker\u5148\u751f\u306f\uff0c3\u6b73\u304b\u308921\u6b73\u307e\u3067\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u9ac4\u82bd\u816b379\u4eba\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u5927\u898f\u6a21\u81e8\u5e8a\u8a66\u9a13\u306e\u7d50\u679c\u3092\u5831\u544a\u3057\u307e\u3057\u305f\u3002<span style=\"color: #000080;\"><strong>\u5168\u6458\u3042\u308b\u3044\u306f\u4e9c\u5168\u6458\u8853\u5f8c31\u65e5\u4ee5\u5185\u306b\u653e\u5c04\u7dda\u6cbb\u7642\uff0823.4Gy\u5168\u8133\u810a\u9ac4\u7167\u5c04\uff0c55.8Gy\u5f8c\u982d\u7aa9\u7167\u5c04\uff09\u304c\u958b\u59cb<\/strong><\/span>\u3055\u308c\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306f\u6bce\u9031\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3(1.5mg\/m2)\u306e\u6295\u4e0e\u304c\u306a\u3055\u308c\uff0c\u305d\u306e\u5f8c\uff0c<span style=\"color: #000080;\"><strong>\u30ed\u30e0\u30b9\u30c1\u30f3\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u4f75\u7528\u5316\u5b66\u7642\u6cd5<\/strong><\/span>\u3042\u308b\u3044\u306f<span style=\"color: #000080;\"><strong>\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u3092\u4f7f\u3046\u5316\u5b66\u7642\u6cd5<\/strong><\/span>\u306e\u3044\u305a\u308c\u304b\u304c\uff0c\u5408\u8a08\uff18\u30b3\u30fc\u30b9\u52a0\u3048\u3089\u308c\u305f\u3082\u306e\u3067\u3059\u3002\uff15\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f81%\uff0c\uff15\u5e74\u5168\u751f\u5b58\u5272\u5408\u306f86%\u3068\u3044\u3046\u3059\u3070\u3089\u3057\u3044\u6210\u7e3e\u3092\u6b8b\u3057\u307e\u3057\u305f\u3002\u5316\u5b66\u7642\u6cd5\u306e\u9055\u3044\uff08\u30ed\u30e0\u30b9\u30c1\u30f3\u304b\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff09\u3067\u306f\u751f\u5b58\u5272\u5408\u306b\u5dee\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u3053\u306e\u5831\u544a\u306f\uff0c\u6700\u5927\u898f\u6a21\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u81e8\u5e8a\u8a66\u9a13\u3067\u3042\u308a\uff0c\u304b\u3064\u6700\u3082\u512a\u308c\u305f\u6210\u7e3e\u3092\u6b8b\u3057\u305f\u6545\u306b\uff0c\u4eca\u5f8c\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u9ac4\u82bd\u816b\u3067\u306e\u6a19\u6e96\u6cbb\u7642\u3068\u3055\u308c\u308b\u3079\u304d\u3082\u306e\u306b\u306a\u3063\u305f\u3068\u8a55\u4fa1\u3055\u308c\u307e\u3059\u3002<\/p>\n<p>\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u304a\u3044\u3066\u3082\u4f4e\u7dda\u91cf\u7167\u5c04\u3092\u7528\u3044\u308b\u4ee3\u8868\u7684\u6210\u7e3e\u306f\uff0c23.4Gy\u306e\u8133\u810a\u9ac4\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\u3042\u308a\u307e\u3059\u3002\u3057\u304b\u3057\uff0c\u73fe\u5728\u3067\u3082\u69d8\u3005\u306a\u5316\u5b66\u7642\u6cd5\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u304c\u6a21\u7d22\u3055\u308c\u3066\u3044\u308b\u306e\u304c\u73fe\u72b6\u3067\u3059\u30022011\u5e74\u307e\u3067\u884c\u308f\u308c\u305f\u7814\u7a76\u3067\u3082\uff0c\uff13\u6b73\u4ee5\u4e0a\u306e\u9ad8\u30ea\u30b9\u30af\u7fa4\uff08\u5b9f\u969b\u306b\u306f\u64ad\u7a2e\u304c\u3042\u308b\uff09\u306b\u306f\uff0c36.0- 39.6 Gy\u306e\u8133\u810a\u9ac4\u7167\u5c04\u306855.8 Gy conformal primary site boost\u304c\u52a0\u3048\u3089\u308c\uff0c\u3055\u3089\u306b4\u30b5\u30a4\u30af\u30eb\u306e\u5e79\u7d30\u80de\u6551\u63f4\u3092\u7528\u3044\u308b\u9ad8\u7528\u91cf\u5316\u5b66\u7642\u6cd5\u304c\u306a\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u4e00\u65b9\u3067\uff0c<span style=\"color: #000080;\"><strong>\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<\/strong><\/span>\u306b\u306a\u308a\u307e\u3057\u305f\u3002<\/p>\n<p><span style=\"color: #000080;\"><strong>\u64ad\u7a2e\u304c\u306a\u3044\uff13\u6b73\u4ee5\u4e0b\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<\/strong><\/span>\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u3057\u304b\u3057\u3053\u308c\u3082\u660e\u3089\u304b\u306a\u5229\u70b9\u3092\u8a3c\u660e\u3059\u308b\u306b\u306f\u81f3\u3063\u3066\u3044\u307e\u305b\u3093\u3057\uff0c\u5316\u5b66\u7642\u6cd5\u6b7b\u3092\u542b\u3081\u305f\u5f37\u3044\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\u308a\u307e\u305b\u3093\u3002\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\uff0c\u30c1\u30aa\u30c6\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\u307e\u3057\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\u307e\u3059\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\u307e\u3059\u3002 \u65e5\u672c\u3067\u3082\u4e00\u90e8\u306e\u65bd\u8a2d\u3067\u884c\u308f\u308c\u3066\u3044\u307e\u3059\u304c\u3053\u308c\u304c\u6709\u52b9\u304b\u3069\u3046\u304b\u306e\u9577\u671f\u6210\u7e3e\u306f\u6b63\u5f0f\u306b\u306f\u767a\u8868\u3055\u308c\u3066\u3044\u307e\u305b\u3093\u3002<\/p>\n<p>\u6fa4\u6751\u306f1992\u5e74\u304b\u30892010\u5e74\u307e\u3067\uff0c\u5e74\u9f62\u306b\u5fdc\u3058\u305f18-25Gy\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3068\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\u3092\u4f75\u7528\u3059\u308b\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3092\u7528\u3044\u3066\u3044\u307e\u3057\u305f\u30022009\u5e74\u6642\u70b9\u3067\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u3082\u542b\u3081\u3066\u6cbb\u7642\u5f8c\u8ffd\u8de1\u671f\u9593\u4e2d\u592e\u502465\u30f6\u6708\u3067\u306e\uff15\u5e74\u751f\u5b58\u7387\u306f70%\u7a0b\u5ea6\u3067\u3057\u305f\u304b\u3089\u6b27\u7c73\u304b\u3089\u306e\u5831\u544a\u3068\u5927\u5dee\u306f\u306a\u3044\u3082\u306e\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u3092\u4e2d\u5fc3\u3068\u3057\u305f\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u306f\u5316\u5b66\u7642\u6cd5\u306e\u4e2d\u8ef8\u306b\u3042\u308a\u307e\u3059\u3002<\/p>\n<p>2018\u5e74\u6642\u70b9\u3067\u306f\uff0c\u907a\u4f1d\u5b50\u8a3a\u65ad\u306e\u7d50\u679c\u306b\u3088\u3063\u3066\uff0c\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u6cbb\u7642\u3092\u884c\u3048\u308b\u9ac4\u82bd\u816b\u3092\u5224\u5225\u3059\u308b\u65b9\u5411\u6027\u304c\u4e3b\u4f53\u3067\u3059\u3002\u3057\u304b\u3057\uff0c\u307e\u3060\u6210\u529f\u3068\u8a00\u3048\u308b\u5831\u544a\u304c\u3042\u308a\u307e\u305b\u3093\u3002\u9006\u306b\uff0c\u300c<span style=\"color: #000080;\"><strong>\u907a\u4f1d\u5b50\u78ba\u5b9a\u8a3a\u65ad\u3092\u5f85\u3063\u3066\u3044\u308b\u3046\u3061\u306b\u6cbb\u7642\u304c\u624b\u9045<\/strong><strong>\u308c<\/strong><\/span>\u300d\uff0c\u3068\u3044\u3046\u5b50\u4f9b\u305f\u3061\u306e\u65b9\u304c\u591a\u3044\u3067\u3059\u3002<\/p>\n<h4>\u5236\u304c\u3093\u5264\u306e\u52b9\u679c\u306f\u3069\u306e\u304f\u3089\u3044\uff1f\uff08\u5c0f\u5150\u79d1\u306e\u5148\u751f\u3068\u5bb6\u65cf\u306e\u65b9\u3078\uff09<\/h4>\n<p>\u300c\u9ac4\u82bd\u816b\u306f\u5316\u5b66\u7642\u6cd5\u611f\u53d7\u6027\u304c\u9ad8\u3044\u300d\u3068\u3044\u3046\u901a\u8aac\u304c\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u8a00\u8449\u306e\u89e3\u91c8\u306f\u3080\u305a\u304b\u3057\u3044\u3067\u3059\u3002\u9ac4\u82bd\u816b\u306e\u5316\u5b66\u7642\u6cd5\u611f\u53d7\u6027\uff08\u85ac\u306b\u3088\u308b\u6cbb\u7642\u304c\u52b9\u304f\u304b\u3069\u3046\u304b\uff09\u306f\uff0c\u5b9f\u969b\u306b\u306f\u75c7\u4f8b\u3054\u3068\u306b\u5927\u304d\u304f\u9055\u3046\u306e\u3067\u3059\u3002<\/p>\n<p>\u7b2c\uff14\u8133\u5ba4\u306b\u3068\u3069\u307e\u308b\u9ac4\u82bd\u816b(M0)\u3082\u64ad\u7a2e\u3057\u305f\u306e\u9ac4\u82bd\u816b(M3)\u3082\uff0c\u5316\u5b66\u7642\u6cd5\u3067\u5b8c\u5168\u306b\u6d88\u3048\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059(CR; complete response)\u3002\u3057\u304b\u3057\uff0c\u7cbe\u5ea6\u306e\u9ad8\u3044\u8584\u3044MRI (1mm\u30b9\u30e9\u30a4\u30b9\u306e3D-CISS\u3084\u30ac\u30c9\u30ea\u30cb\u30a6\u30e0MPR)\u3067\u898b\u76f4\u3059\u3068\uff0c\u307b\u3068\u3093\u3069\u306e\u5834\u5408\u3067\u816b\u760d\u306f\u5c11\u3057\u6b8b\u3063\u3066\u3044\u307e\u3059\u3002\u66f4\u306b\u305d\u308c\u3092\u624b\u8853\u3067\u6458\u51fa\u3059\u308b\u3068\u6b8b\u5b58\u816b\u760d\u7d30\u80de\u304c\u75c5\u7406\u3067\u8a3c\u660e\u3055\u308c\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059\u3002\u3067\u3059\u304b\u3089\uff0c \u9ac4\u82bd\u816b\u306e\u5316\u5b66\u7642\u6cd5\u306b\u3088\u308bCR\u7387\uff08\u8457\u52b9\u5272\u5408\uff09\u306f\u8ad6\u6587\u3067\u66f8\u304b\u308c\u3066\u3044\u308b\u4ee5\u4e0a\u306b\u610f\u5916\u3068\u4f4e\u3044\u306e\u3067\u3059\u3002\u6d88\u3048\u305f(CR)\u3068\u601d\u3063\u3066\u3082\u7cbe\u5ea6\u306e\u9ad8\u3044MRI\u3067\u306f\uff0cPR\uff08\u6709\u52b9\uff09\u4f8b\u3067\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u306f\u7a00\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<p>\u5747\u4e00\u306a\u5c0f\u7d30\u80de (small round cell)\u306e\u307f\u3067\u69cb\u6210\u3055\u308c\u308b\u9ac4\u82bd\u816b\uff0c\u7d50\u7bc0\u6027 (extensive nodularity)\u3042\u308b\u3044\u306f\u795e\u7d4c\u7d30\u80de\u3078\u306e\u5206\u5316\u3092\u542b\u3080\u9ac4\u82bd\u816b (neuronal differentiation, cerebellar neuroblastoma\u3068\u3044\u308f\u308c\u305f\u3082\u306e\uff09\u3068\u3055\u308c\u308b\u9ac4\u82bd\u816b\u306f\u4e00\u822c\u7684\u306b\u5316\u5b66\u7642\u6cd5\u611f\u53d7\u6027\u304c\u9ad8\u3044\u3068\u8003\u3048\u3089\u308c\u3066\u304d\u307e\u3057\u305f\u30022016\u5e74\u6642\u70b9\u3067\u306f\uff0cWNT\u3084MBEN\u306a\u3069\u306e\u30bf\u30a4\u30d7\u304c\u5316\u5b66\u7642\u6cd5\u306e\u6709\u52b9\u6027\u304c\u9ad8\u3044\u3068\u89e3\u3063\u3066\u3044\u307e\u3059\u3002 \u9006\u306b\uff0c\u5316\u5b66\u7642\u6cd5\u306b\u307b\u3068\u3093\u3069\u53cd\u5fdc\u3057\u306a\u3044 (NC\uff1a\u4e0d\u5909\uff09\u9ac4\u82bd\u816b\u3082\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u3088\u3046\u306a\u4f8b\u306f\u540c\u6642\u306b\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u306b\u3082\u62b5\u6297\u6027\u306e\u9ac4\u82bd\u816b\u3067\u3042\u308b\u3068\u8003\u3048\u305f\u65b9\u304c\u3044\u3044\u3067\u3057\u3087\u3046\u3002\u6cbb\u7642\u304c\u3068\u3066\u3082\u96e3\u3057\u3044\u4f8b\u3067\u3059\u3002\u30e1\u30e9\u30cb\u30f3\u6027\u9ac4\u82bd\u816b(medulloblastoma with melanotic differentiation)\u3068\u304b\u5927\u7d30\u80de\u6027\uff0f\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b (large cell\/ anaplastic medulloblastoma)\u3068\u304b\u3044\u308f\u308c\u308b\u75c5\u7406\u50cf\u3092\u3082\u3063\u305f\u9ac4\u82bd\u816b\u306b\u591a\u3044\u306e\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002 \u3053\u308c\u3089\u306f\u4eca\u3067\u3082\uff0c\u624b\u8853\u306b\u3088\u308b\u5b8c\u5168\u6458\u51fa\u304c\u547d\u7db1\u306b\u306a\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u4f8b\u3067\u3059\u3002\u5316\u5b66\u7642\u6cd5\u3092\u884c\u3046\u6642\u306b\u306f\uff0c\u9ac4\u82bd\u816b\u306e\u75c5\u7406\u7d44\u7e54\u50cf\u3092\u3057\u3063\u304b\u308a\u898b\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n<p>\u9ac4\u82bd\u816b\u304c\u624b\u8853\u3067\u5168\u90e8\u53d6\u308c\u3066\u3057\u307e\u3046\u3068\uff0c\u305d\u306e\u5f8c\u306b\u5316\u5b66\u7642\u6cd5\u3092\u3057\u3066\u3082\uff0c\u305d\u308c\u304c\u52b9\u3044\u3066\u3044\u308b\u306e\u304b\u3069\u3046\u304b\u306e\u5224\u5b9a\u304c\u3067\u304d\u307e\u305b\u3093\u304b\u3089\uff0c\u5316\u5b66\u7642\u6cd5\u62b5\u6297\u6027\u306e\u9ac4\u82bd\u816b\u304b\u3069\u3046\u304b\u308f\u304b\u3089\u306a\u3044\u307e\u307e\u6cbb\u7642\u3092\u7d9a\u3051\u308b\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002\u3082\u3057MRI\u3060\u3051\u3067\u9ac4\u82bd\u816b\u304c\u8a3a\u65ad\u3067\u304d\u3066\uff0c\u3042\u308b\u304c\u307e\u307e\u306e\u816b\u760d\u306b\u5316\u5b66\u7642\u6cd5\u3092\u884c\u3046\u3053\u3068\u304c\u3067\u304d\u308c\u3070\uff0c\u4f7f\u3063\u305f\u5316\u5b66\u7642\u6cd5\u5264\u304c\u305d\u306e\u9ac4\u82bd\u816b\u306b\u52b9\u304f\u304b\u3069\u3046\u304b\u304c\u306f\u3063\u304d\u308a\u5224\u5b9a\u3067\u304d\u307e\u3059\u3002\u6fa4\u6751\u306f\u305d\u306e\u3088\u3046\u306b\u3057\u3066\u5316\u5b66\u7642\u6cd5\uff0f\u653e\u5c04\u7dda\u6cbb\u7642\u611f\u53d7\u6027\u3092\u898b\u3066\u304b\u3089\u9ac4\u82bd\u816b\u306e\u88dc\u52a9\u7642\u6cd5\u3092\u6c7a\u3081\u3066\u3044\u307e\u3057\u305f\u304c\uff0c\u3053\u306e\u8003\u3048\u65b9\u306f\u4e00\u822c\u7684\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u9ac4\u82bd\u816b\u306f\u307b\u3068\u3093\u3069\u306e\u65bd\u8a2d\u3067\uff0c\u6700\u521d\u306b\u958b\u982d\u816b\u760d\u6458\u51fa\u8853\u304c\u884c\u308f\u308c\u307e\u3059\u3057\uff0c\u305d\u308c\u304c\u6a19\u6e96\u6cbb\u7642\u3067\u3059\u304b\u3089\u304a\u52e7\u3081\u306f\u3057\u307e\u305b\u3093\u3002\u624b\u8853\u3082\u3057\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u306f\uff0c\u9006\u306b\uff0c\u5148\u306b\u66f8\u3044\u305f\u3088\u3046\u306a\u75c5\u7406\u3082\u898b\u306a\u3044\u3067\u5316\u5b66\u7642\u6cd5\u3092\u3059\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u304c\uff0c\u3082\u3046\u4e00\u3064\u5927\u304d\u306a\u5229\u70b9\u304c\u3042\u308a\u307e\u3059\u3002\u624b\u8853\u304c\u539f\u56e0\u306e\u9ac4\u6db2\u64ad\u7a2e\u3092\u306a\u304f\u305b\u308b\u306e\u3067\u3059\u3002M0\u3092M3\u306b\u3057\u306a\u3044\u3053\u3068\u306f\uff0c\u5168\u8133\u810a\u9ac4\u7167\u5c04\u3092\u907f\u3051\u308b\u3068\u3044\u3046\u5c06\u6765\u306e\u6cbb\u7642\u6cd5\u306b\u3082\u3064\u306a\u304c\u308b\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u304c\uff0c\u4eca\u306f\u307e\u3060\u79d1\u5b66\u7684\u306a\u6839\u62e0\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<p>\u8133\u810a\u9ac4\u7167\u5c04\u306e\u7dda\u91cf\u3092\u4e0b\u3052\u308b\uff0c\u5c40\u6240\u7167\u5c04\u306e\u9818\u57df\u3092\u7d5e\u308b\u3068\u3044\u3046\u306e\u304c\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u8ca0\u62c5\u306e\u6e1b\u91cf\u3068\u3057\u3066\u5927\u304d\u306a\u76ee\u6a19\u3067\u3059\u3002\u3057\u304b\u3057\u4e00\u65b9\u3067\uff0c\u795e\u7d4c\u6bd2\u6027\u304c\u5c11\u306a\u304f\u304b\u3064\u6709\u52b9\u306a\u5316\u5b66\u7642\u6cd5\u5264\u3092\u9078\u629e\u3059\u308b\u3068\u3044\u3046\u3053\u3068\u3082\u3068\u3066\u3082\u5927\u5207\u306a\u3053\u3068\u3067\u3059\u3002\u305d\u306e\u610f\u5473\u3067\u306f\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u306f\u907f\u3051\u3089\u308c\u308b\u3079\u304d\u85ac\u5264\u3067\u3059\u3002<\/p>\n<\/div>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-2192\" title=\"pigs\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/pigs.jpg\" alt=\"\" width=\"600\" height=\"269\" \/><\/p>\n<h5>\u907a\u4f1d\u7684\u7d20\u56e0\u306b\u3088\u3063\u3066\u767a\u751f\u3059\u308b\u9ac4\u82bd\u816b<\/h5>\n<p>\u907a\u4f1d\u5b50\u306e\u7570\u5e38\u304c\u3042\u308b\u5148\u5929\u6027\u306e\u75be\u60a3\u306b\u9ac4\u82bd\u816b\u304c\u767a\u751f\u3057\u307e\u3059\u3002\u3044\u305a\u308c\u306e\u75be\u60a3\u306b\u5408\u4f75\u3057\u3066\u3082\u901a\u5e38\u306e\u9ac4\u82bd\u816b\u3088\u308a\u306f\u4e88\u5f8c\u304c\u60aa\u3044\u3053\u3068\u304c\u77e5\u3089\u308c\u3066\u3044\u307e\u3059\u3002<br \/>\n\u30d5\u30a1\u30f3\u30b3\u30cb\u8ca7\u8840\uff0c\u30b4\u30fc\u30ea\u30f3\u75c7\u5019\u7fa4\uff0c\u30ea\u30fb\u30d5\u30e9\u30a6\u30e1\u30ea\u75c7\u5019\u7fa4\u306f\uff0c\u30bd\u30fc\u30cb\u30c3\u30af\u30d8\u30c3\u30b8\u30db\u30c3\u30af SHH pathway\u306e\u7570\u5e38\u3067\u9ac4\u82bd\u816b\u3092\u767a\u75c7\u3057\u307e\u3059\u3002<span style=\"color: #ff0000;\"><strong>SHH\u30bf\u30a4\u30d7\u3067\u306f\uff0c\u907a\u4f1d\u30ab\u30a6\u30f3\u30bb\u30ea\u30f3\u30b0\u304c\u5fc5\u8981<\/strong><\/span>\u3067\u3059\u3002<\/p>\n<ul id=\"_666\">\n<li><span style=\"color: #000080;\"><strong>\u30bf\u30fc\u30b3\u30c3\u30c8\u75c7\u5019\u7fa4<\/strong><\/span> Turcot syndrome (related to germline mutations in <em>APC<\/em>)<\/li>\n<li><span style=\"color: #000080;\"><strong>\u30eb\u30fc\u30d3\u30f3\u30b7\u30e5\u30bf\u30a4\u30f3-\u30c6\u30a4\u30d3\u75c7\u5019\u7fa4<\/strong><\/span> Rubinstein-Taybi syndrome (related to germline mutations in <em>CREBBP<\/em>)<\/li>\n<li><strong><span style=\"color: #000080;\">\u30b4\u30fc\u30ea\u30f3\u75c7\u5019\u7fa4<\/span><\/strong> Gorlin syndrome (also known as basal cell nevus syndrome or nevoid basal cell carcinoma syndrome, associated with germline <em>PTCH1<\/em> and <em>SUFU<\/em> mutations).<\/li>\n<li><span style=\"color: #000080;\"><strong>\u30ea\u30fb\u30d5\u30e9\u30a6\u30e1\u30ea\u75c7\u5019\u7fa4<\/strong><\/span> Li-Fraumeni syndrome (related to germline mutations in <em>TP53<\/em>)<\/li>\n<li><strong><span style=\"color: #000080;\">\u30d5\u30a1\u30f3\u30b3\u30cb\u8ca7\u8840<\/span><\/strong> Fanconi anemia<\/li>\n<\/ul>\n<h5><strong>\u6587\u732e\u60c5\u5831<\/strong><\/h5>\n<div class=\"meta-article-title-wrap\">\n<h4>\u653e\u5c04\u7dda\u6cbb\u7642\u3068\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u306e\u4f75\u7528\u306f\uff0c\u9ad8\u30ea\u30b9\u30af\u3067\u3042\u308b\u30b0\u30eb\u30fc\u30d73\u306e\u4e88\u5f8c\u3092\u6539\u5584\u3059\u308b<\/h4>\n<p class=\"meta-article-title \"><span class=\"meta-authors--limited\"><span class=\"wi-fullname brand-fg\">Leary SES:\u00a0<\/span><\/span>Efficacy of Carboplatin and Isotretinoin in Children With High-risk Medulloblastoma<span class=\"subtitle\">A Randomized Clinical Trial From the Children\u2019s Oncology Group. JAMA Oncol 2021<br \/>\n261\u4eba\u306e\u9ac4\u82bd\u816b\u60a3\u8005\u3055\u3093\u3067\u306e\u81e8\u5e8a\u7b2c3\u76f8\u8a66\u9a13\u3067\u3059\u3002\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u3092\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306b\u6295\u4e0e\u3059\u308b\uff0c\u30a4\u30bd\u30c8\u30ec\u30c1\u30ce\u30a4\u30f3\u3092\u7dad\u6301\u5316\u5b66\u7642\u6cd5\u306b\u52a0\u3048\u308b\u3068\u3044\u3046\u8a66\u9a13\u304c\u306a\u3055\u308c\u307e\u3057\u305f\u300236\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u304c\u7528\u3044\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u30a4\u30bd\u30c8\u30ec\u30c1\u30ce\u30a4\u30f3\u306e\u6709\u52b9\u6027\u306f\u3042\u308a\u307e\u305b\u3093\u3067\u3057\u305f\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306e\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u6295\u4e0e\u306f\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u306e\u30b0\u30eb\u30fc\u30d73\u306b\u304a\u3044\u3066\uff0c5\u5e74\u751f\u5b58\u5272\u5408\u309254%\u304b\u308973\uff05\u3078\u3068\u6539\u5584\u3057\u307e\u3057\u305f\u3002<span style=\"color: #000080;\"><strong>\u30b0\u30eb\u30fc\u30d7\uff13\u9ac4\u82bd\u816b\u3060\u3051\u3067\u306f\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306b\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u3092\u4f75\u7528\u3057\u305f\u65b9\u304c\u826f\u3044<\/strong><\/span>\u3068\u306e\u7d50\u8ad6\u3067\u3059\u3002\u4ed6\u306e\u9ac4\u82bd\u816b\u3067\u306f\u7528\u3044\u307e\u305b\u3093\u3002\u3053\u306e\u7814\u7a76\u306e\u9ad8\u30ea\u30b9\u30af\u7fa4\u3068\u306f\uff0c\u8ee2\u79fb\uff0c\u8853\u5f8c\u6b8b\u5b58\u816b\u760d\uff0c\u7d44\u7e54\u50cf\u3067anaplasia\u304c\u3042\u308b\u3082\u306e\u3092\u542b\u307f\u307e\u3057\u305f\u3002<\/span><\/p>\n<\/div>\n<h4>\u653e\u5c04\u7dda\u9818\u57df\u306e\u7e2e\u5c0f\u3068\u6e1b\u91cf\u306e\u30c8\u30e9\u30a4\u30a2\u30eb<\/h4>\n<p class=\"heading-title\">Michalski JM: Children&#8217;s Oncology Group Phase III Trial of Reduced-Dose and Reduced-Volume Radiotherapy With Chemotherapy for Newly Diagnosed Average-Risk Medulloblastoma. Clin Oncol 2021<br \/>\n\u6a19\u6e96\u30ea\u30b9\u30af\u9ac4\u82bd\u816b\u304c\u5bfe\u8c61\u3067464\u4f8b\u306e\u5927\u898f\u6a21\u7814\u7a76\u3067\u3059\u3002\u5f8c\u982d\u7aa9\u7167\u5c04 (posterior fossa)\u3068\u816b\u760d\u5e8a\u7167\u5c04 (involved field)\u304c\u6bd4\u8f03\u3055\u308c\uff0c3-7\u6b73\u3067\u306f\u8133\u305b\u304d\u9ac4\u7167\u5c0423.4Gy\u306818Gy\u304c\u6bd4\u8f03\u3055\u308c\u307e\u3057\u305f\u3002\u7d50\u8ad6\u306f\uff0c5\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f\uff0c\u5f8c\u982d\u7aa9\u7167\u5c04 80.5%\u3068invloved field 82.5%\u3067\u3042\u308a\uff0c<span style=\"color: #000080;\"><strong>\u816b\u760d\u306e\u3042\u3063\u305f\u5834\u6240\u3060\u3051\u306bboost<\/strong><\/span>\u3059\u308c\u3070\u3088\u3044\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u5f8c\u982d\u7aa9\u3068\u3044\u3046\u5e83\u3044\u9818\u57df\u306f\u5fc5\u8981\u3042\u308a\u307e\u305b\u3093\u3002\u3067\u3082\u6b8b\u5ff5\u306a\u304c\u3089\uff0c\u8133\u810a\u9ac4\u7167\u5c04\u309218Gy\u306b\u6e1b\u91cf\u3059\u308b\u30685\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u304c\u4f4e\u4e0b\u3057\u3066\u3057\u307e\u3044\u307e\u3059\u3002<\/p>\n<h4><strong>\u30ea\u30b9\u30af\u306b\u5fdc\u3058\u305f\u6cbb\u7642\u6cd5\u9078\u629e\u306e\u305f\u3081\u306e\u7814\u7a76\u7d50\u679c\uff1a\u5927\u898f\u6a21\u81e8\u5e8a\u7814\u7a76<\/strong><\/h4>\n<p class=\"heading-title\"><span class=\"authors-list-item \">Gajjar A:\u00a0<\/span>Outcomes by Clinical and Molecular Features in Children With Medulloblastoma Treated With Risk-Adapted Therapy: Results of an International Phase III Trial (SJMB03). J Clin Oncol 2021<br \/>\nSJMB03 \u81e8\u5e8a\u7b2c3\u76f8\u8a66\u9a13\u306e\u7d50\u679c\u3067\u3059\u3002\u5bfe\u8c61\u5e74\u9f62\u306f3-21\u6b73\uff0c\u8ee2\u79fb\u306e\u6709\u7121\u3068\u624b\u8853\u6458\u51fa\u5ea6\u3092\u3082\u3063\u3066\u6a19\u6e96\u30ea\u30b9\u30af\u3068\u9ad8\u30ea\u30b9\u30af\u306b\u5206\u3051\u3066\u6cbb\u7642\u304c\u9078\u629e\u3055\u308c\u307e\u3057\u305f\u30024\u3064\u306e\u30b0\u30eb\u30fc\u30d7\u306b\u5206\u985e\u3055\u308c\u8a55\u4fa1\u3055\u308c\u307e\u3057\u305f\u3002330\u4eba\u304c\u767b\u9332\u3055\u308c\u307e\u3057\u305f\u30025\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 PFS \u306f\uff0c\u6a19\u6e96\u30ea\u30b9\u30af\u306783%\uff0c\u9ad8\u30ea\u30b9\u30af\u306759%\u3067\u3057\u305f\u3002\u3053\u308c\u306f\u5f93\u6765\u306e\u5831\u544a\u3068\u5927\u304d\u306a\u5dee\u306f\u3042\u308a\u307e\u305b\u3093\u30023\u3064\u306e\u4f4e\u30ea\u30b9\u30af\u30b0\u30eb\u30fc\u30d7\u304c\u8a8d\u3081\u3089\u308c\uff0cWNT, low-risk SHH, low-risk combined groups 3 and 4\u3067\u306f\uff0c\uff15\u5e74PFS\u304c90%\u3092\u8d85\u3048\u307e\u3057\u305f\u3002\u5f93\u6765\u3069\u304a\u308a\u7d44\u7e54\u5b66\u7684\u306b\u306fDNMB\u304c\u4f4e\u30ea\u30b9\u30af\u3067\u3059\u3002\u9006\u306b\uff0c2\u3064\u306e\u9ad8\u5ea6\u9ad8\u30ea\u30b9\u30af\u30b0\u30eb\u30fc\u30d7\uff0chigh-risk SHH\u3068high-risk combined groups 3 and 4\u3067\u306f\uff0c\uff15\u5e74PFS\u306f60%\u3092\u4e0b\u56de\u308a\u307e\u3057\u305f\u3002ERBB\uff12\u5909\u7570\u306e\u6709\u7121\u3068PFS\u306b\u306f\u95a2\u9023\u304c\u3042\u308a\u307e\u305b\u3093\u3067\u3057\u305f\u3002\u4eca\u5f8c\u306e\u81e8\u5e8a\u7814\u7a76\u306b\u304a\u3044\u3066\u306f\uff0c\u3053\u308c\u3089\u306e\u7d50\u679c\u3092\u8e0f\u307e\u3048\u3066\u30ea\u30b9\u30af\u5206\u985e\u306b\u3088\u308b\u6cbb\u7642\u65b9\u91dd\u304c\u7acb\u3066\u3089\u308c\u308b\u3068\u306e\u7d50\u8ad6\u3067\u3059\u3002<\/p>\n<h4 class=\"cit\">\u6210\u4eba\u306e\u9ac4\u82bd\u816b\u306f\u5c0f\u5150\u3068\u7570\u306a\u308b<\/h4>\n<p><span class=\"Apple-converted-space\">Penas-Prado M: <\/span>Proceedings of the Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) Adult Medulloblastoma Workshop, 2020<br \/>\n<span class=\"Apple-converted-space\">\u5206\u5b50\u30de\u30fc\u30ab\u30fc\u304c\u5c0f\u5150\u9ac4\u82bd\u816b\u3068\u6210\u4eba\u3067\u306f\u7570\u306a\u308a\u307e\u3059\u3002\u3067\u3059\u304b\u3089\u5c0f\u5150\u9ac4\u82bd\u816b\u304c4\u3064\u306e\u30bf\u30a4\u30d7\u306b\u5206\u985e\u3055\u308c\u6cbb\u7642\u65b9\u91dd\u304c\u6c7a\u307e\u308a\uff0c\u4e88\u5f8c\u304c\u63a8\u5b9a\u3067\u304d\u308b\u3068\u3044\u3046\u4eee\u8aac\u304c\u6210\u4eba\u3067\u306f\u9069\u5fdc\u3067\u304d\u307e\u305b\u3093\u3002\u4f8b\u3048\u3070\uff0cmonosomy 6\u306f\uff0c\u5c0f\u5150\u3067\u306f\u4f8b\u5916\u306a\u304fWNT\u9ac4\u82bd\u816b\u306b\u3042\u308b\u306e\u3067\u3059\u304c\uff0c\u6210\u4eba\u9ac4\u82bd\u816b\u3067\u306fSHH\u3068Group 4\u306b\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002\u3055\u3089\u306b\uff0cmonosomy 6\u306f\u6210\u4eba\u3067\u306f\u4e88\u5f8c\u826f\u597d\u56e0\u5b50\u3068\u306a\u308a\u307e\u305b\u3093\u3002\u653f\u6cbb\u3067\u306fSHH-MB\u304c70%\u306e\u983b\u5ea6\u3092\u5360\u3081\uff0cSHH \u03b4\u30bf\u30a4\u30d7\u304c\u591a\u304f\u3092\u5360\u3081\u307e\u3059\u3002\u6210\u4eba\u9ac4\u82bd\u816b\u306e30%\u307b\u3069\u306b\uff0c\u4e2d\u67a2\u795e\u7d4c\u5185\u3042\u308b\u3044\u306f\u4e2d\u67a2\u795e\u7d4c\u5916\u306e\u64ad\u7a2e\u518d\u767a\u304c\u3042\u308b\u306e\u3067\u3059\u304c\uff0c\u305d\u308c\u3068\u5206\u5b50\u30de\u30fc\u30ab\u30fc\u306e\u95a2\u9023\u3082\u308f\u304b\u3063\u3066\u3044\u307e\u305b\u3093\u3002<br \/>\n<\/span><\/p>\n<h4 class=\"cit\">\u5f8c\u982d\u7aa9\u75c7\u5019\u7fa4 posteriro fossa syndrome\u3068\u3044\u3046\u7528\u8a9e\u306f\u5ec3\u3055\u308c\u305f<\/h4>\n<p><span class=\"highlight\">Schmahmann JD:\u00a0<\/span>Pediatric post-operative cerebellar <span class=\"highlight\">mutism<\/span> syndrome, cerebellar cognitive affective syndrome, and posterior fossa syndrome: historical review and proposed resolution to guide future study. <span role=\"menubar\">Childs Nerv Syst.<\/span> 2019<br \/>\nThere is consensus among investigators in the international Posterior Fossa Society that the designation be retired. \u3068\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002\u5f8c\u982d\u7aa9\u624b\u8853\u5f8c\u306e\u5408\u4f75\u75c7\u3092\u7dcf\u79f0\u3059\u308b\uff0c\u5f8c\u982d\u7aa9\u75c7\u5019\u7fa4\u306f\u4eca\u5f8c\u7528\u3044\u3089\u308c\u306a\u304f\u306a\u308a\u307e\u3059\u3002\u5916\u79d1\u624b\u8853\u5408\u4f75\u75c7\u3092\u6e1b\u3058\u308b\u30ea\u30b9\u30af\u968e\u5c64\u5316\u306e\u305f\u3081\u306b\uff0ccerebellar motor syndrome, cerebellar vestibular syndrome, cerebellar cognitive affective syndrome including emotional dyscontrol, and <span class=\"highlight\">mutism\u306e\u7406\u89e3\u304c\u5fc5\u8981\u3068\u8aac\u304b\u308c\u3066\u3044\u307e\u3059\u3002\u6b8b\u5ff5\u306a\u304c\u3089\u3053\u308c\u3089\u306e\u75c7\u5019\u3092\u65e5\u672c\u8a9e\u306b\u8a33\u3059\u3053\u3068\u304c\u3067\u304d\u305a\uff0c\u65e5\u672c\u306e\u8133\u5916\u79d1\u533b\u306e\u9593\u306e\u7406\u89e3\u306f\u9045\u308c\u308b\u3068\u601d\u3044\u307e\u3059\u3002<\/span><\/p>\n<h4 class=\"cit\">\u967d\u5b50\u7dda\u306e\u307b\u3046\u304c\u77e5\u80fd\u4e88\u5f8c\u304c\u826f\u3044<\/h4>\n<p><span class=\"highlight\">Kahalley LS: Superior<\/span> <span class=\"highlight\">Intellectual<\/span> <span class=\"highlight\">Outcomes<\/span> <span class=\"highlight\">After<\/span> <span class=\"highlight\">Proton<\/span> <span class=\"highlight\">Radiotherapy<\/span> <span class=\"highlight\">Compared<\/span> With <span class=\"highlight\">Photon<\/span> <span class=\"highlight\">Radiotherapy<\/span>for <span class=\"highlight\">Pediatric<\/span> <span class=\"highlight\">Medulloblastoma<\/span>. <span role=\"menubar\">J Clin Oncol.<\/span> 2019<br \/>\n\u9577\u304f\u8b70\u8ad6\u304c\u3042\u3063\u305f\u547d\u984c\u306e\u7b54\u3048\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u30022007\u5e74\u304b\u30892018\u5e74\u306b\u6cbb\u7642\u3055\u308c\u305f\u9ac4\u82bd\u816b\u306b\uff0c37\u4eba\u306b\u967d\u5b50\u7dda\u304c\uff0c42\u4eba\u306b\u5149\u5b50\u7dda\uff08photon radiotherepy, \u65e7\u6765\u306e\u653e\u5c04\u7dda\u6cbb\u7642\uff09\u304c\u7528\u3044\u3089\u308c\u307e\u3057\u305f\u3002\u8133\u810a\u9ac4\u7dda\u91cf\u4e2d\u592e\u5024\u306f\u540c\u305823.4Gy\u3067\uff0c\u5e73\u5747\u5e74\u9f628.6\u6b73\uff0c\u5e73\u5747\u8ffd\u8de1\u671f\u9593\u306f4.3\u5e74\u3067\u3059\u3002<span style=\"color: #000080;\"><strong>\u65e7\u6765\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u306f\u8a8d\u77e5\u6a5f\u80fd\u306f\u4f4e\u4e0b\u3057\u307e\u3057\u305f\u304c\uff0c\u967d\u5b50\u7dda\u3067\u306fstable scores\u3067\u3042\u3063\u305f<\/strong><\/span>\u305d\u3046\u3067\u3059\u3002\u305d\u306e\u307e\u307e\u53d7\u3051\u53d6\u308c\u3070\u76ee\u7acb\u3063\u305f\u77e5\u80fd\u4f4e\u4e0b\u306f\u306a\u3044\u3068\u8a33\u305b\u307e\u3059\u3002\u3053\u306e\u8ad6\u6587\u306f\u4eca\u5f8c\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u306b\u5bfe\u3057\u3066\u5927\u304d\u306a\u30a4\u30f3\u30d1\u30af\u30c8\u3092\u3082\u3064\u3082\u306e\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u8457\u8005\u306f\uff0cprocessing speed\u306f\u967d\u5b50\u7dda\u3067\u3082\u4f4e\u4e0b\u3057\u305f\u3068\u5f37\u8abf\u3057\u3066\u3044\u307e\u3059\u3002\u539f\u767a\u5de3\u5468\u56f2\u306e\u5c0f\u8133\u306b\u306f\u540c\u3058\u9ad8\u7dda\u91cf\u304c\u5165\u308a\u307e\u3059\u306e\u3067\uff0c\u967d\u5b50\u7dda\u306b\u304a\u3044\u3066\u3082\uff0c\u5c0f\u8133\u6a5f\u80fd\u3092\u4ecb\u3059\u308b\u8a8d\u77e5\u6a5f\u80fd\u3068\u3057\u3066\u306eprocessing speed\u306f\u4f4e\u4e0b\u3059\u308b\u3068\u7406\u89e3\u3055\u308c\u307e\u3059\u3002\u6ce8\u610f\u3057\u305f\u3044\u306e\u306f\uff0c\u6cbb\u7642\u5bfe\u8c61\u3068\u306a\u3063\u305f\u5e74\u9f62\u304c\u9ac4\u82bd\u816b\u306b\u3057\u3066\u306f\u6bd4\u8f03\u7684\u9ad8\u3044\u3053\u3068\uff0c\u307e\u305f\u5bfe\u8c61\u304c\u4f4e\u30ea\u30b9\u30af\u7fa4\u3067\u3042\u3063\u305f\u3068\u3044\u3046\u9650\u5b9a\u6761\u4ef6\u3067\u3059\u3002\u307e\u305f\u8133\u810a\u9ac4\u7167\u5c04\u306f\u540c\u3058\u7dda\u91cf\u304c\u5165\u3063\u3066\u3044\u307e\u3059\u306e\u3067\uff0c\u8133\u810a\u9ac4\u7167\u5c04\u304c23.4Gy\u3068\u3044\u3046\u4f4e\u7dda\u91cf\u6761\u4ef6\u306b\u304a\u3044\u3066\u6210\u7acb\u3057\u5f97\u308b\u6cbb\u7642\u6210\u7e3e\u3067\u3059\u3002<\/p>\n<h4>\u53e4\u3044\u85ac\u3060\u3051\u3069\u7d4c\u53e3\u30a8\u30c8\u30dd\u30b7\u30c9\u304c\u6709\u52b9\u306a\u4f8b\u304c\u3042\u308b<\/h4>\n<p class=\"cit\"><span role=\"menubar\">Perez-Somarriba M:\u00a0<\/span>Old drugs still work! Oral etoposide in a relapsed <span class=\"highlight\">medulloblastoma<\/span>.\u00a0<span role=\"menubar\">Childs Nerv Syst.<\/span> 2019<br \/>\n\u5206\u5b50\u6a19\u7684\u6cbb\u7642\u85ac\u306e\u6210\u679c\u304c\u898b\u3048\u306a\u3044\u4e2d\uff0c\u8ee2\u79fb\u518d\u767a\u3057\u305f8\u6b73\u306e\u5973\u5150\u306b\u7d4c\u53e3\u30a8\u30c8\u30dd\u30b7\u30c9\u304c\u6709\u52b9\u3067QOL\u3092\u4fdd\u6301\u3057\u3066\u5bdb\u89e3\u7dad\u6301\u3067\u304d\u305f\u3068\u3044\u30461\u4f8b\u5831\u544a\u3067\u3059\u3002<\/p>\n<div class=\"article-citation\">\n<h4>\u518d\u767a\u6cbb\u7642\u5f8c\u306e\u751f\u5b58<\/h4>\n<\/div>\n<p class=\"heading-title\">Jhonson DL: Survival Following Tumor Recurrence in Children With Medulloblastoma. Pediatr Hematol Oncol 2018<br \/>\n\u30ab\u30ca\u30c0\u304b\u3089\u306e550\u4f8b\u306e\u5831\u544a\u3067\u3059\u3002173\u4f8b (31%)\u304c\u518d\u767a\u3057\u518d\u6cbb\u7642\u306e\u7d50\u679c\uff0c5\u5e74\u751f\u5b58\u5272\u5408\u306f12%\u3067\u3057\u305f\u3002\u518d\u767a\u3059\u308b\u30689\u5272\u306f\u52a9\u3051\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u305b\u3093\u3002<\/p>\n<h4>\u6210\u4eba\u306e\u9ac4\u82bd\u816b\u3082\u60aa\u6027\u5ea6\u306f\u540c\u3058<\/h4>\n<p class=\"cit\"><span role=\"menubar\">Atalar B: <\/span>Treatment outcome and prognostic factors for adult patients with medulloblastoma: The Rare Cancer Network (RCN) experience. R<span role=\"menubar\">adiother Oncol.<\/span> 2018<br \/>\n1976\u5e74\u304b\u30892014\u5e74\u307e\u3067\u306b\u6b27\u7c73\u3067\u96c6\u7a4d\u3055\u308c\u305f206\u4eba\u306e\u9ac4\u82bd\u816b\u60a3\u8005\u3055\u3093\u306e\u4e88\u5f8c\u3067\u3059\u3002\u5e74\u9f62\u4e2d\u592e\u5024\u306f29\u6b73\u3067\u3059\u300210\u5e74\u5c40\u6240\u5236\u5fa1\u5272\u5408\u306f46%\uff0c10\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f38%\uff0c10\u5e74\u524d\u751f\u5b58\u5272\u5408\u306f51%\u3067\u3057\u305f\u3002\u30a8\u30d3\u30c7\u30f3\u30b9\u30ec\u30d9\u30eb\u306f\u4f4e\u3044\u5831\u544a\u3067\u3059\u304c\uff0c\u6210\u4eba\u306e\u9ac4\u82bd\u816b\u304c\u5c0f\u5150\u3068\u540c\u69d8\u306b\u4e88\u5f8c\u4e0d\u826f\u306e\u9ad8\u5ea6\u60aa\u6027\u816b\u760d\u3060\u3068\u3044\u3046\u3053\u3068\u306f\u308f\u304b\u308a\u307e\u3059\u3002\u6210\u4eba\u3060\u304b\u3089\u3068\u3044\u3063\u3066\u624b\u3092\u7de9\u3081\u3066\u306f\u3044\u3051\u306a\u3044\u3002<\/p>\n<h4><span class=\"highlight\">\u6a19\u6e96\u30ea\u30b9\u30af non-WNT<\/span>\/<span class=\"highlight\">non-SHH<\/span> medulloblastoma \u306e\u65b0\u305f\u306a\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7<\/h4>\n<p>Goschzik T, et al.:\u00a0Prognostic\u00a0effect\u00a0of\u00a0whole\u00a0chromosomal\u00a0aberration\u00a0signatures\u00a0in\u00a0standard-risk,\u00a0non-WNT\/non-SHH\u00a0medulloblastoma: a retrospective, molecular analysis of the HIT-SIOP PNET 4 trial.\u00a0Lancet Oncol.\u00a02018<br \/>\n2006\u5e74\u307e\u3067\u884c\u308f\u308c\u305fHIT-SIOP PNET4\u306e136\u4f8b\u306e\u89e3\u6790\u3067\u3059\u3002\u30b0\u30eb\u30fc\u30d73\u3068\u30b0\u30eb\u30fc\u30d74\u306e\u9ac4\u82bd\u816b\u306e\u3046\u3061\uff0c\u7279\u5b9a\u306e\u67d3\u8272\u4f53\u7570\u5e38\u304c\u3042\u308b\u3082\u306e(at least two of chromosome 7 gain, chromosome 8 loss, and chromosome 11 loss) \u306f\uff0c\u4e88\u5f8c\u304c\u826f\u3044\u4f4e\u30ea\u30b9\u30af\u816b\u760d\u306b\u5206\u985e\u3067\u304d\u308b\u3068\u306e\u7d50\u8ad6\u3067\u3059\u3002<\/p>\n<h4>\u00a03-5\u6b73\u9ac4\u82bd\u816b\uff1a<span style=\"color: #000080;\"><strong>\u30ea\u30b9\u30af\u5206\u985e\u3067\u306e\u6cbb\u7642\u9078\u629e\u3067\u751f\u5b58\u671f\u9593\u3092\u5ef6\u3070\u305b\u306a\u304b\u3063\u305f<\/strong><\/span><\/h4>\n<p>Robinson G, et al.: Risk-adapted\u00a0therapy\u00a0for\u00a0young\u00a0children\u00a0with\u00a0medulloblastoma\u00a0(SJYC07):\u00a0therapeutic\u00a0and\u00a0molecular\u00a0outcomes\u00a0from a\u00a0multicentre,\u00a0phase\u00a02\u00a0trial.\u00a0Lancet Oncol 2018<br \/>\n3\u6b73\u304b\u30895\u6b73\u307e\u3067\u306e\u9ad8\u30ea\u30b9\u30af\u3067\u306f\u306a\u3044\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u3067\u3059\u3002\u624b\u8853\u304b\u308931\u65e5\u4ee5\u5185\u306b\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3092\u958b\u59cb\u3057\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002Lansky performance score\u306f30\uff05\u4ee5\u4e0a\u3002\u4f4e\u30ea\u30b9\u30af\uff0c\u4e2d\u9593\u30ea\u30b9\u30af\uff0c\u9ad8\u30ea\u30b9\u30af\u306b\u5206\u985e\u3055\u308c\u307e\u3057\u305f\u3002\u5c0e\u5165\u5316\u5b66\u7642\u6cd5\u306f\u540c\u3058\u3067\u00a0methotrexate, vincristine, cisplatin, cyclophosphamide \u3067\u3059\u3002\u9ad8\u30ea\u30b9\u30af\u306e\u5b50\u4f9b\u3060\u3051\u306bvinblastine\u304c\u52a0\u3048\u3089\u308c\u307e\u3057\u305f\u3002\u6b21\u3044\u3067\u5730\u56fa\u3081\u7642\u6cd5\u304c\u884c\u308f\u308c\u307e\u3059\uff0c\u305d\u308c\u305e\u308c\uff0c<br \/>\n\u4f4e\u30ea\u30b9\u30af\u3067\u306f\uff0ccyclophosphamide (1500 mg\/m<sup>2<\/sup> on day 1), etoposide (100 mg\/m<sup>2<\/sup> on days 1 and 2), and carboplatin (area under the curve 5 mg\/mL per min on day 2) for two 4-week cycles<br \/>\n\u4e2d\u9593\u30ea\u30b9\u30af\u3067\u306f\uff0cfocal radiation <span class=\"highlight\">therapy<\/span> (54 Gy with a clinical target volume of 5 mm over 6 weeks) to the tumour bed<br \/>\n\u9ad8\u30ea\u30b9\u30af\u3067\u306f\uff0cchemotherapy with targeted intravenous topotecan (area under the curve 120-160 ng-h\/mL intravenously on days 1-5) and cyclophosphamide (600 mg\/m<sup>2<\/sup> intravenously on days 1-5).<br \/>\n\u5168\u3066\u306e\u60a3\u5150\u3067cyclophosphamide, topotecan, erlotinib\u7dad\u6301\u5316\u5b66\u7642\u6cd5\u304c\u8ffd\u52a0\u3055\u308c\u307e\u3057\u305f\u3002<br \/>\n\u4f4e\u30ea\u30b9\u30af\u7fa4\u306f\u6210\u7e3e\u304c\u60aa\u304f\u767b\u9332\u306f\u4e2d\u65ad\u3055\u308c\u307e\u3057\u305f\u3002 <span style=\"color: #000080;\"><strong>2017\u5e74\u307e\u3067\u306b81\u4eba\u304c\u6cbb\u7642\u3055\u308c\uff0c5\u5e74\u7121\u5897\u60aa\u751f\u5b58\u671f\u9593\u306f31%\u3067\u3057\u305f\u3002<\/strong><\/span>SSH\u306e\u30e1\u30c1\u30ec\u30fc\u30b7\u30e7\u30f3\u30bf\u30a4\u30d7\u306b\u3088\u3063\u3066\u306f\u4e88\u5f8c\u304c\u826f\u3044\u3082\u306e\u304c\u3042\u3063\u305f\u305d\u3046\u3067\u3059\u304c\uff0c\u4fe1\u983c\u5ea6\u306f\u9ad8\u304f\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u7d50\u8ad6\u3068\u3057\u3066\uff0c\u30ea\u30b9\u30af\u306b\u5fdc\u3058\u305f\u6cbb\u7642\u9078\u629e\u306f\u60a3\u5150\u306e\u7121\u5897\u60aa\u751f\u5b58\u671f\u9593\u3092\u5ef6\u9577\u3057\u307e\u305b\u3093\u3067\u3057\u305f\u3002<\/p>\n<h4>\u5e7c\u3044\u5b50\u306eDNMB\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u306e\u30b8\u30ec\u30f3\u30de<\/h4>\n<p>Cabdelbaki MS, et al;\u00a0Desmoplastic Nodular\u00a0Medulloblastoma\u00a0in Young Children: A Management Dilemma. Neuro Oncol\u00a02017<br \/>\nGerman (HIT) trials\u306e\u7d20\u6674\u3089\u3057\u3044\u6cbb\u7642\u6210\u7e3e\u3092\u53d7\u3051\u3066\uff0c2013\u5e74\u304b\u3089ACNS1221\u304c3\u6b73\u4ee5\u4e0b\u306e<span style=\"color: #000080;\"><strong>DNMB\u306b\u5bfe\u3057\u3066\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u3068MTX\u306e\u9ac4\u6ce8\u3092\u884c\u308f\u306a\u3044\u3068\u3044\u3046\u8a66\u9a13\u3092\u59cb\u3081\u307e\u3057\u305f\u3002\u3057\u304b\u3057\uff0c2\u5e74\u4e2d\u9593\u89e3\u6790\u3067\u518d\u767a\u304c\u591a\u304f\u3053\u306e\u8a66\u9a13\u306f\u4e2d\u65ad\u3055\u308c\u307e\u3057\u305f<\/strong><\/span>\u3002<\/p>\n<h4>\u8ee2\u79fb\u3057\u3066\u3044\u308b\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u6210\u7e3e<\/h4>\n<p>von Bueren AO, et al.:\u00a0Treatment of Children and Adolescents With Metastatic\u00a0Medulloblastoma\u00a0and Prognostic Relevance of\u00a0Clinical\u00a0and Biologic Parameters. J Clin Oncol 2016<br \/>\n2001\u5e74\u304b\u3089\u5c0e\u5165\u5316\u5b66\u7642\u6cd5\uff0c\u591a\u5206\u5272\u8133\u810a\u9ac4\u7167\u5c04\uff0c\u7dad\u6301\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u305f\uff0c4\u6b73\u4ee5\u4e0a\u306e\u9ac4\u82bd\u816b\u60a3\u8005\u3055\u3093123\u4eba\u306e\u6cbb\u7642\u6210\u7e3e\u3067\u3059\u30025\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f52%\uff0c\u5168\u751f\u5b58\u5272\u5408\u306f74%\u3067\u3057\u305f\u3002 DNMB\u3067\u306f89%\u306889% (n = 11)\u3067\u3042\u3063\u305f\u306e\u306b\u5bfe\u3057\u3066\uff0c large-cell\/anaplastic\u3067\u306f20%\u306840%\u3067\u3057\u305f (n = 5) \u3002\u4e21\u8005\u3068\u3082\u6570\u306f\u5c11\u306a\u3044\u306e\u3067\u3059\u304c\u304b\u306a\u308a\u5927\u304d\u306a\u5dee\u3067\u3059\u3002\u907a\u4f1d\u5b50\u5909\u7570\u3067\u306fWNT wingless\u306e\u4e88\u5f8c\u304c\u6700\u3082\u826f\u3044\u4f4e\u30ea\u30b9\u30af\u3067\u3042\u308b\u3053\u3068\u304c\u78ba\u8a8d\u3055\u308c\u307e\u3057\u305f\u3002\u9006\u306b\uff0c<span style=\"color: #000080;\"><strong>MYCC\/ MYCN amplification\u306f\u9ad8\u30ea\u30b9\u30af<\/strong><\/span>\u3068\u6349\u3048\u3089\u308c\u307e\u3059\u3002<br \/>\n\u4eca\u307e\u3067\u5f53\u7136\u308f\u304b\u3063\u3066\u3044\u305f\u306e\u3053\u3068\u306a\u306e\u3067\u3059\u304c\uff0c<strong><span style=\"color: #000080;\">\u521d\u56de\u306e\u5316\u5b66\u7642\u6cd5\u306e\u6295\u4e0e\u306b\u53cd\u5fdc\u3057\u305f\u4f8b\u3067\u751f\u5b58\u5272\u5408\u304c\u9ad8\u304b\u3063\u305f<\/span><\/strong>\u3053\u3068\u3092\u78ba\u8a8d\u3057\u3066\u3044\u307e\u3059\u3002\u521d\u56de\u6295\u4e0e\u3067\u816b\u760d\u9670\u5f71\u304c\u9855\u8457\u306b\u7e2e\u5c0f\u3057\u306a\u3051\u308c\u3070\u305d\u306e\u5316\u5b66\u7642\u6cd5\u3092\u5909\u3048\u305f\u307b\u3046\u304c\u3044\u3044\u3068\u3044\u3046\u53e4\u3044\u793a\u5506\u3067\u3082\u3042\u308a\u307e\u3059\u3002<\/p>\n<h4>3\u6b73\u304b\u30898\u6b73\u306e\u5e7c\u3044\u5b50\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u9045\u3089\u305b\u305f\u5834\u5408\u306b\u306f\u751f\u5b58\u5272\u5408\u306f\u4e0b\u304c\u308b<\/h4>\n<p>Kann BH, et al.: Postoperative Radiotherapy Patterns of Care and Survival Implications for Medulloblastoma in Young Children. JAMA Oncol 2016<br \/>\n\u7c73\u56fd\u306e\u30c7\u30fc\u30bf\u30d9\u30fc\u30b9\u306e\u89e3\u6790\u3067\u3059\u3002\u5e7c\u3044\u5b50\u306b\u306a\u308b\u307b\u3069\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u6669\u671f\u969c\u5bb3\u304c\u591a\u3044\u306e\u306f\u77e5\u3089\u308c\u3066\u3044\u307e\u3059\u30022004\u5e74\u304b\u30892012\u5e74\u307e\u3067\uff0c3\u6b73\u306e\u9ac4\u82bd\u816b\u306e\u5b50\u306e37%\u304c\u624b\u8853\u76f4\u5f8c (RT upfront) \u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u53d7\u3051\u305a\uff0c\u6642\u671f\u3092\u9045\u3089\u305b\u307e\u3057\u305f (RT deferred)\u30028\u6b73\u306e\u5b50\u4f9b\u3067\u306f4%\u3067\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u9045\u3089\u305b\u307e\u3057\u305f\u3002\u4e88\u60f3\u4ee5\u4e0a\u306b\u624b\u8853\u5f8c\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u5ef6\u671f\u304c\u751f\u3058\u308b\u50be\u5411\u306b\u3042\u308b\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u3057\u304b\u3057\uff0c5\u5e74\u5168\u751f\u5b58\u5272\u5408\u306f\uff0c\u624b\u8853\u5f8c\u653e\u5c04\u7dda\u6cbb\u7642 upfront\u306782%\uff0c\u9045\u5ef6\u3055\u305b\u305f\u5834\u5408\u306f63.4%\u3067\u3057\u305f\u3002<span style=\"color: #000080;\"><strong>\u8a8d\u77e5\u6a5f\u80fd\u969c\u5bb3\u3092\u907f\u3051\u308b\u305f\u3081\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u6642\u671f\u3092\u9045\u3089\u305b\u3088\u3046\u3068\u3059\u308c\u3070\uff0c\u660e\u3089\u304b\u306b\u9577\u671f\u751f\u5b58\u5272\u5408\u306f\u4f4e\u4e0b\u3059\u308b<\/strong><\/span>\u3068\u3044\u3046\u7d50\u8ad6\u3067\u3059\u3002<\/p>\n<h4>\u9ac4\u82bd\u816b\u306e\u967d\u5b50\u7dda\u6cbb\u7642<\/h4>\n<p>Yock TI et al. Long-term toxic effects of proton radiotherapy for\u00a0paediatric medulloblastoma: a phase 2 single-arm study. Lancet Oncology Published online January 29, 2016<br \/>\n\u30dc\u30b9\u30c8\u30f3MGH\u304b\u3089\u306e\u5831\u544a\u3067\uff0c2003\u5e74\u304b\u30892009\u5e74\u306b59\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u6210\u7e3e\u3067\u3059\u300214\u4f8b\u306e\u9ad8\u30ea\u30b9\u30af\u7fa4\u306e\u60a3\u5150\u304c\u542b\u307e\u308c\u3066\u3044\u307e\u3059\u3002\u967d\u5b50\u7dda\u3067\u8133\u810a\u9ac418\u201336 Gy (GyRBE) (1\u00b78 GyRBE per fraction)\u3068\u5c40\u6240\u7167\u5c04\u304c\u4f7f\u7528\u3055\u308c\u307e\u3057\u305f\u3002\u5168\u54e1\u304c\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u3066\u304a\u308a\uff0c\u8133\u810a\u9ac4\u7dda\u91cf\u4e2d\u592e\u5024\u306f23.4Gy\uff0c\u5c40\u6240\u306f54Gy\u3067\u3057\u305f\u3002\u751f\u5b58\u8005\u5e73\u5747\u8ffd\u8de1\u671f\u9593\u306f7\u5e74\u3067\u3059\u300245\u4eba\u4e2d\u306e4\u4eba(9%)\u3067\u4e21\u5074\u306e\u8074\u529b\u4f4e\u4e0b(grade 3-4)\u304c\u751f\u3058\uff0c3\u4eba\u3067\u7247\u5074\u306e\u8074\u529b\u4f4e\u4e0b\u304c\u751f\u3058\u307e\u3057\u305f\u30025\u5e74\u3067\u306e\u7d2f\u7a4d\u5272\u5408\u3067\u306f16%\u3067\u3057\u305f\u30025\u5e74\u8ffd\u8de1\u671f\u9593\u3067FIQ\u304c\u5e74\u5e73\u57471.5 point\u4f4e\u4e0b\u3057\u307e\u3057\u305f\u3002\u5185\u5206\u6ccc\u6a5f\u80fd\u306f55%\u3067\u4f4e\u4e0b\u3057\u3066\u3044\u3066\uff0c\u6210\u9577\u30db\u30eb\u30e2\u30f3\u6b20\u640d\u75c7\u304c\u983b\u5ea6\u3068\u3057\u3066\u9ad8\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u30025\u5e74\u5168\u751f\u5b58\u5272\u5408\u306f83%(95%CI 67-88)\u3068\u63a8\u5b9a\u3055\u308c\u307e\u3057\u305f\u3002\u967d\u5b50\u7dda\u3067\uff0c\u65e7\u6765\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u3068\u540c\u7b49\u306e\u751f\u5b58\u5272\u5408\u3092\u5f97\u3089\u308c\u308b\u3068\u306e\u7d50\u8ad6\u3067\u3059\u3002<br \/>\n\u300cCCLG\u306e\u30b3\u30e1\u30f3\u30c8\u300d<br \/>\n\u4e2d\u77ed\u671f\u306e\u89b3\u5bdf\u671f\u9593\u306b\u304a\u3044\u3066\uff0c\u967d\u5b50\u7dda\u306b\u3088\u308b\u751f\u5b58\u5272\u5408\u3068\u526f\u4f5c\u7528\u306f\u65e7\u6765\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u3068\u540c\u7b49\u3067\u3042\u308b\u8a55\u4fa1\u3057\u3066\u3044\u307e\u3059\u3002\u7406\u8ad6\u7684\u671f\u5f85\u304c\u3042\u308b\u3082\u306e\u306e\u305d\u308c\u306f\u307e\u3060\u8a3c\u660e\u306b\u306f\u81f3\u3063\u3066\u3044\u307e\u305b\u3093\u3002\u30e1\u30c7\u30a3\u30a2\u3067\u5831\u9053\u3055\u308c\u305f\u3082\u306e\u306f\u8ad6\u6587\u306e\u8457\u8005\u306b\u3088\u3063\u3066\u66f8\u304b\u308c\u305f\u7d50\u8ad6\u306b\u5c3e\u3072\u308c\u304c\u3064\u3044\u3066\u3044\u308b\u3088\u3046\u3067\uff0c\u4e00\u90e8\u306e\u5831\u9053\u306e\u967d\u5b50\u7dda\u306b\u5bfe\u3059\u308b\u71b1\u6c17\u306b\u8b66\u544a\u3092\u767a\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4>\u9ac4\u82bd\u816b\u306f\u518d\u767a\u3059\u308b\u3068\u6cbb\u7642\u62b5\u6297\u6027\u306b\u306a\u308b<\/h4>\n<p>Morrissy AS, et al.: Divergent clonal selection dominates medulloblastoma at recurrence. Nature 529, 351\u2013357, 2016<br \/>\nNature\u3067\u3059\u304c\uff0c\u81e8\u5e8a\u5bb6\u306b\u3068\u3063\u3066\u306f\u5f53\u305f\u308a\u524d\u3068\u3044\u3048\u3070\u5f53\u305f\u308a\u524d\u306e\u3053\u3068\u304c\u8a3c\u660e\u3055\u308c\u307e\u3057\u305f\u3002\u518d\u767a\u3057\u305f\u9ac4\u82bd\u816b\u3067\u306f\u5927\u90e8\u5206\u3067\u907a\u4f1d\u5b50\u5909\u7570\u304c\u751f\u3058\u3066\u304a\u308a\uff0c\u3042\u308b\u5206\u5b50\u6a19\u7684\u6cbb\u7642\u85ac\u304c\u521d\u767a\u6642\u306b\u52b9\u3044\u3066\u3082\uff0c\u518d\u767a\u6642\u306b\u306f\u7121\u52b9\u3068\u306a\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u521d\u767a\u6642\u306e\u9ac4\u82bd\u816b\u306e\u4e2d\u306e\u6cbb\u7642\u62b5\u6297\u6027\u306e\u30af\u30ed\u30fc\u30f3\u304c\u751f\u304d\u6b8b\u3063\u3066\u518d\u767a\u3059\u308b clonal selection \u306e\u305f\u3081\u3067\u3042\u308d\u3046\u3068\u89e3\u91c8\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4>MRI\u3067\u5206\u5b50\u8a3a\u65ad\u306e\u4e88\u6e2c\u304c\u3067\u304d\u308b\u304b<\/h4>\n<p>Patay Z, et al.: MR Imaging Characteristics of Wingless-Type-Subgroup Pediatric Medulloblastoma. AJNR Am J Neuroradiol 36: 2015<br \/>\nWNT\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u9ac4\u82bd\u816b16\u4f8b\u306eMRI\u6240\u898b\u304c\u691c\u8a0e\u3055\u308c\u307e\u3057\u305f\u3002\u30eb\u30b7\u30e5\u30ab\u5b54\u5468\u8fba\u304b\u3089\u767a\u751f\u3059\u308blateralized tumor\u3067\u3042\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u5927\u69fd\u306e\u65b9\u5411\u3067\u306f\u306a\u304f\uff0c\u30eb\u30b7\u30e5\u30ab\u5b54\u65b9\u5411\u3078\u3068\u9032\u5c55\u3059\u308b\u3082\u306e\u306fWNT\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3057\u3087\u3046\u304c\uff0c\u624b\u8853\u65b9\u91dd\u3092\u5909\u3048\u308b\u307b\u3069\u306e\u6240\u898b\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<h4>SHH-MB\u30b0\u30eb\u30fc\u30d7\u306bvismodegib\u304c\u6709\u52b9\u304b\u3082\u3057\u308c\u306a\u3044<\/h4>\n<p>Robinson GW, et al.: Vismodegib Exerts Targeted Efficacy Against Recurrent Sonic Hedgehog-Subgroup Medulloblastoma: Results From Phase II Pediatric Brain Tumor Consortium Studies PBTC-025B and PBTC-032. J Clin Oncol 33:2646-2654, 2015<br \/>\nSHH pathway\u3092\u6291\u5236\u3059\u308bvismodegib\u306e\u52b9\u679c\u304c\u8a66\u3055\u308c\u307e\u3057\u305f\u3002\u6210\u4eba\u4f8b\u306e\u518d\u767aSHH-MB\u3067\uff0c31\u4eba\u4e2d\u306e3\u4eba\u3067\u7121\u5897\u60aa\u751f\u5b58\u671f\u9593\u306e\u5ef6\u9577\u304c\u5f97\u3089\u308c\u305f\u305d\u3046\u3067\u3059\u304c\uff0c\u5c11\u6570\u4f8b\u5831\u544a\u3067\u5c06\u6765\u306f\u308f\u304b\u308a\u307e\u305b\u3093\u3002<\/p>\n<h4>MRS\u3067\u5206\u5b50\u5206\u985e\u304c\u4e88\u60f3\u3067\u304d\u308b<\/h4>\n<p>Bl\u00fcml S, et al.: Molecular subgroups of medulloblastoma identification using noninvasive magnetic resonance spectroscopy. Neuro Oncol 2015<br \/>\nMRS\u3067\u9ac4\u82bd\u816b\u306e\u4e88\u5f8c\u5206\u985e\u304c\u3042\u308b\u7a0b\u5ea6\u3067\u304d\u308b\u3068\u3044\u3046\u5831\u544a\u3067\u3059\u3002Group 3\/4 (17\u4f8b)\u3067\u306ftaurine\u306e\u30ec\u30d9\u30eb\u304c\u9ad8\u304f\uff0c\u8102\u80aa\u6210\u5206\u306e\u30ec\u30d9\u30eb\u304c\u4f4e\u304f\uff0ccreatinine\u306e\u30ec\u30d9\u30eb\u304c\u9ad8\u304b\u3063\u305f\u305d\u3046\u3067\u3059\u3002SHH\u00a0(12\u4f8b)\u3067\u306f\uff0cchorine\u3068\u8102\u80aa\u304c\u76ee\u7acb\u3061\uff0ccreatinine\u306e\u30ec\u30d9\u30eb\u304c\u4f4e\u304f\uff0ctaurine\u306f\u540c\u5b9a\u3067\u304d\u306a\u3044\u3068\u306e\u7d50\u679c\u3067\u3059\u3002Cr, Cho, myo-inositol, taurine, aspartate, lipid 13a\u306e\u7d44\u307f\u5408\u308f\u305b\u3067Group 3\/4\u3068SHH\u306e\u9451\u5225\u306f\u304b\u306a\u308a\u306e\u5236\u5ea6\u3067\u3067\u304d\u308b\u3068\u3044\u3046\u7d50\u8ad6\u3067\u3059\u3002<\/p>\n<h4><strong>\u967d\u5b50\u7dda\u6cbb\u7642\u5f8c\u306e\u518d\u767a\u90e8\u4f4d<\/strong><\/h4>\n<p>Sethi RV, et al.: Patterns of failure after proton therapy in medulloblastoma; linear energy transfer distributions and relative biological effectiveness associations for relapses. Int J Radiat Oncol Biol Phys 88: 655-63, 2014<br \/>\n\u967d\u5b50\u7dda proton\u306e\u4f7f\u7528\u3055\u308c\u308b\u983b\u5ea6\u306f\u9ad8\u304f\u306a\u3063\u3066\u3044\u308b\u3088\u3046\u3067\u3059\u304c\uff0c\u5f93\u6765\u306e\u653e\u5c04\u7dda photon\u306b\u3088\u308b\u6cbb\u7642\u6210\u7e3e\u3068\u306e\u53b3\u5bc6\u306a\u6bd4\u8f03\u306f\u307e\u3060\u306a\u3055\u308c\u3066\u3044\u307e\u305b\u3093\u3002MGH\u30672002\u5e74\u304b\u30892011\u5e74\u306b109\u4eba\u306e\u9ac4\u82bd\u816b\u304c\u967d\u5b50\u7dda\u3067\u6cbb\u7642\u3055\u308c\u307e\u3057\u305f\u300216\u4f8b (15%) \u3067\u518d\u767a\u304c\u751f\u3058\u307e\u3057\u305f\u3002\u30c6\u30f3\u30c8\u4e0a 8\u30ab\u6240\uff0c\u810a\u67f1\u7ba1\u5185 11\u30ab\u6240\uff0c\u5f8c\u982d\u7aa9 5\u30ab\u6240\u3067\u3059\u3002\u6700\u3082\u591a\u3044\u5358\u72ec\u518d\u767a\u306fspinal junciton\u3092\u542b\u3081\u305f\u810a\u9ac4\u3067\u3042\u308a\uff0c\u5f93\u6765\u306ephoton\u306b\u3088\u308bCSI\u3068\u5909\u308f\u308a\u306f\u3042\u308a\u307e\u305b\u3093\u3067\u3057\u305f\u3002<\/p>\n<div class=\"setumei\">\n<h4><strong>\u77e5\u80fd\u4e88\u5f8c\u3092\u8003\u3048\u308b\u306a\u3089<span style=\"color: #ff0000;\">\u816b\u760d\u5c40\u6240\u7167\u5c04\u3082\u4f4e\u4fb5\u8972\u306b\u3059\u308b\u3079\u304d<\/span><\/strong><\/h4>\n<p>Moxon-Emre I et al.: Impact of Craniospinal Dose, Boost Volume, and Neurologic Complications on Intellectual Outcome in Patients With Medulloblastoma J Clin Oncol [Epub], 2014<br \/>\n113\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u5b50\u3069\u3082\u304c\u8ffd\u8de1\u8abf\u67fb\u3055\u308c\u307e\u3057\u305f\u3002\u8133\u810a\u9ac4\u7167\u5c04\u304c\u5b50\u3069\u3082\u305f\u3061\u306e\u8a8d\u77e5\u6a5f\u80fd\u4e88\u5f8c\u3092\u60aa\u5316\u3055\u305b\u308b\u3068\u3044\u3046\u3053\u3068\u306f\u3088\u304f\u77e5\u3089\u308c\u3066\u3044\u308b\u3053\u3068\u3067\u3059\u3002\u8133\u810a\u9ac4\u7167\u5c04\u306e\u6a19\u6e96\u7dda\u91cfstandard dose\u306f 30.6-39.4Gy\u3067\u3042\u308a\uff0c\u4f4e\u7dda\u91cfreduced-dose\u306f 18-23.4Gy\u3068\u3055\u308c\u3066\u3044\u3066\uff0c\u73fe\u5728\u3067\u306f\u7279\u5225\u306a\u7406\u7531\u304c\u306a\u3051\u308c\u3070\u4f4e\u7dda\u91cf\u8133\u810a\u9ac4\u7167\u5c04\u304c\u306a\u3055\u308c\u307e\u3059\u3002\u8133\u810a\u9ac4\u7167\u5c04\u306e\u5f8c\u3067\u816b\u760d\u539f\u767a\u90e8\u4f4d\u306b\u8ffd\u52a0\u7167\u5c04\u304c\u306a\u3055\u308c\u308b\u3053\u3068\u304c\u666e\u901a\u306a\u306e\u3067\u3059\u304c\uff0c\u305d\u306e<span style=\"color: #000080;\"><strong>\u7167\u5c04\u91ce\u306e\u5e83\u3055 boost volume\u304c\u5e83\u3044\u3068\u77e5\u80fd\u4e88\u5f8c\u304c\u60aa\u304f\u306a\u308b<\/strong><\/span>\u3068\u3044\u3046\u7d50\u8ad6\u3067\u3059\u3002\u7279\u306b\uff0c\u5f8c\u982d\u7aa9\u7167\u5c04\u304c\u77e5\u80fd\u4e88\u5f8c\u3092\u60aa\u5316\u3055\u305b\u308b\u3067\u518d\u691c\u8a0e\u3055\u308c\u308b\u3079\u304d\u3067\uff0c\u816b\u760d\u5e8a\u7167\u5c04 tumor-bed boost \u3092\u7528\u3044\u308b\u3079\u304d\u3067\u3042\u308b\u3068\u52e7\u544a\u3057\u3066\u3044\u307e\u3059\u3002\u307e\u305f\uff0c<span style=\"color: #000080;\"><strong>\u6c34\u982d\u75c7\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u3092\u8981\u3057\u305f\u60a3\u5150\u3067\u306e\u77e5\u80fd\u306e\u60aa\u5316<\/strong><\/span>\u304c\u3042\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<\/p>\n<h4><strong>\u518d\u767a\u306b\u5bfe\u3057\u3066\u306f<span style=\"color: #ff0000;\">\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u304c\u3042\u308b\u7a0b\u5ea6\u6709\u52b9<\/span>\u3067\u3042\u308b<\/strong><\/h4>\n<p>Cefalo G, et al: Temozolomide is an active agent in children with recurrent medulloblastoma\/primitive neuroectodermal tumor: an Italian multi-institutional phase II trial. Neuro Oncol 16: 748-53, 2014<br \/>\n\u518d\u767a\u3057\u305f\u9ac4\u82bd\u816b\u3042\u308b\u3044\u306fPNET\u306e42\u4eba\u306e\u5b50\u3069\u3082\u305f\u3061\u304c\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u3067\u6cbb\u7642\u3092\u53d7\u3051\u307e\u3057\u305f\u3002120-200m2\u3092\uff15\u65e5\u9593\u4f7f\u7528\u3059\u308b\u666e\u901a\u306e\u4f7f\u3044\u65b9\u3067\u3059\u30026\u4eba\u3067\u816b\u760d\u304c\u6d88\u5931\u3057\u307e\u3057\u305f\uff08\u5b8c\u5168\u594f\u529f\uff09\uff0c11\u4eba\u3067\u90e8\u5206\u594f\u529f\uff0c10\u4eba\u3067\u5909\u5316\u304c\u306a\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002PFS\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f\uff16\u30f6\u6708\u306742\uff05\uff0c1\u5e74\u306717%\u3067\u3057\u305f\u3002\u3053\u308c\u3089\u306e\u5b50\u3069\u3082\u305f\u3061\u306f\u521d\u671f\u6cbb\u7642\u3067\u304b\u306a\u308a\u304d\u3064\u3044\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3044\u308b\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u304c\u3042\u308b\u7a0b\u5ea6\u306e\u6709\u52b9\u6027\u3092\u793a\u3057\u305f\u3068\u7d50\u8ad6\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<\/div>\n<h4><strong>\u518d\u767a\u9ac4\u82bd\u816b\u3078\u306e\u30a4\u30ea\u30ce\u30c6\u30ab\u30f3\u3068\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306e\u4f75\u7528\u5316\u5b66\u7642\u6cd5 <span style=\"color: #ff0000;\">TIMERI<\/span><\/strong><\/h4>\n<p>Grill J, et al.: Phase II study of irinotecan in combination with temozolomide (TEMIRI) in children with recurrent or refractory medulloblastoma: a joint ITCC and SIOPE brain tumor study. Neuro Oncol 15:1236-1243, 2013<br \/>\nTIMERI\u3068\u3042\u3048\u3066\u540d\u4ed8\u3051\u308b\u307b\u3069\u306e\u3082\u306e\u3067\u3082\u306a\u3055\u305d\u3046\u3067\u3059\u30023\u9031\u9593\u306e\u3046\u30615\u65e5\u9593\uff0c\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9 100-150mg\/m2\u3068\u30a4\u30ea\u30ce\u30c6\u30ab\u30f3 10mg\/m2\u306e\u6295\u4e0e\u304c\u306a\u3055\u308c\u307e\u3057\u305f\u300266\u4eba\u304c\u6cbb\u7642\u3055\u308c\u816b\u760d\u7e2e\u5c0f\u3068\u3044\u3046\u610f\u5473\u3067\u306eobjective response\u306f33%\u306e\u60a3\u8005\u3055\u3093\u3067\u307f\u3089\u308c\uff0c\u594f\u529f\u671f\u9593\u4e2d\u592e\u5024\u306f27\u9031\u9593\uff084\u30f6\u6708\u5f31\uff09\u3067\uff0c\u751f\u5b58\u671f\u9593\u4e2d\u592e\u5024\u306f16.7\u30f6\u6708\u3067\u3057\u305f\u3002\u7d50\u8ad6\u3068\u3057\u3066\uff0c\u671f\u5f85\u3055\u308c\u305f\u594f\u529f\u5272\u5408 tumor response\u306f\u5f97\u3089\u308c\u307e\u305b\u3093\u3067\u3057\u305f\u3002<\/p>\n<div class=\"setumei\">\n<h4><strong style=\"color: #ff0000;\">\u4f4e\u5e74\u9f62\u306e\u5b50\u3069\u3082\u306b\u8133\u810a\u9ac4\u7167\u5c04\u3092\u305b\u305a\u5f8c\u982d\u7aa9\u7167\u5c04\u3060\u3051\u3092\u4f7f\u3046<\/strong><\/h4>\n<p>Ashley DM, et al.: Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children&#8217;s Oncology Group study P9934. J Clin Oncol. 30:3181-3186, 2012<br \/>\n8\u30f6\u6708\u304b\u30893\u6b73\u307e\u3067\u8ee2\u79fb\u306e\u306a\u304474\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u5b50\u3069\u3082\u306b\uff0c\u624b\u8853\uff0c\u5c0e\u5165\u5316\u5b66\u7642\u6cd5\uff0c18-23.4Gy\u306e\u5f8c\u982d\u7aa9\u7167\u5c04 (conformal radiation therapy)\uff0c50.4-54Gy\u306e\u816b\u760d\u3078\u306e\u7167\u5c04\uff0c\u7dad\u6301\u5316\u5b66\u7642\u6cd5\u3068\u3044\u3046\u6cbb\u7642\u304c\u306a\u3055\u308c\u307e\u3057\u305f\u3002\uff14\u5e74\u306e\u6642\u70b9\u3067\u306e\u7121\u5897\u60aa\u751f\u5b58 EFS\u306f50\uff05\uff0c\u5168\u751f\u5b58\u5272\u5408 OS\u306f69\uff05\u3067\u3057\u305f\u3002\u7279\u306b\uff0cdesmoplastic \/nodular type\u3067\u306eEFS\u306f58%\u3068\u826f\u597d\u3067\u3057\u305f\u30027\u4f8b\u3067\u306f\u539f\u767a\u5de3\u306e\u5897\u5927\uff0c15\u4f8b\u3067\u306f\u8ee2\u79fb\u304c\u751f\u3058\u307e\u3057\u305f\u3002\u6cbb\u7642\u5f8c\u306b\u8a8d\u77e5\u6a5f\u80fd\u3068\u904b\u52d5\u6a5f\u80fd\u306e\u4f4e\u4e0b\u306f\u8a8d\u3081\u3089\u308c\u306a\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u7d50\u8ad6\u3068\u3057\u3066\uff0c\u3053\u306e\u4f4e\u5e74\u9f62\u5c64\u3067\u5f93\u6765\u884c\u306a\u308f\u308c\u3066\u6765\u305f\u5316\u5b66\u7642\u6cd5\u5358\u72ec\u306e\u6cbb\u7642\u3088\u308a\u3082\uff0c\u5f8c\u982d\u7aa9\u7167\u5c04\u3092\u52a0\u3048\u305f\u65b9\u304c\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u304c\u9ad8\u3044\u3068\u8ff0\u3079\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4><strong><span style=\"color: #ff0000;\">\u591a\u5206\u5272\u7167\u5c04\u306e\u52b9\u679c<\/span><\/strong><\/h4>\n<p>Lannering B, et al.: Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: results from the randomized multicenter HIT-SIOP PNET 4 trial. J Clin Oncol. 30: 3187-3193, 2012<br \/>\n\u7121\u4f5c\u70ba\u5927\u898f\u6a21\u7814\u7a76\u3067\u3059\u30024\u6b73\u304b\u308921\u6b73\u307e\u3067\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306e340\u4eba\u304c\uff0c\u591a\u5206\u5272\u7167\u5c04 HFRT hyperfractionated radiotherapy\u3068\u901a\u5e38\u7167\u5c04 STRT standard radiotherapy\u3067\u6cbb\u7642\u3055\u308c\u307e\u3057\u305f\u3002\u5316\u5b66\u7642\u6cd5\u306f\u6a19\u6e96\u6cbb\u7642\uff08\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30ed\u30e0\u30b9\u30c1\u30f3 CCNU\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\uff09\uff18\u30b3\u30fc\u30b9\u3067\u3059\u30025\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306fSTRT 77%, HFRT 78%\u3067\u5dee\u304c\u3042\u308a\u307e\u305b\u3093\u3002\u5168\u751f\u5b58\u5272\u5408\u308287%\u306885%\u3067\u3057\u305f\u3002\u6cbb\u7642\u6210\u7e3e\u306b\u6700\u3082\u60aa\u5f71\u97ff(strongest negative prognostic factor)\u3092\u4e0e\u3048\u305f\u306e\u304c\u624b\u8853\u5f8c\u306b\u6b8b\u5b58\u816b\u760d\u304c\u3042\u308b\u3053\u3068\u3067\u3057\u305f\u3002\u624b\u8853\u5f8c\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u304c\uff17\u9031\u9593\u76ee\u4ee5\u964d\u306b\u306a\u3063\u305f\u60a3\u5150\u306e\u4e88\u5f8c\u304c\u4e00\u756a\u60aa\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u76ee\u7684\u3068\u3055\u308c\u305f\u8074\u529b\u6e29\u5b58\u7387\u306f\uff0cHFRT\u3068STRT\u306e\u9593\u3067\u5dee\u304c\u306a\u3044\u305f\u3081\u306b\uff0c\u591a\u5206\u5272\u7167\u5c04\u306e\u5f79\u5272\u306f\u306a\u3044\u3068\u7d50\u8ad6\u3055\u308c\u307e\u3057\u305f\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u7e70\u308a\u8fd4\u3057\u8a00\u308f\u308c\u3066\u6765\u305f\u3053\u3068\u3067\u3059\u304c\uff0c\u3053\u306e\u8ad6\u6587\u3067\u3082\u307e\u305f\uff0c\u624b\u8853\u3067\u5168\u6458\u51fa\u3067\u304d\u3066\u3044\u306a\u3044\u5834\u5408\uff0c\u624b\u8853\u5408\u4f75\u75c7\u3067\u653e\u5c04\u7dda\u6cbb\u7642\u958b\u59cb\u6642\u671f\u304c\u9045\u308c\u308b\u5834\u5408\u306b\u751f\u5b58\u5272\u5408\u306f\u4f4e\u304f\u306a\u308b\u3068\u5f37\u8abf\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4>\u64ad\u7a2e\u8ee2\u79fb\u3057\u305f\u9ac4\u82bd\u816b\u306e<span style=\"color: #ff0000;\"><strong>\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d<\/strong><strong>\u306b\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3<\/strong><\/span>\u3092\u4f7f\u7528\u3059\u308b<\/h4>\n<p align=\"left\">Jakacki RI, et al.: Outcome of children with metastatic medulloblastoma treated with carboplatin during craniospinal radiotherapy: a Children&#8217;s Oncology Group Phase I\/II study. J Clin Oncol 30: 2648-2653, 2012<br \/>\n161\u4eba\u306e\u8ee2\u79fb\u306e\u3042\u308b\u9ac4\u82bd\u816b\u306e\u60a3\u8005\u3055\u3093\u304c\u6cbb\u7642\u3055\u308c\u307e\u3057\u305f\u3002\u5168\u3066\u306e\u60a3\u8005\u3055\u3093\u306f\uff0c\u8133\u810a\u9ac4\u7167\u5c0436Gy\u3092\u53d7\u3051\uff0c\u816b\u760d\u306e\u3042\u308b\u90e8\u4f4d\u306b\u5c40\u6240\u7167\u5c04\u304c\u8ffd\u52a0\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u4e2d\u306b\u5f93\u6765\u306e\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u9031\u4e00\u56de\u6295\u4e0e\u306b\u52a0\u3048\u3066\uff0cCBDCA (30mg\/m2\/dose)\u304c15-30\u56de\u6295\u4e0e\u3055\u308c\u307e\u3057\u305f\u3002\u653e\u5c04\u7dda\u5f8c\u306f\uff0cCY\/VCR\u5316\u5b66\u7642\u6cd5\u304bCDDP\u7dad\u6301\u5316\u5b66\u7642\u6cd5\u304c\uff16\u30f6\u6708\u9593\u4f7f\u7528\u3055\u308c\u307e\u3057\u305f\u3002\u524d\u8005\u3067\u306e\uff15\u5e74\u5168\u751f\u5b58\u5272\u5408\u304c82%\u3001\u5f8c\u8005\u3067\u306f68%\u3067\u3057\u305f\u3002\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b\u306e\u75c7\u4f8b\u3067\u6210\u7e3e\u304c\u660e\u3089\u304b\u306b\u60aa\u304b\u3063\u305f\u305d\u3046\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u307e\u305f\u5149\u9855\u75c5\u7406\u306e<strong><span style=\"color: #000080;\">\u9000\u5f62\u6210\u3092\u793a\u3059\u9ac4\u82bd\u816b\u306e\u4e88\u5f8c\u304c\u60aa\u3044<\/span><\/strong>\u3053\u3068\u304c\u78ba\u8a8d\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u64ad\u7a2e\u4f8b\u306e\u8133\u810a\u9ac4\u7167\u5c04\u4e2d\u306e\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u306e\u6295\u4e0e\u306f\u671f\u5f85\u304c\u6301\u3066\u305d\u3046\u3067\u3059\u3002\u3053\u308c\u306f2012\u5e74\u306e\u5831\u544a\u3067\u3059\u304c\uff0c\u8133\u810a\u9ac4\u7167\u5c04\u7dda\u91cf\u306f\u76f8\u5909\u308f\u3089\u305a36\u30b0\u30ec\u30a4\u3067\u3042\u308b\u3053\u3068\u306b\u6ce8\u610f\u3057\u3066\u4e0b\u3055\u3044\u3002\u3053\u308c\u4ee5\u4e0b\u306e\u7dda\u91cf\u3067\u306f\u64ad\u7a2e\u3057\u305f\u9ac4\u82bd\u816b\u3092\u6cbb\u3059\u3068\u3044\u3046\u3053\u3068\u306f\u307e\u3060\u96e3\u3057\u3044\u306e\u3067\u3059\u3002\u3067\u3082\uff0c<span style=\"color: #000080;\"><strong>\u5b9f\u969b\u306b\u5168\u8133\u306b36\u30b0\u30ec\u30a4\u3082\u5165\u308b\u3068\u6cbb\u7642\u5f8c\u306e\u8a8d\u77e5\u6a5f\u80fd\u4f4e\u4e0b\u306f\u8457\u3057\u3044\u3082\u306e\u3067\u3059\u3002<\/strong><\/span>\u3053\u306e\u7dda\u91cf\u306f\u4f55\u3068\u304b\u907f\u3051\u305f\u3044\uff0c\u3067\u3082\u305d\u308c\u4ee5\u4e0b\u3067\u6cbb\u308b\u3068\u3044\u3046\u4fdd\u8a3c\u306f\u3069\u3053\u306b\u3082\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/p>\n<h4><strong><span style=\"color: #ff0000;\"><span class=\"style1\">FSTL5\u967d\u6027\u306e\u9ac4\u82bd\u816b\u306e\u518d\u767a\u7387\u3068\u6b7b\u4ea1\u7387\u304c\u9ad8\u3044<\/span><\/span><\/strong><\/h4>\n<p>Remke M, et al.: FSTL5 Is a Marker of Poor Prognosis in Non-WNT\/ Non-SHH Medulloblastoma<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21911727\">.<\/a> J Clin Oncol. 2011<br \/>\n\u524d\u306b\u66f8\u3044\u305f4\u3064\u306e\u30b0\u30eb\u30fc\u30d7\u306b\u5206\u3051\u308b\u65b9\u6cd5\u3067\uff0c\u30b0\u30eb\u30fc\u30d7C\u3068\u30b0\u30eb\u30fc\u30d7D\u3067\u306f\u6cbb\u7642\u7d4c\u904e\u304c\u826f\u3044\u75c7\u4f8b\u3068\u60aa\u3044\u75c7\u4f8b\u304c\u6df7\u5728\u3057\u3066\u3044\u307e\u3057\u305f\u3002\u3053\u308c\u3092\u3055\u3089\u306bFSTL5 (follistatin-like 5) \u3067\u514d\u75ab\u67d3\u8272\u3059\u308b\u3068\u967d\u6027\u306b\u306a\u3063\u305f\u4f8b\u3067\u306e\u518d\u767a\u7387\u3068\u6b7b\u4ea1\u7387\u304c\u6709\u610f\u306b\u9ad8\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u4e88\u5f8c\u3092\u4e88\u6e2c\u3059\u308b prognostication\u306b\u3053\u306e\u67d3\u8272\u65b9\u6cd5\u306f\u3068\u3066\u3082\u5f79\u306b\u7acb\u3064\u3068\u306e\u7d50\u8ad6\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u3082\u3057\u305d\u3046\u3060\u3068\u3059\u308b\u3068\uff0cDKK1 (WNT), SFRP1 (SHH)\u3068non-WNT\/non-SHH FSTL5 negative, non-WNT\/non-SHH FSTL5 positive\u306b\u5206\u3051\u308b\u65b9\u304c\u6cbb\u7642\u65b9\u6cd5\u3092\u8003\u3048\u308b\u306e\u306b\u4fbf\u5229\u3067\uff0cnon-WNT\/non-SHH FSTL5 positive\u306e\u9ac4\u82bd\u816b\u3060\u3051\u304c\u3069\u306e\u3088\u3046\u306a\u6cbb\u7642\u3092\u3057\u3066\u3082\u6700\u60aa\u306e\u7d4c\u904e\u3092\u305f\u3069\u308b\u7fa4\u3067\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\u307e\u3059\u3002<\/p>\n<h4><span style=\"color: #ff0000;\"><strong>MBEN\u3068DMB\u306f\u5316\u5b66\u7642\u6cd5\u3067\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3067\u304d\u308b<\/strong><\/span><\/h4>\n<p align=\"left\">von Bueren AO, et al.: Treatment of young children with localized medulloblastoma by chemotherapy alone: results of the prospective, multicenter trial HIT 2000 confirming the prognostic impact of histology. Neuro Oncol 13: 669-679, 2011<br \/>\n<span style=\"color: #000080;\"><strong>4\u6b73\u672a\u6e80<\/strong><\/span>\u306e\u64ad\u7a2e\u8ee2\u79fb\u306e\u306a\u304445\u4eba\u306e\u5b50\u3069\u3082\u305f\u3061\u304c\u6cbb\u7642\u3092\u53d7\u3051\u307e\u3057\u305f\u30023\u30b5\u30a4\u30af\u30eb\u306e\u591a\u5264\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u3068\u8133\u5ba4\u5185\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u6ce8\u5165\u3067\u3059\u3002\u816b\u760d\u304c\u6d88\u5931\u3057\u306a\u304b\u3063\u305f\u5834\u5408\u306e\u307f\u306b\uff0c\u518d\u624b\u8853\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\uff0c\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306a\u3069\u304c\u7528\u3044\u3089\u308c\u307e\u3057\u305f\u30025\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f57%\uff0c\u5168\u751f\u5b58\u5272\u5408\u306f80%\u3067\u3057\u305f\u3002<span style=\"color: #000080;\"><strong>desmoplastic\/nodular MB (DMB\u3068MBEN)\u3067\u306f\uff15\u5e74\u751f\u5b58\u5272\u5408\u304c100%<\/strong><\/span>\u3067\u3042\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002\u4e00\u65b9\u3067\uff0c\u624b\u8853\u5f8c\u6b8b\u5b58\u816b\u760d\u304c\u7121\u304b\u3063\u305f30\u4eba\u306e\u3046\u306129\u4eba\u3067\u5b8c\u5168\u5bdb\u89e3\u304c\u7dad\u6301\u3067\u304d\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u624b\u8853\u3067\u5168\u6458\u51fa\u3067\u6765\u3066\u3044\u308c\u3070\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u5b8c\u5168\u5bdb\u89e3\u304c\u7dad\u6301\u3067\u304d\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u307e\u305f<span style=\"color: #000080;\"><strong>desmoplastic\/nodular MB\u306e\u75c5\u7406\u7d44\u7e54\u8a3a\u65ad\u3067\u3042\u308c\u3070\u3053\u306e\u5e74\u9f62\u5c64\u306b\u304a\u3044\u3066\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u816b\u760d\u306e\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u304c\u3067\u304d\u308b<\/strong><\/span>\u3051\u308c\u3069\u3082\uff0c\u305d\u308c\u4ee5\u5916\u306e\u7d44\u7e54\u578b\u3067\u306f\u7121\u7406\u306a\u306e\u3067\u5c40\u6240\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u5fdc\u7528\u3059\u308b\u3053\u3068\u306b\u306a\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<\/p>\n<\/div>\n<h4><strong><span class=\"style1\">\u5c0f\u3055\u306a\u5b50\u3069\u3082\u3078\u306e\u653e\u5c04\u7dda\u524d\u5316\u5b66\u7642\u6cd5<\/span>\u306e\u52b9\u679c<\/strong><\/h4>\n<p>Rutkowski S, et al: Treatment of early childhood medulloblastoma by postoperative chemotherapy and deferred radiotherapy . Neuro Oncol 11: 201-210, 2009<br \/>\n1987\u5e74\u304b\u30891993\u5e74\u307e\u3067HIT-SKK&#8217;87 trial\u306729\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u60a3\u8005\u3055\u3093\u304c\u6cbb\u7642\u3055\u308c\u3066\u3044\u307e\u3059\u3002<span style=\"color: #000080;\"><strong>\u6cbb\u7642\u5e74\u9f62\u4e2d\u592e\u50241.7\u6b73<\/strong><\/span>\u3067\u3042\u308a\uff0c12.6\u5e74\u9593\u8ffd\u8de1\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u4f7f\u7528\u3055\u308c\u305f\u5316\u5b66\u7642\u6cd5\u5264\u306f\uff0c\u30d7\u30ed\u30ab\u30eb\u30d0\u30b8\u30f3\uff0c\u30a4\u30d5\u30a9\u30b9\u30de\u30df\u30c9\uff0c\u30a8\u30c8\u30dd\u30b7\u30c9\uff0c\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30b7\u30bf\u30e9\u30d3\u30f3\u3067\u3059\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u816b\u760d\u304c\u518d\u71c3\u3057\u305f\u6642\u3042\u308b\u3044\u306f\uff13\u6b73\u306b\u306a\u3063\u3066\u304b\u3089\u4f7f\u7528\u3055\u308c\u307e\u3057\u305f\u3002\u8ee2\u79fb\u306e\u306a\u304b\u3063\u305f\u60a3\u5150\u306e10\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f53%\uff0c\u5168\u751f\u5b58\u5272\u5408\u306f59%\u3067\u3057\u305f\u3002\u8ee2\u79fb\u306e\u3042\u3063\u305f3\u4f8b\u3067\u306f\u305d\u308c\u305e\u308c0%\u3067\u3059\u3002\u75c5\u7406\u7d44\u7e54\u3067<strong><span style=\"color: #000080;\">MBEN<\/span><\/strong>\u00a0<strong><span style=\"color: #000080;\">desmoplastic\/extensive nodullar type\u3067\u3042\u3063\u305f\u5b50\u3069\u3082\u306f\uff19\u5272\u304f\u3089\u3044\u304c\u751f\u5b58<\/span><\/strong>\u3057\u305f\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u4e00\u65b9\u3067\uff0cclassic type\u306e\u9ac4\u82bd\u816b\u3067\u306f12\u4f8b\u4e2d\u306e11\u4f8b\u3067\u5316\u5b66\u7642\u6cd5\u4e2d\u306b\u816b\u760d\u5897\u60aa\u304c\u751f\u3058\u305f\u305d\u3046\u3067\u3059\u3002\u3082\u3061\u308d\u3093\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u53d7\u3051\u305f\u5b50\u3069\u3082\u306e\u77e5\u80fd\u6307\u6570\u306f\u305d\u3046\u3067\u306a\u3044\u5b50\u3069\u3082\u3088\u308a\u3082\u4f4e\u304f\u306a\u3063\u3066\u3044\u307e\u3057\u305f\u3002\u7d50\u8ad6\u3068\u3057\u3066\uff0c\u75c5\u7406\u8a3a\u65ad\u3067desmoplastic\/extensive nodullar histology\u304c\u3042\u308b\u5c0f\u3055\u306a\u5b50\u3069\u3082\u3067\u306f\u5316\u5b66\u7642\u6cd5\u306b\u3088\u3063\u3066\u8133\u810a\u9ac4\u7167\u5c04\u3092\u9045\u3089\u305b\u308b\u3053\u3068\u304c\u3067\u304d\u308b\u3067\u3042\u308d\u3046\u3068\u3057\u3066\u307e\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u5c11\u6570\u4f8b\u3067\u3059\u304c\u8ee2\u79fb\u304c\u751f\u3058\u3066\u3044\u308b\u4f8b\u3067\u306f\uff13\u6b73\u672a\u6e80\u3068\u3044\u3048\u3069\u3082\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u6cbb\u7642\u3092\u7d9a\u3051\u308b\u3053\u3068\u304c\u96e3\u3057\u3044\u3088\u3046\u3067\u3059\u3002\u6b8b\u5ff5\u306a\u306e\u306f\u5b9a\u578b\u7684\u9ac4\u82bd\u816b(classic histology)\u3067\u306f\u5316\u5b66\u7642\u6cd5\u3067\u75c5\u52e2\u306e\u9032\u884c\u3092\u6291\u5236\u3067\u304d\u306a\u304b\u3063\u305f\u3053\u3068\u3067\u3059\u300212\u4f8b\u4e2d11\u4f8b\u306e\u5897\u60aa\u3068\u3044\u3046\u306e\u306f\u9ad8\u3059\u304e\u308b\u306e\u3067\uff0c\u3053\u3053\u3067\u7528\u3044\u3089\u308c\u305f\u591a\u5264\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u81ea\u4f53\u304c\u3042\u307e\u308a\u826f\u304f\u306a\u3044\u7d44\u307f\u5408\u305b\u3060\u3063\u305f\u306e\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u30023\u6b73\u672a\u6e80\u306e\u968f\u82bd\u816b\u306f\u75c5\u7406\u7d30\u5206\u985e\u3067\u3001\u5316\u5b66\u7642\u6cd5\u3060\u3051\u3067\u6cbb\u7642\u3067\u304d\u308b\u304b\u3069\u3046\u304b\u304c\u89e3\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u304c\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<div class=\"setumei\">\n<h4><span style=\"color: #ff0000;\"><strong><span class=\"style1\">\u9ac4\u82bd\u816b\u6cbb\u7642\u306e\u65b0\u85ac<\/span><\/strong><\/span><\/h4>\n<p>Rudin CM, et al.: Treatment of medulloblastoma with hedgehog pathway inhibitor GDC-0449. N Engl J Med 361: 1173-1178, 2009<br \/>\nhedgehog signaling pathway\u3068\u3044\u3046\u306e\u304c\u9ac4\u82bd\u816b\u306e\u5897\u6b96\u306b\u6df1\u304f\u95a2\u308f\u308b\u3053\u3068\u304c\u77e5\u3089\u308c\u3066\u3044\u307e\u3057\u305f\u3002\u305d\u306e\u7d4c\u8def\u3092\u6291\u5236\u3057\u3066\u9ac4\u82bd\u816b\u3092\u6cbb\u7642\u3059\u308b\u65b0\u3057\u3044\u85ac\uff0cGDC-0449\u304c\u518d\u767a\u3057\u3066\u64ad\u7a2e\u3057\u305f\u9ac4\u82bd\u816b\u3092\u62b1\u3048\u308b26\u6b73\u306e\u7537\u6027\u306b\u8a66\u3055\u308c\u307e\u3057\u305f\u3002\u85ac\u306e\u6295\u4e0e\u5f8c\u3059\u307f\u3084\u304b\u306b\u816b\u760d\u306f\u5c0f\u3055\u304f\u306a\u3063\u3066\u75c7\u72b6\u3082\u826f\u304f\u306a\u3063\u305f\u305d\u3046\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300dPTCH-1\u3068\u3044\u3046\u907a\u4f1d\u5b50\u306e\u5909\u7570\u304c\u3053\u306e\u816b\u760d\u306b\u306f\u3042\u3063\u305f\u306e\u3067\u6709\u52b9\u3060\u3063\u305f\u3088\u3046\u3067\u3059\u3002\u540c\u69d8\u306e\u907a\u4f1d\u5b50\u5909\u7570\u304c\u306a\u3044\u3068\uff0c\u307e\u305f\u306fhedgehog pathway\u306e\u6d3b\u6027\u5316\u304c\u306a\u3044\u30bf\u30a4\u30d7\u3067\u306a\u3044\u3068\u3053\u306e\u85ac\u5264\u306f\u52b9\u304d\u307e\u305b\u3093\u3002\u307e\u305f\uff0c\u3053\u306e\u7537\u6027\u3078\u306e\u85ac\u306e\u52b9\u679c\u306ftransient\u4e00\u6642\u7684\u3060\u3068\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002 \u3067\u3059\u304b\u3089\uff0c\u3053\u306e\u85ac\u3067\u9ac4\u82bd\u816b\u304c\u6cbb\u308b\u3068\u3044\u3046\u7d50\u8ad6\u306b\u306f\u3082\u3061\u308d\u3093\u9054\u3057\u3066\u3044\u307e\u305b\u3093\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u518d\u767a\u3057\u305f\u9ac4\u82bd\u816b\u3078\u306e\u5927\u91cf\u5316\u5b66\u7528\u6cd5<\/span>\u306e\u52b9\u679c<\/strong><\/h4>\n<p>Gururangan S, et al.: Efficacy of high-dose chemotherapy or standard salvage therapy in patients with recurrent medulloblastoma, Neuro Oncol 10: 745-751, 2008<br \/>\n1995\u5e74\u304b\u30892005\u5e74\u307e\u3067\u306b\u30c7\u30e5\u30fc\u30af\u5927\u5b66\u3067\u518d\u767a\u9ac4\u82bd\u816b30\u4eba\u306e\u60a3\u8005\u3055\u3093\u304c\u6cbb\u7642\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u521d\u671f\u6cbb\u7642\u3067\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u518d\u767a\u3057\u305f\uff17\u4eba\u3068\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u518d\u767a\u3057\u305f12\u4eba\u306f\uff0c\u5c0e\u5165\u5316\u5b66\u7642\u6cd5\u306e\u5f8c\u3067\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3068\u81ea\u5bb6\u5e79\u7d30\u80de\u6551\u63f4\u3092\u3046\u3051\u307e\u3057\u305f\u3002\u4e00\u65b9\uff0c\u6b8b\u308a\u306e11\u4eba\u306f\u901a\u5e38\u306e\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3092\u53d7\u3051\u307e\u3057\u305f\u300230\u4eba\u306e\u5185\u3067\u751f\u5b58\u3057\u305f\u306e\u306f\uff13\u4eba\u3067\u3059\u3002\u3053\u306e\uff13\u4eba\u306f\u521d\u671f\u6cbb\u7642\u3067\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u306a\u304b\u3063\u305f\u60a3\u5150\u3067\uff0c\u518d\u767a\u6cbb\u7642\u306e\u6642\u306b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3068\u5341\u5206\u306a\u8133\u810a\u9ac4\u7167\u5c04\u3092\u53d7\u3051\u308b\u3053\u3068\u304c\u3067\u304d\u3066\u3044\u307e\u3057\u305f\u3002\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3082\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u5341\u5206\u306b\u4f75\u7528\u3067\u304d\u306a\u304b\u3063\u305f12\u4eba\u3067\u306f\u751f\u5b58\u671f\u9593\u4e2d\u592e\u502435\u30f6\u6708\u3067\u5168\u54e1\u304c\u6b7b\u4ea1\u3057\u3066\u3044\u307e\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u7d50\u5c40\u306e\u3068\u3053\u308d\u521d\u671f\u6cbb\u7642\u3067\u7528\u3044\u3089\u308c\u308b\u306e\u3068\u540c\u7b49\u306a\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u3067\u304d\u306a\u3051\u308c\u3070\uff0c\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3092\u4f7f\u7528\u3057\u3066\u3082\u518d\u767a\u3057\u305f\u9ac4\u82bd\u816b\u306e\u9577\u671f\u751f\u5b58\u306f\u671b\u3081\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u521d\u671f\u6cbb\u7642\u3067\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u3057\u306a\u3051\u308c\u3070\u304b\u306a\u308a\u9ad8\u3044\u78ba\u7387\u3067\u518d\u767a\u3059\u308b\u306e\u3067\u3059\u3057\uff0c\u518d\u767a\u3057\u305f\u5834\u5408\u306b\u5341\u5206\u306a\u653e\u5c04\u7dda\u6cbb\u7642\u304c\u3067\u304d\u3066\u3082\u9577\u671f\u751f\u5b58\u3059\u308b\u671b\u307f\u306f\u9ad8\u304f\u306f\u306a\u3044\u3068\u8aad\u307f\u53d6\u308b\u3053\u3068\u3082\u3067\u304d\u307e\u3059\u3002\u3067\u306f\u9ac4\u82bd\u816b\u304c\u518d\u767a\u3057\u305f\u6642\u306b\u306a\u306b\u304c\u3067\u304d\u308b\u304b\uff1f\u3068\u3044\u3046\u7591\u554f\u3078\u306e\u7b54\u3048\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u4eca\u3067\u3082\uff0c\u518d\u767a\u3057\u305f\u5834\u5408\u306b\u306f\uff0c\u901a\u5e38\u5316\u5b66\u7642\u6cd5\u3092\u3092\u305f\u3081\u3057\u3066\uff0c\u3082\u3057\u6709\u52b9\u3067\u3042\u308c\u3070\u5e79\u7d30\u80de\u6551\u63f4\u3092\u7528\u3044\u308b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u306e\u5730\u56fa\u3081\u3068\u5c40\u6240\u306e\u8ffd\u52a0\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u52a0\u3048\u308b\u3057\u304b\u624b\u3060\u3066\u306f\u306a\u3044\u306e\u3067\u3057\u3087\u3046\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">metronomic chemotherapy<\/span>\u3068\u3044\u3046\u8003\u3048\u65b9<\/strong><\/h4>\n<p>Choi LM, et al.: Feasibility of metronomic maintenance chemotherapy following high-dose chemotherapy for malignant central nervous system tumors. Pediatr Blood Cancer 50: 970-975, 2008<br \/>\nBaruchel S, et al.: Safety and pharmacokinetics of temozolomide using a dose-escalation, metronomic schedule in recurrent paediatric brain tumors. Eur J Cancer 2006<br \/>\n\u30e1\u30c8\u30ed\u30ce\u30fc\u30e0\u7dad\u6301\u5316\u5b66\u7642\u6cd5\u3068\u3044\u3046\u8003\u3048\u65b9\u304c\u3042\u308a\u307e\u3059\u3002\u307b\u3093\u306e\u5c11\u3057\u305a\u3064\u4f11\u307f\u306a\u304f\u7e70\u308a\u8fd4\u3057\u7d99\u7d9a\u3066\u3044\u304f\u5316\u5b66\u7642\u6cd5\u306e\u3053\u3068\u3067\u3059\u3002\u4ee3\u8868\u7684\u306a\u85ac\u5264\u306b\u30a8\u30c8\u30dd\u30b7\u30c9\uff0c\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30c6\u30e2\u30be\u30ed\u30de\u30a4\u30c9\u306a\u3069\u306e\u7d4c\u53e3\u9023\u7d9a\u6295\u4e0e\u304c\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u30e1\u30c8\u30ed\u30ce\u30fc\u30e0\u5316\u5b66\u7642\u6cd5\u306f\uff0c\u96e3\u6cbb\u6027\u816b\u760d\u306e\u521d\u671f\u6cbb\u7642\uff08\u90e8\u5206\u5bdb\u89e3\uff09\u306b\u7d9a\u304f\u3082\u306e\u3067\u3042\u3063\u3066\u3082<span style=\"color: #000080;\"><strong>\u518d\u767a\u6cbb\u7642\u306b\u3042\u3063\u3066\u3082\uff0c\u3042\u304f\u307e\u3067\u3082\u5bdb\u89e3\u7dad\u6301\u7642\u6cd5<\/strong><\/span>\u3067\u3042\u308b\u3068\u3044\u3046\u8a8d\u8b58\u304c\u5927\u5207\u3067\u3059\u3002\u5bdb\u89e3\u5c0e\u5165\u306b\u306f\uff0c\u901a\u5e38\u5316\u5b66\u7642\u6cd5\u3067\u3042\u3063\u305f\u308a\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u3042\u3063\u305f\u308a\u3055\u307e\u3056\u307e\u306a\u65b9\u6cd5\u304c\u3042\u308a\u307e\u3059\u30022009\u5e74\u521d\u982d\u306e\u73fe\u6642\u70b9\u3067\u306f\uff0c\u307e\u3060\u307e\u3060\u78ba\u7acb\u3055\u308c\u305f\u8003\u3048\u65b9\u3068\u306f\u5168\u304f\u8a00\u3048\u307e\u305b\u3093\u304b\u3089\uff0c\u5b89\u6613\u306b\u5fdc\u7528\u3057\u3066\u306f\u306a\u308a\u307e\u305b\u3093\u3002\u518d\u767a\u6cbb\u7642\u306e\u5f8c\u306e\u5bdb\u89e3\u7dad\u6301\u7642\u6cd5\u3068\u3057\u3066\u5fdc\u7528\u3092\u8003\u3048\u308b\u3079\u304d\u3067\u3059\u3002\u521d\u671f\u6cbb\u7642\u5f8c\u306b\u6d88\u5931(CR)\u3057\u3066\u3044\u308b\u9ac4\u82bd\u816b\u3084\u30b8\u30e3\u30fc\u30df\u30ce\u30fc\u30de\u3078\u306e\u4f7f\u7528\u306f\u884c\u306a\u3046\u3079\u304d\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u8ee2\u79fb\u3057\u305f\u9ac4\u82bd\u816b\u3078\u306e\u591a\u5206\u5272\u7167\u5c04<\/span>\u306e\u52b9\u679c<\/strong><\/h4>\n<p>Gandola l , et al.: Hyperfractionated accelerated radiotherapy in Milan strategy for metastatic medulloblastoma. J Clin Oncol 2008<br \/>\n1998\u5e74\u304b\u30892007\u5e74\u307e\u306733\u4eba\u306e\u8ee2\u79fb\u3092\u4f34\u3046\u9ac4\u82bd\u816b\u306e\u60a3\u8005\u3055\u3093\u304c\u6cbb\u7642\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u624b\u8853\u5f8c\u306b\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\uff0c\u30a8\u30c8\u30dd\u30b7\u30c9\uff0c\u30b5\u30a4\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\uff0c\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u5316\u5b66\u7642\u6cd5\u3092\uff12\u30f6\u6708\u6295\u4e0e\u3057\uff0c\u3053\u306e\u5316\u5b66\u7642\u6cd5\u306b\u306f32\u4eba\u4e2d\u306e22\u4eba\u304c\u594f\u52b9\u3057\u3066\u3044\u307e\u3059\u3002\u4e00\u4eba\u304c\u5316\u5b66\u7642\u6cd5\u6b7b\u3057\u307e\u3057\u305f\u3002\u305d\u306e\u5f8c\u306b\uff0c\u8133\u810a\u9ac439\u30b0\u30ec\u30a4\uff08\uff11\u56de1.3\u30b0\u30ec\u30a4\u3067\uff11\u65e5\uff12\u56de\u306e\u591a\u5206\u5272\uff09\u3068\u5f8c\u982d\u84cb\u7aa9\u3078\u7dcf\u7dda\u91cf\u3068\u3057\u306660\u30b0\u30ec\u30a4 \uff08\uff11\u56de1.5\u30b0\u30ec\u30a4\u3067\uff11\u65e5\uff12\u56de\u306e\u591a\u5206\u5272\uff09\u306e\u7167\u5c04\u3092\u53d7\u3051\u307e\u3057\u305f\u3002\u5316\u5b66\u7642\u6cd5\u5f8c\u306b\u816b\u760d\u304c\u6d88\u3048\u305f10\u6b73\u672a\u6e80\u306e\u4f8b\u3067\u8133\u810a\u9ac4\u7167\u5c04\u306f31.2\u30b0\u30ec\u30a4\u306b\u843d\u3068\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u521d\u671f\u5316\u5b66\u7642\u6cd5\u3067\u64ad\u7a2e\u304c\u6d88\u3048\u306a\u304b\u3063\u305f14\u4eba\u306e\u60a3\u8005\u3055\u3093\u306b\u306f\u7167\u5c04\u5f8c\u306b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u304c\u306a\u3055\u308c\u3066\u3044\u307e\u3059\u3002\uff15\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f72%\uff0c\uff15\u5e74\u5168\u751f\u5b58\u5272\u5408\u306f73%\u3067\u3057\u305f\u3002\u3053\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u306e\u53b3\u3057\u3044\u526f\u4f5c\u7528\u306f\u8a8d\u3081\u3089\u308c\u306a\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300dM1(n=9), M2(n=9), M3(n-17, M4(n=1) \u3067\u3059\u3002\u679c\u305f\u3057\u3066M1\u3092\u8ee2\u79fb (metastasis)\u3068\u3059\u308b\u306e\u304b\uff0cM1\u4f8b\u306b\u3053\u308c\u307b\u3069\u53b3\u3057\u3044\u6cbb\u7642\u304c\u5fc5\u8981\u306a\u306e\u304b\u307e\u305a\u7591\u554f\u306b\u601d\u3048\u307e\u3059\u3002M1\u3092\u9664\u3044\u3066\u3057\u307e\u3048\u3070\uff15\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f\u9ad8\u3044\u3068\u3044\u3048\u308b\u306e\u304b\u3069\u3046\u304b\u4e0d\u660e\u3067\u3059\u3002\u307e\u305f\uff0c\u4ed6\u5206\u5272\u7167\u5c04\u3068\u3044\u3048\u3069\u3082\uff11\u65e52.6\u30b0\u30ec\u30a4\u3067\u8133\u810a\u9ac4\u7167\u5c04\u304c39\u30b0\u30ec\u30a4\u306b\u304a\u3088\u3076\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u306e\u53b3\u3057\u3044\u81e8\u5e8a\u7684\u306a\u5408\u4f75\u75c7\u304c\u306a\u304b\u3063\u305f\u3044\u3046\u3053\u3068\u3092\u9d5c\u5451\u307f\u306b\u3067\u304d\u308b\u304b\u3069\u3046\u304b\u4e0d\u660e\u3067\u3059\u3002\u30a4\u30bf\u30ea\u30a2\u306e\u30df\u30e9\u30ce\u304b\u3089\u306e\u5831\u544a\u3068\u8a00\u3048\u3070\u305d\u3046\u3089\u3057\u3044\u30fc\u30fc\u3002\u3067\u3082\uff0cM3\u306e\u64ad\u7a2e\u4f8b\u3067\u306f\u5931\u3046\u3082\u306e\u3092\u899a\u609f\u3057\u306a\u3044\u3068\u751f\u547d\u306f\u305f\u3059\u304b\u3089\u306a\u3044\u3068\u3044\u3046\u306e\u3082\uff0c\u307e\u3060\u4e00\u65b9\u3067\u4e8b\u5b9f\u3067\u3059\u304b\u3089\uff0c\u3053\u306e\u7167\u5c04\u6cd5\u3092\u691c\u8a0e\u3059\u308b\u4fa1\u5024\u3082\u3042\u308b\u306e\u3067\u3057\u3087\u3046\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u305f\u3053\u3068\u3067\u306e\u751f\u5b58\u8005\u306e\u5065\u5eb7<\/span><\/strong><\/h4>\n<p>Bull KS, et al.: Reduction of health status 7 years after addition of chemotherapy to craniopsinal irradiaiton for medulloblastoma: a follow-up study in PNET 3 trial survivors on behalf of the CCLG (formerly UKCCSG). J Clin Oncol 25: 4239-4245, 2007<br \/>\n\u5e74\u9f62\u306f6.6-24\u6b73\uff0c147\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u751f\u5b58\u8005\u306e\u8abf\u67fb\u5831\u544a\u3067\u3059\u3002\u5065\u5eb7\u72b6\u614b\u306f\uff0c\u8133\u810a\u9ac4\u7167\u5c04\u5358\u72ec\u3088\u308a\u3082\u7167\u5c04\u306b\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u305f\u751f\u5b58\u8005\u3067\u52a3\u3063\u3066\u3044\u305f\u3068\u3057\u3066\u3044\u307e\u3059\u3002\u884c\u52d5\u3084\u751f\u5b58\u306e\u8cea\u3082\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u305f\u65b9\u304c\u4f4e\u304f\uff0c\u904b\u52d5\u3084\u5b66\u7fd2\u3067\u306e\u652f\u63f4\u304c\u5fc5\u8981\u3067\u3042\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u306e\u5f8c\u907a\u75c7\u3068\u3044\u3048\u3070\uff0c\u624b\u8853\u3084\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u5f71\u97ff\u304c\u5f37\u8abf\u3055\u308c\u307e\u3059\u304c\uff0c\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u308b\u3053\u3068\u306b\u3088\u3063\u3066\u3082\u751f\u5b58\u8005\u306e\u5065\u5eb7\u72b6\u614b\u306f\u4f4e\u4e0b\u3057\u3066\u3044\u308b\u3068\u3057\u3066\u3044\u307e\u3059\u3002\u3067\u3082\uff0c\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u305f\u65b9\u304c\u751f\u5b58\u5272\u5408\u306f\u3042\u304c\u308b\u306e\u3067\uff0c\u304b\u306a\u308a\u3080\u305a\u304b\u3057\u3044\u5224\u65ad\u3068\u306a\u308a\u307e\u3059\u3002\u306f\u3063\u304d\u308a\u8a00\u3048\u308b\u3053\u3068\u306f\uff0c\u306f\u3063\u304d\u308a\u3057\u305f\u6839\u62e0\u306e\u7121\u3044\u5316\u5b66\u7642\u6cd5\u3092\u52a0\u3048\u3066\u306f\u306a\u3089\u306a\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u624b\u8853\u5f8c\u306e\u7121\u8a00\u75c7<\/span><\/strong><\/h4>\n<p>Robertson PL , et al: Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children&#8217;s Oncology Group. J Neurosurg 105: 444-451, 2006<br \/>\n\u5c0f\u8133\u6027\u7121\u8a00\u75c7\u3068\u306f\uff0c\u5c0f\u8133\u816b\u760d\u306e\u624b\u8853\u76f4\u5f8c\u306b\u4e00\u6642\u7684\u306b\u8a00\u8449\u304c\u51fa\u306a\u304f\u306a\u308b\u3053\u3068\u3092\u8a00\u3044\u307e\u3059\u3002450\u4eba\u306e\u9ac4\u82bd\u816b\u306e\u5b50\u4f9b\u304c\u624b\u8853\u3092\u53d7\u3051\u3066\uff0c\u8853\u5f8c\u306b\u5c0f\u8133\u6027\u7121\u8a00\u75c7\u306b\u306a\u3063\u305f\u306e\u306f107\u4eba(24%)\u3060\u3063\u305f\u3068\u5831\u544a\u3055\u308c\u307e\u3057\u305f\u3002\u91cd\u3044\u75c7\u72b6\u304c43%\uff0c\u4e2d\u7b49\u5ea6\u304c49%\uff0c\u8efd\u75c7\u304c8%\u3067\u3057\u305f\u3002\u91cd\u75c7\u3068\u306f\u7121\u8a00\u75c7\u3068\u5c0f\u8133\u5931\u8abf\u75c7\u304c\u9855\u8457\u3067\uff0c\u624b\u8853\u524d\u306b\u9ac4\u82bd\u816b\u304c\u8133\u5e79\u90e8\u306b\u6d78\u6f64\u3057\u3066\u3044\u305f\u4f8b\u306b\u3088\u308a\u591a\u304f\u767a\u751f\u3057\u305f\u3068\u5f37\u8abf\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u8a3a\u65ad\u306e\uff11\u5e74\u5f8c\u306b\uff0c\u7121\u8a00\u75c7\u304c\u3067\u305f\u5b50\u3069\u3082\u306e\u591a\u304f\u306b\uff0c\u8a00\u8a9e\u3084\u8a8d\u77e5\u6a5f\u80fd\u969c\u5bb3\u3084\u5931\u8abf\u75c7 (nonmotor speech\/language deficits, neurocognitive deficits, ataxia)\u304c\u6b8b\u3063\u3066\u3044\u307e\u3057\u305f\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u3053\u3093\u306a\u306b\u591a\u3044\u3068\u306f\u304a\u3069\u308d\u304d\u3067\u3059\u3002\u7c73\u56fd\u3067\u306f\u9ac4\u82bd\u816b\u306f\u305d\u306e\u624b\u8853\u306b\u306a\u308c\u3066\u3044\u308b\u8133\u5916\u79d1\u533b\u304c\u3057\u307e\u3059\u304b\u3089\uff0c\u65e5\u672c\u306e\u3088\u3046\u306b\u9ac4\u82bd\u816b\u304c\u4e00\u5b9a\u306e\u65bd\u8a2d\u306b\u96c6\u307e\u3089\u306a\u3044\u6240\u3067\u306f\uff0c\u3082\u3063\u3068\u3053\u306e\u5408\u4f75\u75c7\u306f\u591a\u3044\u3068\u4e88\u60f3\u3055\u308c\u307e\u3059\u3002\u3084\u306f\u308a\u65e5\u672c\u3067\u306f\uff0c\u9ac4\u82bd\u816b\u306f\u624b\u8853\u3057\u306a\u3044\u3067\u6cbb\u3059\u65b9\u6cd5\u3092\u63a2\u3063\u305f\u65b9\u304c\u3044\u3044\u306e\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u79c1\u306f\u7b2c4\u8133\u5ba4\u816b\u760d\u306e\u8853\u5f8c\u306b\u307b\u3068\u3093\u3069\u7121\u8a00\u75c7\u3092\u307f\u307e\u305b\u3093\u3002\u539f\u56e0\u306f\u3044\u308d\u3044\u308d\u63a8\u5b9a\u3055\u308c\u3066\u306f\u3044\u307e\u3059\u304c\u3001\u307b\u3068\u3093\u3069\u306e\u5834\u5408\u306f\u3001\u624b\u8853\u3067\u5c0f\u8133\u866b\u90e8\u3068\u3044\u3046\u3068\u3053\u308d\u3092\u5207\u958b\u3057\u3059\u304e\u3001\u5c0f\u8133\u6df1\u90e8\u640d\u50b7\u3092\u751f\u3058\u308b\u3053\u3068\u306b\u8d77\u56e0\u3057\u307e\u3059\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3078\u306e\u4f75\u7528<\/span><\/strong><\/h4>\n<p>Cajjar A , et al: Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial. Lancet Oncol 7:813-820, 2006<br \/>\n\u5e79\u7d30\u80de\u6551\u63f4 PBSCT \u3092\u7528\u3044\u308b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306e\u6210\u7e3e\u3067\u3059\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u91cf\u3092\u30ea\u30b9\u30af\u306b\u5fdc\u3058\u3066\u5909\u3048\u3066\u3044\u307e\u3059\u3002\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u306f\u5316\u5b66\u7642\u6cd5\u306e\u524d\u306b23.4\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u304c\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u3067\u306f36-39.6\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u304c\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u816b\u760d\u5c40\u6240\u7dda\u91cf\u306f\u3044\u305a\u308c\u308255.8\u30b0\u30ec\u30a4\u3067\u3059\u3002\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306e\u85ac\u5264\u306f\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\uff0c\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\uff0c\u30b5\u30a4\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\u3067\u3059\u3002134\u4eba\u306e\u60a3\u5150\u306e\u5185\u306e119\u4eba(89%)\u3067\u6cbb\u7642\u3092\u304d\u3061\u3093\u3068\u7d42\u3048\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3057\u305f\u3002\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u306e\uff15\u5e74\u5168\u751f\u5b58\u5272\u5408\u306f85%\u3067\u9ad8\u30ea\u30b9\u30af\u7fa4\u3067\u306f70%\u3067\u3057\u305f\u3002\u7d44\u7e54\u50cf\u3092\u307f\u308b\u3068\u5927\u7d30\u80de\u6027\u9ac4\u82bd\u816blarge-cell medulloblatoma\u3067\u306f57%\u306e\uff15\u5e74\u751f\u5b58\u5272\u5408\u3060\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300dSt Jude (\u30bb\u30f3\u30c8\u30b8\u30e5\u30fc)\u75c5\u9662\u306e\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3068\u3057\u3066\u77e5\u3089\u308c\u308b\u6cbb\u7642\u6cd5\u306e\u5831\u544a\u3067\u3059\u3002\u3068\u3066\u3082\u3044\u3044\u6210\u7e3e\u3067\u3059\u3002\u3067\u3082\uff0c\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306e\u524d\u306b\u3059\u3067\u306b\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u306f23.4\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u304c\u9ad8\u30ea\u30b9\u30af\u7fa4\u3067\u306f36-39.6\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u304c\u4f75\u7528\u3055\u308c\u3066\u3044\u308b\u3053\u3068\u306b\u6ce8\u76ee\u3067\u3059\u3002\u5f93\u6765\u306e\u653e\u5c04\u7dda\u6cbb\u7642\u306b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3092\u304b\u3076\u305b\u308c\u3070\u3044\u3044\u6210\u7e3e\u306a\u306e\u3067\u3059\u304c\uff0c\u3053\u308c\u306f\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u5358\u72ec\u3060\u3051\u306e\u6709\u52b9\u6027\u3092\u78ba\u8a8d\u3057\u305f\u3082\u306e\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u307e\u305f\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3067\u306f\uff0c\u4e0a\u306b\u66f8\u3044\u3066\u3042\u308bPacker\u5148\u751f\u306e\u5831\u544a\u3068\u540c\u3058\u304f\u3089\u3044\u306a\u306e\u3067\uff0c\u526f\u4f5c\u7528\uff08\u6709\u5bb3\u4e8b\u8c61\uff09\u304c\u5f37\u3044\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306f\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u306f\u4f7f\u3046\u3079\u304d\u3067\u306a\u3044\u3068\u5224\u65ad\u3055\u308c\u307e\u3059\u3002\u4e00\u65b9\uff0c\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u306f\u8a66\u3057\u3066\u3082\u3044\u3044\u6cbb\u7642\u6cd5\u3067\u3059\u304c\u3001\u8133\u810a\u9ac4\u7167\u5c0436\u30b0\u30ec\u30a4\u306f\u6e1b\u91cf\u3067\u304d\u307e\u305b\u3093\u3002\u3053\u306e\u6cbb\u7642\u306f\u7c73\u56fd\u306e\u5de8\u5927\u306a\u5c0f\u5150\u75c5\u9662\u3067\u591a\u304f\u306e\u5c02\u9580\u30b9\u30bf\u30c3\u30d5\u306e\u3082\u3068\u3067\u306e\u307f\u53ef\u80fd\u306a\u6cbb\u7642\u6cd5\u3067\u3059\u3057\u3001\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306f\u5316\u5b66\u7642\u6cd5\u6b7b\u306e\u4ed6\u306b\u3082\u305f\u304f\u3055\u3093\u306e\u6709\u5bb3\u4e8b\u8c61\u304c\u3042\u308a\u5f97\u308b\u6cbb\u7642\u3060\u3068\u3044\u3046\u3053\u3068\u3082\u5fd8\u308c\u3066\u306f\u3044\u3051\u306a\u3044\u3067\u3057\u3087\u3046\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u624b\u8853\u3059\u308b\u524d\u306b\u3057\u3063\u304b\u308a\u5316\u5b66\u7642\u6cd5<\/span>\u3092\u884c\u3046\u3053\u3068<\/strong><\/h4>\n<p>Grill J et al. Preoperative chemotherapy in children with high-risk medulloblastomas: a feasibillity study. J Neurosurg (Pediatrics 4) 103: 312-318, 2005<br \/>\n\u30d5\u30e9\u30f3\u30b9\u306e\u30d1\u30ea\u306e\u5c0f\u5150\u75c5\u9662\u304b\u3089\u306e\u5831\u544a\u3067\u3059\u3002\u9ad8\u30ea\u30b9\u30af\u7fa4(Chang M&gt;1, or T3b\/T4)\u306e21\u4eba\u306e\u5b50\u4f9b\u306b\u6c34\u982d\u75c7\u306e\u6cbb\u7642\uff08\u8133\u5ba4\u958b\u7a93\u885313\u4f8b\u3068\u30b7\u30e3\u30f3\u30c8\u8853\uff16\u4f8b\uff09\u3068\u751f\u691c\u75c5\u7406\u8a3a\u65ad\u3092\u884c\u3063\u305f\u5f8c\u306b\uff0c\u901a\u5e38\u5316\u5b66\u7642\u6cd5\uff08\uff18\u4f8b\uff09\u3042\u308b\u3044\u306f\u5927\u91cf\u5316\u5b66\u7642\u6cd5\uff0811\u4f8b\uff09\u3092\u3057\u3066\u304b\u3089\u816b\u760d\u6458\u51fa\u8853\u304c\u884c\u308f\u308c\u307e\u3057\u305f\u30021\u4f8b\u3067\u751f\u691c\u8853\u306e\u3068\u304d\u816b\u760d\u5185\u51fa\u8840\u304c\u3042\u308a\u307e\u3059\u3002\u624b\u8853\u524d\u306b\u64ad\u7a2e\u3057\u305f2\u4f8b\u304c\u4ea1\u304f\u306a\u3063\u3066\u3044\u307e\u3059\u3002\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u95a2\u9023\u6b7b\u306f\uff11\u4f8b\u3067\u3059\u3002\u8133\u810a\u9ac4\u7167\u5c04\u306f\uff15\u6b73\u4ee5\u4e0a\u306b\uff0c\u305d\u308c\u4ee5\u4e0b\u306e\u5b50\u4f9b\u306f\u5c40\u6240\u7167\u5c04\u3092\u53d7\u3051\u307e\u3057\u305f\u3002<br \/>\n\uff12\u30b3\u30fc\u30b9\u306e\u5316\u5b66\u7642\u6cd5\u306e\u5f8c\u3067\u306e\u816b\u760d\u3078\u306e\u594f\u529f\u7387\u306f71%\uff0c\u8ee2\u79fb\u5de3\u3078\u306e\u594f\u529f\u7387\u306f59%\u3067\u3059\u3002\u5316\u5b66\u7642\u6cd5\u5f8c\u306b\u6458\u51fa\u3055\u308c\u305f\u6b8b\u5b58\u816b\u760d\u306e\u75c5\u7406\u306f\uff0c\uff17\u4f8b\u3067\u9ac4\u82bd\u816b\u7d44\u7e54\uff0c\uff13\u4f8b\u3067\u816b\u760d\u304c\u306a\u3044\u8133\u7d44\u7e54\u306e\u307f\uff0c\uff19\u4f8b\u3067\u4e21\u8005\u304c\u6df7\u3058\u3063\u305f\u3082\u306e\u3067\u3057\u305f\u3002\uff13\u5e74\u7121\u5897\u60aa\u751f\u5b58\u7387\u306f\u671f\u5f85\u306b\u53cd\u3057\u3066\u4f4e\u304f37%\u3067\u3057\u305f\u3002<\/p>\n<p>\u300cDr. Packer\u306e\u89e3\u8aac\u300d\u624b\u8853\u524d\u5316\u5b66\u7642\u6cd5\u306e\u610f\u7fa9\u304c\u3042\u308b\u3068\u3059\u308c\u3070\uff0c\u816b\u760d\u306e\u5927\u304d\u3055\u3092\u7e2e\u5c0f\u3057\u3066\u624b\u8853\u3092\u5b89\u5168\u306b\uff08\u7279\u306b\u5927\u304d\u306a\u816b\u760d\u3067\u751f\u3058\u308b\u5f8c\u982d\u7aa9\u7121\u8a00\u75c7\u306e\u983b\u5ea6\u3092\u4e0b\u3052\u308b\uff09\u304b\u3064\u5b8c\u5168\u6458\u51fa\u3092\u78ba\u5b9f\u306b\u53ef\u80fd\u306b\u3059\u308b\u3053\u3068\uff0c\u305d\u3057\u3066\u751f\u547d\u4e88\u5f8c\u3092\u6539\u5584\u3059\u308b\u306b\u3042\u308b\u306e\u3067\u3059\u304c\uff0c\u3053\u306e\u5831\u544a\u3067\u8853\u5f8c\u306e\u5f8c\u982d\u7aa9\u75c7\u5019\u7fa4\uff08\u4f55\u3089\u304b\u306e\u5c0f\u8133\u8133\u5e79\u640d\u50b7\uff09\u304c19\u4f8b\u4e2d\u306e\uff19\u4f8b\u306b\u751f\u3058\u3066\u3044\u308b\u306e\u306b\u5931\u671b\uff1f\u3057\u3066\u3044\u307e\u3059\u3002<br \/>\n\u307e\u305f\uff0c\u3042\u3089\u304b\u3058\u3081\u624b\u8853\u3092\u3057\u3066\u75c5\u7406\u7d44\u7e54\u3092\u78ba\u304b\u3081\u308b\u306e\u304c\u3068\u3066\u3082\u91cd\u8981\u306a\u306e\u306b\u305d\u308c\u306e\u53cd\u5bfe\u3092\u884c\u304f\u65b9\u6cd5\u306a\u306e\u3067\u7d0d\u5f97\u3067\u304d\u306a\u3044\u3068\u8ff0\u3079\u3066\u3044\u307e\u3059\u3002\u7406\u7531\u306f\uff0c\uff12\u6b73\u672a\u6e80\u306e\u5b50\u4f9b\u306e\u672a\u5206\u5316\u816b\u760d\u306e\uff14\u5206\u306e\uff11\u304cAT\/RT\uff08\u3068\u3066\u3082\u6cbb\u3089\u306a\u3044\u3088\u3046\u306a\u60aa\u6027\u816b\u760d\u306e\u4e00\u3064\u3067\u3059\uff09\u3067\u3042\u308b\u3053\u3068\uff0c\u6700\u8fd1\u306e\u7c73\u56fd\u306e\u5171\u540c\u7814\u7a76\u3067\u306f\u6cbb\u7642\u3092\u59cb\u3081\u308b\u524d\u306b\u75c5\u7406\u6240\u898b\u306e\u4e2d\u592e\u8a3a\u65ad\u3092\u3057\u3066\u3044\u308b\u3053\u3068\uff0c\u5206\u5b50\u30de\u30fc\u30ab\u30fc(ERBB2 protein, MYCC and TRKC messenger RNA)\u304c\u4e88\u5f8c\u56e0\u5b50\uff08\u751f\u7269\u5b66\u7684\u60aa\u6027\u5ea6\u3092\u4e88\u60f3\u3059\u308b\uff09\u3068\u306a\u308b\u306e\u306b\u305d\u308c\u304c\u89e3\u3089\u306a\u304f\u306a\u308b\u305f\u3081\u306b\u6cbb\u7642\u306eintensity\uff08\u5f37\u3055\uff09\u304c\u6c7a\u3081\u3089\u308c\u306a\u304f\u306a\u308b\u3068\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\u300c\u6fa4\u6751\u306e\u5370\u8c61\u300d\u3053\u306e\u5831\u544a\u306f\u7a4d\u6975\u7684\u6458\u51fa\u624b\u8853\u306e\u30ea\u30b9\u30af\u3092\u4e0b\u3052\u3088\u3046\u3068\u3057\u305f\u89b3\u70b9\u304b\u3089\u306f\u3068\u3066\u3082\u8208\u5473\u6df1\u3044\u3082\u306e\u3067\u3059\u3002\u305d\u3057\u3066\uff0c\u9ad8\u3044\u30ea\u30b9\u30af\u306e\u9ac4\u82bd\u816b\u306b\u307e\u305a\u5927\u91cf\u306e\u5316\u5b66\u7642\u6cd5\u306e\u307f\u304c\u3055\u308c\u305f\u3068\u3044\u3046\u3053\u3068\u306b\u6ce8\u76ee\u3067\u3059\u3002\u6458\u51fa\u8853\u524d\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u4f7f\u308f\u308c\u307e\u305b\u3093\u3067\u3057\u305f\u3002<br \/>\n\u524d\u306e\u3068\u3053\u308d\u306b\u66f8\u3044\u305f\u3088\u3046\u306b\u9ac4\u82bd\u816b\u306e\u624b\u8853\u306f\u7c21\u5358\u306a\u3082\u306e\u3067\u306f\u306a\u3044\u306e\u3067\uff0c\u816b\u760d\u3092\u5c0f\u3055\u304f\u3057\u3066\u304a\u3044\u3066\u304b\u3089\uff0c\u958b\u982d\u624b\u8853\u3067\u5168\u90e8\u53d6\u308c\u308c\u3070\u305d\u308c\u306b\u8d8a\u3057\u305f\u3053\u3068\u306f\u306a\u3044\u306e\u3067\u3059\u3002\u3061\u3087\u3068\u89b3\u70b9\u3092\u5909\u3048\u3066\uff0c\u30ea\u30b9\u30af\u306e\u4f4e\u3044\u3068\u601d\u308f\u308c\u308b\u9ac4\u82bd\u816b\u306b\uff0c\u307e\u305a\u8efd\u3044\u5316\u5b66\u7642\u6cd5\u3068\u5c40\u6240\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u5c0f\u3055\u304f\u3057\u3066\u304b\u3089\u624b\u8853\u3092\u3059\u308b\u3068\u3044\u3046\u65b9\u6cd5\u3082\u3042\u308b\u306e\u3067\u306f\u306a\u3044\u3067\u3057\u3087\u3046\u304b\u3002\u3082\u3061\u308d\u3093\u52b9\u679c\u3092\u78ba\u5b9f\u306b\u4e88\u6e2c\u3059\u308b\u65b9\u6cd5\u306f\u3042\u308a\u307e\u305b\u3093\u3057\uff0c\u3053\u3053\u3067\u306f\u66f8\u304d\u304d\u308c\u306a\u3044\u304f\u3089\u3044\u69d8\u3005\u306a\u554f\u984c\u3092\u542b\u3093\u3067\u306f\u3044\u307e\u3059\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u3078\u306e25Gy\u5168\u8133\u810a\u9ac4\u7167\u5c04<\/span>\u306e\u6210\u7e3e<\/strong><\/h4>\n<p>Oyharcabal-Bourden V et al.: Standard-risk medulloblastoma treated by adjuvant chemotherapy followed by reduced-dose craniospinal radiation therapy. J Clin Oncol 23: 4726-4734, 2005<br \/>\n\u30d5\u30e9\u30f3\u30b9\u306e\u5c0f\u5150\u8133\u816b\u760d\u30b0\u30eb\u30fc\u30d7\u3089\u304b\u306e\u767a\u8868\u3067\u3059\u30023\u6b73\u304b\u308918\u6b73\u306e\u5b50\u4f9b\u3067\uff0c\u624b\u8853\u3067\u307b\u3068\u3093\u3069\u816b\u760d\u304c\u53d6\u308c\u3066\uff0c\u304b\u3064\u8ee2\u79fb\u3082\u306a\u3044\uff08\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\uff09136\u75c7\u4f8b\u306e\u6cbb\u7642\u6210\u7e3e\u5831\u544a\u3067\u3059\u3002\u6a19\u6e96\u7684\u306a\u8133\u810a\u9ac4\u7167\u5c04\u306f35Gy\u304c\u4f7f\u308f\u308c\u307e\u3059\u304c\uff0c\u305d\u308c\u3060\u3068\u8a8d\u77e5\u969c\u5bb3\u306e\u767a\u751f\u7387\u304c\u9ad8\u3044\u306e\u3067\uff0c25Gy\u307e\u3067\u8133\u810a\u9ac4\u7167\u5c04\u3092\u843d\u3068\u3057\u3066\u3044\u308b\u306e\u304c\u6700\u5927\u306e\u7279\u5fb4\u3067\u3059\u3002\u8853\u5f8c90\u65e5\u4ee5\u5185\uff08\u3061\u3087\u3063\u3068\u9045\u3044\uff01\uff09\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u958b\u59cb\u3057\u3066\uff0c\u816b\u760d\u306e\u3042\u3063\u305f\u90e8\u5206\u306b\u306f55Gy\u3092\u7167\u5c04\u3057\u3066\u3044\u307e\u3059\u3002\u5316\u5b66\u7642\u6cd5\u306f 8 drugs in one day \u3068\u3044\u3046\u826f\u304f\u77e5\u3089\u308c\u305f\u591a\u5264\u4f75\u7528\u7642\u6cd5\u3092\uff12\u30b3\u30fc\u30b9\u3068\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\uff0f\u30a8\u30c8\u30dd\u30b7\u30c9\u3092\uff12\u30b3\u30fc\u30b9\u4f7f\u3063\u3066\u3044\u307e\u3059\u3002\u672b\u68a2\u8840\u5e79\u7d30\u80de\u6551\u63f4\u3092\u4f7f\u3046\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<br \/>\n\u5168\u4f53\u3067\u306e5\u5e74\u7121\u5897\u60aa\u751f\u5b58\u7387\u306f65%\u3067\uff0c\u6cbb\u7642\u304c\u3046\u307e\u304f\u3044\u304b\u306a\u304b\u3063\u305f\u4f8b\u3067\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u3084\u8853\u5f8c\u306e\u8a55\u4fa1\u304c\u304d\u3061\u3093\u3068\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\u4f8b\u304c\u591a\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u307e\u305f\uff0c\u8a08\u753b\u306b\u6cbf\u3063\u3066\u304d\u3061\u3093\u3068\u6cbb\u7642\u304c\u3055\u308c\u305f \u75c7\u4f8b\u3067\u306e5\u5e74\u7121\u5897\u60aa\u751f\u5b58\u7387\u306f72%\u3067\u3042\u308b\u3068\u5831\u544a\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u751f\u5b58\u3057\u305f31%\u306e\u5b50\u4f9b\u306b\u6210\u9577\u30db\u30eb\u30e2\u30f3\u306e\u88dc\u5145\u304c\u884c\u306a\u308f\u308c\u3066\uff0c25%\u306e\u5b50\u4f9b\u306b\u7279\u6b8a\u306a\u5c31\u5b66\u6307\u5c0e\u304c\u5fc5\u8981\u3067\u3042\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4 \u3067\u306f\u591a\u5264\u4f75\u7528\u5316\u5b66\u7642\u6cd5\u3092\u7d44\u307f\u5408\u308f\u305b\u308b\u3053\u3068\u3067\uff0c25Gy\u306e \u8133\u810a\u9ac4\u7167\u5c04\u3067\u308270%\u7a0b\u306e\u518d\u767a\u306e\u306a\u3044\uff15\u5e74\u751f\u5b58\u7387\u304c\u5f97\u3089\u308c\u308b\u3068\u3044\u3046\u3053\u3068\u3092\u8a3c\u660e\u3057\u3066\u3044\u307e\u3059\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u624b\u8853\u5f8c\u306b\u3042\u307e\u308a\u5f85\u305f\u306a\u3044\u3067\u884c\u306a\u3046\u3053\u3068\u3068\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u8a08\u753b\u304c\u3057\u3063\u304b\u308a\u3057\u3066\u3044\u308b\u3068\u3044\u3046\u6761\u4ef6\u304c\u63c3\u3063\u3066\u3044\u3066\u3053\u306e\u6210\u7e3e\u304c\u51fa\u3066\u3044\u308b\u3053\u3068\u306b\u6ce8\u76ee\u3067\u3059\u3002\u653e\u5c04\u7dda\u7167\u5c04\u306e\u6642\u671f\u3092\u9045\u3089\u305b\u308c\u3070\u3053\u306e\u6cbb\u7642\u6210\u7e3e\u306f\u671f\u5f85\u3067\u304d\u306a\u3044\u304b\u3082\u3057\u308c\u306a\u3044\u306e\u3067\u3059\u3002\u304a\u305d\u3089\u304f10\u6b73\u4ee5\u4e0b\u306e\u5b50\u4f9b\u305f\u3061\u3067\u306f\uff0c\u3053\u306e\u8133\u810a\u9ac4\u7dda\u91cf25Gy\u3067\u3082\u304b\u306a\u308a\u9ad8\u7387\u306b\u4e0b\u5782\u4f53\u6a5f\u80fd\u969c\u5bb3\u3068\u8a8d\u77e5\u969c\u5bb3\u304c\u51fa\u307e\u3059\u304c\uff0c\u305d\u306e\u7a0b\u5ea6\u3068\u5272\u5408\u306f\u5f93\u6765\u306e35Gy\u306b\u6bd4\u3079\u308c\u3070\u8efd\u3044\u3068\u3044\u3048\u307e\u3059\u3002\u540c\u91cf\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3092\u7528\u3044\u308bPacker\u306e<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\uff13\u6b73\u672a\u6e80\u306e\u9ac4\u82bd\u816b\u3078\u306e\u5316\u5b66\u7642\u6cd5<\/span><\/strong><\/h4>\n<p>Rutkowski S, et al.: Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med. 2005 Mar 10;352: 978-86, 2005<br \/>\nNew England Journal of Medicine\u3068\u3044\u3046\u3068\u3066\u3082\u6a29\u5a01\u306e\u9ad8\u3044\u96d1\u8a8c\u306b\u3001Dr. Rutkowski\uff08\u30ef\u30eb\u30c4\u30d6\u30eb\u30b0\u5927\u5b66\u5c0f\u5150\u816b\u760d\u79d1\uff09\u304c\u9ac4\u82bd\u816b\u306e\u6cbb\u7642\u306e\u8ad6\u6587\u3092\u767a\u8868\u3057\u307e\u3057\u305f\u3002<span style=\"color: #000080;\"><strong>\u9ac4\u82bd\u816b\u3092\u3082\u30643\u6b73\u672a\u6e80\u306e\u5b50\u4f9b\u305f\u3061\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u3057\u306a\u3044<\/strong><\/span>\u3067\u5316\u5b66\u7642\u6cd5\u3060\u3051\u3067\u6cbb\u7642\u3057\u3088\u3046\u3068\u3044\u3046\u8a08\u753b\u306e\u6210\u7e3e\u3067\u3059\u3002\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u816b\u760d\u304c\u6d88\u3048\u306a\u304b\u3063\u305f\u5834\u5408\u3068\u518d\u767a\u3057\u305f\u6642\u306b\u4f7f\u308f\u308c\u307e\u3057\u305f\u3002<br \/>\n1992\u5e74\u304b\u30891997\u5e74\u306b\u6cbb\u7642\u3055\u308c\u305f43\u4eba\u306e3\u6b73\u672a\u6e80\u306e\u5b50\u4f9b\u305f\u3061\u306e\u6cbb\u7642\u6210\u7e3e\u3067\u3059\u3002\u624b\u8853\u306e\u5f8c\u30673\u30b3\u30fc\u30b9\u306e<strong><span style=\"color: #000080;\">\u30b7\u30af\u30ed\u30db\u30b9\u30d5\u30a1\u30df\u30c9\u3001\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\u3001\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\uff08\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\uff09\u3001\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\u3001\u30a8\u30c8\u30dd\u30b7\u30c9\u306e\u9759\u8108\u5185\u6295\u4e0e\u3068\u8133\u5ba4\u304b\u3089\u306e\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u306e\u6295\u4e0e<\/span><\/strong>\u3092\u884c\u3063\u3066\u3044\u307e\u3059\u30021\u30b3\u30fc\u30b9\u306b2\u30f6\u6708\u304b\u304b\u308a\u307e\u3059\u304b\u3089\u77ed\u304f\u3066\u30826\u30f6\u6708\u306e\u5316\u5b66\u7642\u6cd5\u3067\u3059\u304c\u3001\u3053\u306e\u7814\u7a76\u3067\u7528\u3044\u3089\u308c\u305f\u306e\u306f\u9020\u8840\u5e79\u7d30\u80de\u6551\u63f4\u3092\u4f75\u7528\u3059\u308b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<ul>\n<li>\u5b8c\u5168\u6458\u51fa\u3092\u53d7\u3051\u305f17\u4eba\u3000\u3000\u3000\u3000\uff15\u5e74\u751f\u5b58\u5272\u5408 93% (\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 82%)<\/li>\n<li>\u6b8b\u5b58\u816b\u760d\u304c\u3042\u3063\u305f14\u4eba\u3000\u3000\u3000\u3000\uff15\u5e74\u751f\u5b58\u5272\u5408 56% (\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 50%)<\/li>\n<li>\u8ee2\u79fb(\u64ad\u7a2e)\u304c\u3042\u3063\u305f12\u4eba\u3000\u3000\u3000 \uff15\u5e74\u751f\u5b58\u5272\u5408 38% (\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 33%)<\/li>\n<\/ul>\n<p><strong><span style=\"color: #000080;\">\u8ee2\u79fb\u306e\u306a\u304b\u3063\u305f31\u4eba\u3067\u306f\uff15\u5e74\u751f\u5b58\u5272\u5408 77% (\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 68%)<\/span><\/strong>\u3002\u521d\u671f\u5316\u5b66\u7642\u6cd5\u306e\u7d42\u4e86\u6642\u70b9\u3067\u816b\u760d\u304c\u6d88\u3048\u306a\u304b\u3063\u305f14\u4eba\u306e\u3046\u306110\u4eba\u304c\u6b7b\u4ea1\u3057\u3066\u3001\u6b8b\u308a\u306e4\u4eba\u306f\u66f4\u306b\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u3066\u751f\u5b58\u3002\u521d\u671f\u5316\u5b66\u7642\u6cd5\u3067\u816b\u760d\u304c\u6d88\u3048\u3066\u3044\u305f(\u624b\u8853\u5168\u6458\u3092\u542b\u3080)29\u4eba\u306e9\u4eba\u306b\u518d\u767a\u304c\u751f\u3058\u3066\u3044\u307e\u3059\u300216\u4eba\u306f\u5897\u60aa\u30fb\u518d\u767a\u306e\u6642\u306b\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3001\u305d\u306e\u5185\u30678\u4eba\u304c\u518d\u767a\u6cbb\u7642\u306b\u6210\u529f\u3057\u305f\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u300223\u4eba\u306e\u5b50\u4f9b\u306e\u5185\u3067\u7121\u75c7\u72b6\u306a\u304c\u3089\u767d\u8cea\u8133\u75c7\u304c\u307f\u3089\u308c\u305f\u306e\u306f19\u4eba(83%)\u3067\u3059\u3002\u6cbb\u7642\u5f8c\u306e\u77e5\u80fd\u6307\u6570\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u53d7\u3051\u305f\u904e\u53bb\u306e\u81e8\u5e8a\u8a66\u9a13\u306e\u60a3\u8005\u3055\u3093\u3088\u308a\u9ad8\u304f\u4fdd\u305f\u308c\u305f\u3068\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\u300c\u89e3\u8aac\u300d\uff13\u6b73\u672a\u6e80\u3068\u3044\u3046\u6cbb\u7642\u304c\u3068\u3066\u3082\u56f0\u96e3\u306a\u5b50\u4f9b\u305f\u3061\u3092\u6cbb\u7642\u3057\u305f\u6210\u7e3e\u3067\u3059\u304b\u3089\u3001\u7d50\u8ad6\u3068\u3057\u3066\u3053\u306e\u5316\u5b66\u7642\u6cd5\u306e\u6210\u7e3e\u306f\u3068\u3066\u3082\u826f\u3044\u3082\u306e\u3067\u3059\u3002<br \/>\n\u3053\u306e\u5831\u544a\u306e\u7d50\u679c\u3067\u3082\uff0c\u624b\u8853\u5f8c\u306b\u6b8b\u5b58\u816b\u760d\u304c\u3042\u308c\u3070\u534a\u6570\u306e\u5b50\u4f9b\u304c\u6b7b\u4ea1\u3057\u3066\u3001\u64ad\u7a2e\u304c\u3042\u308c\u30703\u5206\u306e2\u304c\u6b7b\u4ea1\u3057\u307e\u3059\u3002\u3053\u3053\u3067\u969b\u7acb\u3064\u306e\u306f\u624b\u8853\u3067\u816b\u760d\u304c\u5b8c\u5168(complete)\u306b\u6458\u51fa\u3067\u304d\u305f\u5834\u5408\u306e\u7121\u5897\u60aa5\u5e74\u751f\u5b58\u5272\u5408\u304c80%\u306b\u3082\u306a\u308b\u3053\u3068\u3067\u3059\u3002\u3053\u308c\u306f3\u6b73\u4ee5\u4e0a\u306e\u9ac4\u82bd\u816b\u306e\u5b50\u4f9b\u305f\u3061\u3067\u3082\u306a\u304b\u306a\u304b\u5230\u9054\u3067\u304d\u308b\u6210\u7e3e\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u4ee5\u524d\u304b\u3089\u89e3\u3063\u3066\u3044\u305f\u4e8b\u306a\u306e\u3067\u3059\u304c\u3001\u3042\u3089\u305f\u3081\u3066\u624b\u8853\u306e\u7d50\u679c\u304c\u5316\u5b66\u7642\u6cd5\u306e\u6210\u7e3e\u306b\u3082\u6975\u3081\u3066\u5927\u304d\u306a\u5f71\u97ff\u3092\u53ca\u307c\u3059\u3068\u3044\u3048\u308b\u3067\u3057\u3087\u3046\u3002\u4e0a\u8863\u816b\u3067\u3082\u540c\u3058\u4e8b\u304c\u3044\u3048\u308b\u306e\u3067\u3059\u304c\u3001MRI\u3067\u898b\u3048\u308b\u816b\u760d\u306f\u306a\u3093\u3068\u304b\u304b\u3093\u3068\u304b\u5168\u3066\u6458\u51fa\u3057\u305f\u65b9\u304c\u3044\u3044\u3068\u5b9f\u611f\u3057\u307e\u3059\u3002<br \/>\n\u521d\u671f\u6cbb\u7642\u3067\u816b\u760d\u304c\u6d88\u3048\u306a\u304b\u3063\u305f\u3068\u304d\u306b\u306f\u3068\u3066\u3082\u9ad8\u3044\u6b7b\u4ea1\u7387\u306b\u306a\u308a\u307e\u3059\u304b\u3089\u3001\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u8ffd\u52a0\u3057\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002\u307e\u305f\u6d88\u3048\u3066\u3044\u3066\u3082\u518d\u767a\u3057\u3066\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3092\u8ffd\u52a0\u3057\u305f\u6642\u306e\u6b7b\u4ea1\u7387\u306f50%\u3092\u8d85\u3048\u308b\u3082\u306e\u3068\u601d\u308f\u308c\u307e\u3059\u3002\u305d\u308c\u306b\u8ad6\u6587\u306e\u6210\u7e3e\u306f\u3068\u3066\u3082\u3059\u3070\u3089\u3057\u3044\u306e\u3067\u3059\u304c\u3001\u540c\u3058\u8a08\u753b\u3067\u8ffd\u8a66\u304c\u884c\u308f\u308c\u306a\u3051\u308c\u3070\u672c\u5f53\u306e\u4fa1\u5024\u306f\u5224\u308a\u307e\u305b\u3093\u3057\u3001\u540c\u3058\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3067\u8ffd\u8a66\u3055\u308c\u305f\u5834\u5408\u3067\u3082\u6210\u7e3e\u304c\u60aa\u304f\u306a\u308b\u4e8b\u306f\u3088\u304f\u3042\u308b\u3053\u3068\u306a\u306e\u3067\u3059\u304b\u3089\u3001\u7709\u6bdb\u306b\u3064\u3070\u3092\u3064\u3051\u3066\u614e\u91cd\u306b\u8a55\u4fa1\u3057\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002\u3053\u306e\u8ad6\u6587\u3067\u3082\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u816b\u760d\u304c\u6d88\u3048\u305f\u5834\u5408\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u884c\u308f\u306a\u3044\u3068\u3044\u3046\u65b9\u91dd\u306f\uff13\u6b73\u4ee5\u4e0a\u306e\u5b50\u4f9b\u3067\u306f\u306a\u3055\u308c\u3066\u3044\u307e\u305b\u3093\u3057\uff0c\uff13\u6b73\u306b\u306a\u3063\u3066\u3082\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u3057\u306a\u3044\u3068\u3044\u3046\u8003\u3048\u65b9\u306f\u4e00\u822c\u7684\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<p>\u3053\u306e\u6cbb\u7642\u6cd5\u3067\u306f<span style=\"color: #000080;\"><strong>\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u306e\u6295\u4e0e\u3092\u3057\u3066\u3044\u307e\u3059\u304c\u3001\u539f\u5247\u3068\u3057\u3066\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u52a0\u3048\u306a\u3044\u3068\u3044\u3046\u4eee\u5b9a\u306e\u3082\u3068\u3067\u306e\u8a08\u753b\u3067\u3042\u308b\u4e8b<\/strong><\/span>\u306b\u7279\u306b\u6ce8\u610f\u3057\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002\u5168\u8133\u810a\u9ac4\u7167\u5c04\u3092\u3057\u306a\u3044\u300c\u8a08\u753b\u300d\u306a\u306e\u3067\u64ad\u7a2e\u3092\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3059\u308b\u305f\u3081\u306b\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u306e\u9ac4\u8154\u5185\u6295\u4e0e\u3092\u884c\u3063\u305f\u306e\u3067\u3057\u3087\u3046\u3002\u77e5\u80fd\u691c\u67fb\u306e\u7d50\u679c\u304c\u8133\u5ba4\u5185\u306e\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u6295\u4e0e\uff08\u653e\u5c04\u7dda\u6cbb\u7642\u306a\u3057\uff09\u3067\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u53d7\u3051\u305f\u5b50\u4f9b\u305f\u3061\u3088\u308a\u306f\u826f\u3044\u3068\u306e\u30c7\u30fc\u30bf\u3067\u3059\u3002\u3053\u308c\u3068\u540c\u3058\u5316\u5b66\u7642\u6cd5\u3092\u3057\u30663\u6b73\u3092\u8d85\u3048\u3066\u304b\u3089\u653e\u5c04\u7dda\u3092\u8ffd\u52a0\u3059\u308b\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u3092\u4f5c\u308c\u3070\u767d\u8cea\u8133\u75c7\u306f\u5fc5\u305a\u5897\u3048\u307e\u3059\u3002\u5b9f\u969b\u306b\u3053\u306e\u8ad6\u6587\u306e\u4e2d\u3067\u3082\uff0c23\u4eba\u4e2d15\u4eba\u306e\u5b50\u4f9b\u306b\u4e2d\u7b49\u5ea6\u304b\u3089\u9ad8\u5ea6\u306e\u767d\u8cea\u8133\u75c7\u304c\u753b\u50cf\u4e0a\u3067\u898b\u3089\u308c\u3066\uff0c\u518d\u6cbb\u7642\u6642\u306b\u8133\u810a\u9ac4\u7167\u5c04\u3092\u53d7\u3051\u305f\uff16\u4eba\u306e\u5b50\u4f9b\u306b\u30b0\u30ec\u30fc\u30c92\u30683\u306e\u767d\u8cea\u8133\u75c7\u304c\u767a\u751f\u3057\u305f\u3068\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\u3053\u306e\u8ad6\u6587\u306e\u6210\u7e3e\u3092\u307f\u308b\u9650\u308a\u7528\u3044\u3089\u308c\u305f\u5316\u5b66\u7642\u6cd5\u306e\u6210\u7e3e\u306f\u3068\u3066\u3082\u671f\u5f85\u3067\u304d\u308b\u3082\u306e\u3067\u3059\u3002\u624b\u8853\u306e\u5b8c\u5168\u6458\u51fa\u306e\u91cd\u8981\u6027\u304c\u969b\u7acb\u3061\u307e\u3059\u3002\u307e\u305f\u30013\u6b73\u672a\u6e80\u3067\u3059\u3067\u306b\u8ee2\u79fb(\u64ad\u7a2e)\u304c\u3042\u308b\u75c7\u4f8b\u3067\u306f\u6b7b\u4ea1\u7387\u306f\u6975\u3081\u3066\u9ad8\u3044\u306e\u3067\u3001\u3055\u3089\u306b\u5f37\u3044\u5316\u5b66\u7642\u6cd5\u3001\u81ea\u5bb6\u9020\u8840\u5e79\u7d30\u80de\u6551\u63f4\u3092\u4f75\u7528\u3059\u308b\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u304c\u8a66\u307f\u3089\u308c\u308b\u3079\u304d\u3067\u3042\u308b\u4e8b\u3092\u793a\u5506\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<p>\u632f\u308a\u8fd4\u3063\u3066\u601d\u3044\u51fa\u3055\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u8ad6\u6587\u306b\uff0cRiva D et al: Intrathecal methotrexate affects cognitive function in children with medulloblastoma. Neurology 59: 2002 \u304c\u3042\u308a\u307e\u3059\u3002\u3053\u306e\u8ad6\u6587\u3067\u306f \u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u306e\u9ac4\u8154\u5185\u6295\u4e0e\u3092\u53d7\u3051\u305f\u9ac4\u82bd\u816b\u306e\u5b50\u4f9b\u306e\u8a8d\u77e5\u969c\u5bb3\uff08\u77e5\u80fd\u306e\u767a\u9054\u9045\u5ef6\uff09\u304c\u4ed6\u306e\u5316\u5b66\u7642\u6cd5\u3092\u53d7\u3051\u305f\u5b50\u4f9b\u305f\u3061\u3088\u308a\u9ad8\u5ea6\u3067\u3042\u308a\uff0c\u767d\u8cea\u8133\u75c7\u3068\u8a8d\u77e5\u969c\u5bb3\u306b\u306f\u660e\u3089\u304b\u306b\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u306e\u6295\u4e0e\u3068\u95a2\u9023\u3057\u3066\u3044\u308b\u306e\u3067\u9ac4\u8154\u5185\u6295\u4e0e\u306f\u518d\u8003\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3068\u3057\u3066\u3044\u307e\u3059\u3002\u653e\u5c04\u7dda\u91cf\u3092\u4e0b\u3052\u3066\u3082\u30e1\u30c8\u30c8\u30ec\u30ad\u30b5\u30fc\u30c8\u3092\u4f7f\u7528\u3059\u308c\u3070\u5143\u3082\u5b50\u3082\u306a\u304f\u306a\u308b\u53ef\u80fd\u6027\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n<h4><strong><span class=\"style1\" style=\"color: #ff0000;\">\u64ad\u7a2e\u3057\u305f\u9ac4\u82bd\u816b\u3078\u306e\u7167\u5c04\u524d\u5316\u5b66\u7642\u6cd5<\/span><\/strong><\/h4>\n<p>Taylor RE, et al: Outcome for patients with metastatic (M2-3) medulloblastoma treated with SIOP\/UKCCSG PNET-3 chemotherapy. Eur J Cancer. 2005 Mar;41(5):727-34<br \/>\n\u64ad\u7a2e(M2-3)\u3057\u305f\u9ac4\u82bd\u816b68\u4f8b\u306e\u6cbb\u7642\u6210\u7e3e\u3067\u3059\u30021992\u5e74\u304b\u30892000\u5e74\u307e\u3067\uff0c\u5e74\u9f62\u4e2d\u592e\u50247.8\u6b73\u306e\u5b50\u4f9b\u305f\u3061\u306b\u30d3\u30f3\u30af\u30ea\u30b9\u30c1\u30f3\uff0c\u30a8\u30c8\u30dd\u30b7\u30c9\uff0c\u30ab\u30eb\u30dc\u30d7\u30e9\u30c1\u30f3\uff0c\u30b7\u30af\u30ed\u30d5\u30a9\u30b9\u30d5\u30a1\u30df\u30c9\u3092\u4f7f\u3063\u305f\u5316\u5b66\u7642\u6cd5\u3092\u884c\u3063\u3066\uff0c\u305d\u306e\u5f8c\u3067\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u3057\u305f\u6210\u7e3e\u306e\u767a\u8868\u3067\u3059\u3002\u5316\u5b66\u7642\u6cd5\u306e\u5f8c\u3067\uff0c35Gy\/21\u5206\u5272\u306e\u8133\u810a\u9ac4\u7167\u5c04\u306820Gy\/12\u5206\u5272\u306e\u5f8c\u982d\u7aa9\u7167\u5c04\uff0c\u8ee2\u79fb\u5de3\u3078\u306e\u8ffd\u52a0\u7167\u5c04\u304c\u7528\u3044\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u6cbb\u7642\u5f8c\u306e\u89b3\u5bdf\u671f\u9593\u4e2d\u592e\u5024\u306f7.2\u5e74\u3067\uff0c\u5168\uff15\u5e74\u751f\u5b58\u5272\u5408\u306f44%\uff08\u7121\u5897\u60aa\uff15\u5e74\u751f\u5b58\u5272\u5408\u306f35%\uff09\u3068\u306e\u7d50\u679c\u3067\u3059\u3002\u3053\u306e\u5316\u5b66\u7642\u6cd5\u306e\u594f\u529f\u5272\u5408\uff08\u816b\u760d\u304c\u7e2e\u5c0f\u3057\u305f\u3053\u3068\uff09\u306f73%\u7a0b\u306b\u3082\u306a\u308b\u306e\u3067\u3059\u304c\uff0c\u904e\u53bb\u306e\u5831\u544a\u3068\u6bd4\u8f03\u3057\u3066\u751f\u5b58\u7387\u3092\u6539\u5584\u3059\u308b\u3068\u3044\u3046\u660e\u3089\u304b\u306a\u5229\u70b9\u306f\u306a\u304b\u3063\u305f\u3068\u7d50\u8ad6\u3055\u308c\u307e\u3057\u305f\u3002<br \/>\n\u300c\u89e3\u8aac\u300d\u3053\u306e\u8ad6\u6587\u306e\u7d50\u8ad6\u306e\u3088\u3046\u306b\uff0c\u73fe\u5728\u3067\u306f\u7167\u5c04\u524d\u5316\u5b66\u7642\u6cd5\u306f\u5426\u5b9a\u3055\u308c\u308b\u65b9\u5411\u306b\u3042\u308a\u307e\u3059\u3002\u3067\u304d\u308c\u3070\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u524d\u306b\u3068\u3044\u3046\u65b9\u6cd5\u304c\u5f37\u3044\u3068\u8003\u3048\u307e\u3059\u3002<\/p>\n<h4><span style=\"color: #ff0000;\"><strong>\u306a\u305c\u8853\u5f8c\u6b8b\u5b58\u816b\u760d\u304c1.5 cm3<\/strong><\/span>\u4ee5\u4e0a\u3068\u4ee5\u4e0b\u3067\u6cbb\u7642\u65b9\u91dd\u304c\u5909\u308f\u308b\u306e\u304b<\/h4>\n<p>Zeltzer PM, et al.: Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children&#8217;s Cancer Group 921 randomized phase III study. J Clin Oncol 17: 832-845, 1999<br \/>\n&#8220;eight-drugs-in-one-day&#8221; (8-in-1) \u5316\u5b66\u7642\u6cd5\u3092\u653e\u5c04\u7dda\u6cbb\u7642(54 Gy\u00a0tumor\/36 Gy neuraxis)\u00a0\u306e\u524d\u5f8c\u306b\u884c\u306a\u3046\u3068\u3044\u3046\u8a66\u307f\u304c\u306a\u3055\u308c\uff0c\u7d50\u8ad6\u3068\u3057\u3066\u3053\u306e\u5316\u5b66\u7642\u6cd5\u306e\u6709\u52b9\u6027\u306f\u5426\u5b9a\u3055\u308c\u307e\u3057\u305f\u3002\u3053\u306e\u7814\u7a76\u306e\u4e2d\u3067\uff0c\uff13\u6b73\u4ee5\u4e0a\u3067M0\u306e\u751f\u5b58\u66f2\u7dda\u3092\u89e3\u6790\u3059\u308b\u3068\uff0c\u8853\u5f8c\u6b8b\u5b58\u816b\u760d\u304c1.5cm3\u4ee5\u4e0a\u3042\u3063\u305f\u7fa4\u3067\u306f\uff15\u5e74\u751f\u5b58\u5272\u5408\u304c54%\u3067\uff0c\u305d\u308c\u4ee5\u4e0b\u306e\u7fa4\u3067\u306f78%\u3067\u3042\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3057\u305f\u3002\u3053\u306e\u5f8c\uff0c1.5cm3 (ml, cc)\u3068\u3044\u3046\u5024\u304c\u4e00\u4eba\u6b69\u304d\u3092\u7d9a\u3051\u307e\u3057\u305f\u3002<\/p>\n<h4><strong>\u9ac4\u82bd\u816b\u306e\u75be\u60a3\u6982\u5ff5\uff08\u5c02\u9580\u5bb6\u5411\u3051\uff09<\/strong><\/h4>\n<ul>\n<li>\u9ac4\u82bd\u816b\u306f\u5c0f\u5150\u306e\u4e2d\u67a2\u795e\u7d4c\u306b\u767a\u751f\u3059\u308b\u80ce\u5150\u6027\u816b\u760d\u306e\u4e2d\u3067\u306f\u6700\u3082\u983b\u5ea6\u304c\u9ad8\u3044\u3082\u306e<\/li>\n<li>\u5c0f\u8133\u3068\u304f\u306b<span style=\"color: #000080;\"><strong>\u4e0b\u9ac4\u5e06\u306e\u5e79\u7d30\u80de<\/strong><\/span>\uff08\u5916\u9846\u7c92\u5c64\u7d30\u80de\u3084\u4e0a\u8863\u4e0b\u57fa\u8cea\u7d30\u80de\uff09\u3088\u308a\u767a\u751f\u3057\uff0c\u5f37\u3044\u6d78\u6f64\u30fb\u8ee2\u79fb\u6027\u683c\u3092\u6709\u3059\u308b\u816b\u760d<\/li>\n<li>\u65e5\u672c\u8133\u816b\u760d\u7d71\u8a08\u306b\u304a\u3051\u308b\u767a\u751f\u983b\u5ea6\u306f\uff0c\u5168\u539f\u767a\u6027\u8133\u816b\u760d\u306e1\uff05\u307b\u3069\uff0c\u5c0f\u5150\u306b\u9650\u3063\u3066\u307f\u308c\u3070\u5c0f\u5150\u8133\u816b\u760d\u306e12\uff05\u307b\u3069<\/li>\n<li>\u767a\u75c7\u5e74\u9f62\u306f14\u6b73\u4ee5\u4e0b\u304c90\uff05\u3068\u591a\u304f\uff0c\u6027\u5225\u3067\u306f\u7537\u5150\u306b\u591a\u3044<\/li>\n<li>\u767a\u751f\u90e8\u4f4d\u306f\uff0c\u5c0f\u5150\u4f8b\u306e7\u5272\u304c\u5c0f\u8133\u866b\u90e8\u306b\u767a\u751f\u3057\u3059\u308b\u304c\uff0c\u6210\u4eba\u306b\u306a\u308b\u306b\u3064\u308c\u5c0f\u8133\u534a\u7403\u306b\u767a\u751f\u3059\u308b\u3053\u3068\u304c\u591a\u304f\u306a\u308b<\/li>\n<li>\u539f\u767a\u5de3\u306e\u5c0f\u8133\u304b\u3089\u9ac4\u8154\u5185\u3078\u306e\u64ad\u7a2e\u8ee2\u79fb\u3092\u751f\u3058\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u304f\uff0c\u9ac4\u6db2\u64ad\u7a2e\u304c\u3042\u308b\u4f8b\u3068\u5c0f\u8133\u306b\u9650\u5c40\u3059\u308b\u4f8b\u3067\u306f\u6cbb\u7642\u6cd5\u306e\u9078\u629e\u3068\u751f\u547d\u4e88\u5f8c\u304c\u5927\u304d\u304f\u7570\u306a\u308b<\/li>\n<li>\u767a\u751f\u306e\u539f\u56e0\u306b\u95a2\u3057\u3066\u306f\uff0c\u30a6\u30a3\u30eb\u30b9\u306a\u3069\u306e\u767a\u751f\u8981\u56e0\u8aac\u304c\u3042\u308b\u304c\u5b9a\u8aac\u306f\u306a\u3044\uff0c\u6bcd\u89aa\u306e\u55ab\u7159\uff0c\u30c0\u30a4\u30a8\u30c3\u30c8\u306a\u3069\u816b\u760d\u767a\u751f\u306b\u95a2\u3059\u308b\u74b0\u5883\u56e0\u5b50\u306e\u5f71\u97ff\u306f\u306a\u3044\u3068\u3055\u308c\u3066\u3044\u308b<\/li>\n<li>\u6975\u3081\u3066\u307e\u308c\u306b\uff0c\u5148\u5929\u7684\u306a\u907a\u4f1d\u5b50\u7570\u5e38\uff0c\u653e\u5c04\u7dda\u88ab\u66dd\uff0c\u514d\u75ab\u4e0d\u5168\u306a\u3069\u304c\u767a\u75c7\u3068\u95a2\u9023\u6027\u304c\u3042\u308b<\/li>\n<li>\u907a\u4f1d\u6027\u306e\u75be\u60a3\u3067\u306f\uff0c<span style=\"color: #000080;\"><strong>Li-Fraumeni\u75c7\u5019\u7fa4\uff0cNevoid basal cell carcinoma\u75c7\u5019\u7fa4\uff08Gorlin&#8217;s\u75c7\u5019\u7fa4\uff09\uff0cTurcot&#8217;s\u75c7\u5019\u7fa4A\uff08\u30a6\u30a3\u30f3\u30b0\u30ec\u30b9\u9ac4\u82bd\u816b\uff09\uff0cRubenstein-Taybi\u75c7\u5019\u7fa4<\/strong><\/span>\u306a\u3069\u304c\u6319\u3052\u3089\u308c\u308b<\/li>\n<\/ul>\n<h4>\u9ac4\u82bd\u816b\u306e\u3044\u308d\u3044\u308d<\/h4>\n<h5><strong>medulloblastoma with extensive nodullarity<\/strong><\/h5>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/07\/medullo\/extnodular.png\"><img loading=\"lazy\" decoding=\"async\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/07\/medullo\/extnodular.png\" alt=\"\" width=\"231\" height=\"227\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/07\/medullo\/extnodular2.png\"><img loading=\"lazy\" decoding=\"async\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/07\/medullo\/extnodular2.png\" alt=\"\" width=\"198\" height=\"199\" \/><\/a><\/p>\n<p>\uff12\u6b73\u306e\u5b50\u3069\u3082\u306b\u3067\u304d\u305fmedulloblastoma with extensive nodullarity\u306eMRI CISS image\u77e2\u72b6\u65ad\u5c64\u3002\u591a\u6570\u306e\u7d50\u7bc0\u306b\u5206\u304b\u308c\u308b\u3053\u306e\u30bf\u30a4\u30d7\u306e\u9ac4\u82bd\u816b\u306f3\u6b73\u672a\u6e80\u306e\u5c0f\u5150\u306b\u767a\u751f\u3057\uff0c\u5316\u5b66\u7642\u6cd5\u306b\u3088\u304f\u53cd\u5fdc\u3057\u307e\u3059\uff08\u53f3\u306f\uff11\u30b3\u30fc\u30b9\u306eICE\u5316\u5b66\u7642\u6cd5\u5f8c\u306e\u9855\u8457\u306a\u7e2e\u5c0f\u3092\u793a\u3057\u307e\u3059\uff09\u3002\u5f93\u3063\u3066\uff0cclassical medulloblastoma\u3088\u308a\u3082\u4e88\u5f8c\u304c\u826f\u3044\u3068\u3044\u3048\u307e\u3059\u3002\u30ea\u30b9\u30af\u3092\u4fb5\u3057\u3066\u5168\u6458\u51fa\u3059\u308b\u5fc5\u8981\u306f\u306a\u304f\uff0c\u307e\u305f\u5e7c\u5150\u767a\u751f\u3067\u3042\u308b\u3053\u3068\u3082\u8003\u616e\u3059\u308c\u3070\u653e\u5c04\u7dda\u6cbb\u7642\u306e intensity\u3082\u9ad8\u304f\u8a2d\u5b9a\u3059\u308b\u5fc5\u8981\u306f\u306a\u3044\u306e\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u3002\u540c\u3058\uff13\u6b73\u672a\u6e80\u306ehigh-risk group\u306e\u9ac4\u82bd\u816b\u3068\u3044\u3048\u3069\u3082\uff0c\uff12\u6b73\u5150\u306eanaplastic medulloblastoma\u3068\u306f\u6cbb\u7642\u53cd\u5fdc\u6027\u306b\u5929\u5730\u306e\u958b\u304d\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n<h5><strong>desmoplastic\/nodular medulloblastoma<\/strong><\/h5>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullookgfap.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-5386\" title=\"medullookgfap\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullookgfap-300x290.jpg\" alt=\"\" width=\"300\" height=\"290\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullookgfap-300x290.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullookgfap.jpg 423w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullooksyph.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-5387\" title=\"medullooksyph\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullooksyph-300x295.jpg\" alt=\"\" width=\"300\" height=\"295\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullooksyph-300x295.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medullooksyph.jpg 417w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>\u3053\u306e\u30bf\u30a4\u30d7\u3082\u6cbb\u308a\u3084\u3059\u3044\u9ac4\u82bd\u816b\u306b\u5206\u985e\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u5de6\u304cGFAP\uff0c\u53f3\u304csynaptophysin\u3067\u3059\u3002\u30b0\u30ea\u30a2\u7cfb\u3078\u306e\u5206\u5316\u3092\u793a\u3059GFAP\u306b\u67d3\u307e\u308b\u90e8\u5206\u3067\u7d30\u80de\u306e\u5897\u6b96\u529b\u304c\u9ad8\u304fMIB-1\u306e\u67d3\u8272\u7387\u3082\u9ad8\u3044\u3067\u3059\u3002\u5cf6\u72b6\uff08\u7d50\u7bc0\u72b6\uff09\u306b\u306a\u3063\u3066\u3044\u3066synaptophysin\u3067\u67d3\u307e\u308b\u795e\u7d4c\u7d30\u80de\u3078\u306e\u5206\u5316\u3092\u793a\u3059\u90e8\u5206\u3067\u306f\uff0c\u7d30\u80de\u5897\u6b96\u5272\u5408\u306f\u4f4e\u3044\u3067\u3059\u3002\u9ac4\u82bd\u816b\u3067\u306f\u795e\u7d4c\u7d30\u80de\u3078\u306e\u5206\u5316\u304c\u89b3\u5bdf\u3055\u308c\u308b\u5206\u5316\u578b\u306e\u3082\u306e\u3067\u6cbb\u7642\u53cd\u5fdc\u6027\u304c\u826f\u3044\u3068\u8003\u3048\u3089\u308c\u307e\u3059\u3002<\/p>\n<h5><strong>medulloblastoma with melanotic differentiation<\/strong><\/h5>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-7439\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic-200x200.png\" alt=\"melanotic\" width=\"200\" height=\"200\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic1.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-7440\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic1-300x225.png\" alt=\"melanotic1\" width=\"300\" height=\"225\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic1-300x225.png 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic1-550x412.png 550w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/melanotic1.png 709w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>\u816b\u760d\u7d30\u80de\u306e\u7d30\u80de\u4f53\u306b\u306f\u30e1\u30e9\u30cb\u30f3\u9846\u7c92\u304c\u5145\u6e80\u3057\u3066\u3044\u308b\u3002\u3053\u306e\u30bf\u30a4\u30d7\u306e\u9ac4\u82bd\u816b\u306f\u6cbb\u7642\u62b5\u6297\u6027\u3067\u3042\u308a\u624b\u8853\u5168\u6458\u3067\u304d\u306a\u3051\u308c\u3070\u4e88\u5f8c\u306f\u4e0d\u826f\u3067\u3059\u3002\u8853\u4e2d\u75c5\u7406\u8a3a\u65ad\u3067\u3053\u308c\u304c\u5224\u660e\u3059\u308c\u3070radical resection\u3078\u5411\u3046\u307b\u3046\u304c\u3088\u3044\u306e\u3067\u3057\u3087\u3046\u3002\u306a\u304a\uff0c\u3053\u306e\u4f8b\u3067\u306f\u624b\u8853\u9855\u5fae\u93e1\u4e0b\u306e\u8089\u773c\u89b3\u5bdf\u3067\u3082\u816b\u760d\u8868\u9762\u306b\u30e1\u30e9\u30cb\u30f3\u6c88\u7740\u304c\u660e\u3089\u304b\u3067\u3057\u305f\u3002\u8133\u7d44\u7e54\u3078\u306e\u816b\u760d\u6d78\u6f64\u304c\u9855\u8457\u3067\u3042\u308a\u8133\u5e79\u90e8\u75c7\u72b6\u3092\u51fa\u3055\u306a\u3051\u308c\u3070\u816b\u760d\u5168\u6458\u51fa\u304c\u3067\u304d\u306a\u3044\u3082\u306e\u3067\u3057\u305f\u3002\u5916\u8ee2\u795e\u7d4c\u3068\u9854\u9762\u795e\u7d4c\u6838\u3092\u640d\u50b7\u3059\u308b\u3053\u3068\u304c\u89e3\u3063\u3066\u3044\u306a\u304c\u3089\uff0c\u3054\u4e21\u89aa\u3068\u76f8\u8ac7\u3057\u3066\u5168\u6458\u51fa\u306b\u8e0f\u307f\u5207\u308a\u307e\u3057\u305f\u3002<\/p>\n<h5><strong>anaplastic medulloblastoma LC\/A MB \u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b<\/strong><\/h5>\n<p>\u5149\u9855\u75c5\u7406\u306e\u30ec\u30d9\u30eb\u3067\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\uff08\u5927\u7d30\u80de\u6027\uff09\u9ac4\u82bd\u816b (anaplastic \/ large cell medulloblastoma) \u306f\u53e4\u304f\u304b\u3089\u60aa\u6027\u5ea6\u304c\u9ad8\u3044\u3082\u306e\u3068\u3057\u3066\u77e5\u3089\u308c\u3066\u304d\u307e\u3057\u305f\u3002\u3053\u306e\u7fa4\u3067\u306fErbB2\u86cb\u767d\u3092\u767a\u73fe\u3057\uff0cErbB2\u907a\u4f1d\u5b50\u304c\u9ad8\u767a\u73fe\u3059\u308b\u9ac4\u82bd\u816b\u306f\u8ee2\u79fb\u3057\u3084\u3059\u304f\u6838\u5206\u88c2\u50cf\u304c\u5897\u52a0\u3059\u308b\u3068\u3044\u5831\u544a\u304c\u3042\u308a\u307e\u3059\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\u3053\u3068\u3067\u3059\u3002\u3053\u306e\u4e8b\u5b9f\u304c\u691c\u8a3c\u3055\u308c\u308c\u3070\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\u3057\u3087\u3046\u3002<\/p>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulneurob.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-7441\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulneurob.png\" alt=\"medulneurob\" width=\"227\" height=\"177\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulanapl.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-7442\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/medulanapl.png\" alt=\"medulanapl\" width=\"227\" height=\"177\" \/><\/a><\/p>\n<p>\u5de6\u306f\uff11\u6b73\u5150\u306b\u767a\u751f\u3057\u305f\u4e00\u90e8\u306b\u795e\u7d4c\u82bd\u7d30\u80de\u816b\u69d8\u306e\u5206\u5316 row of the tumor cells (or neuronal differentiation) \u3092\u4f34\u3046\u9ac4\u82bd\u816b medulloblastoma with extensive nodularity\uff08\u5c0f\u8133\u795e\u7d4c\u82bd\u7d30\u80de\u816b cerebellar neuroblastoma\u3068\u3082\u3044\u308f\u308c\u305f\u3082\u306e\uff09\u3002\u53f3\u306f7\u6b73\u5150\u306e\u9000\u5f62\u6210\uff08\u6838\u306e\u7570\u5f62\u6210\uff09\u304c\u9855\u8457\u306a\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b anaplastic medulloblastoma\u3067\u3059\u3002\u524d\u8005\u306e\u6cbb\u7652\u7387\u306f\u9ad8\u304f\uff0c\u5f8c\u8005\u306e\u75c5\u7406\u50cf\u306e\u6cbb\u7652\u7387\u306f\u6975\u3081\u3066\u4f4e\u3044\u3082\u306e\u3067\u3059\u3002<\/p>\n<p><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/Gajjar2006.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-4416\" title=\"Gajjar2006\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/Gajjar2006-550x366.jpg\" alt=\"\" width=\"550\" height=\"366\" srcset=\"https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/Gajjar2006-550x366.jpg 550w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/Gajjar2006-300x200.jpg 300w, https:\/\/plaza.umin.ac.jp\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/Gajjar2006.jpg 720w\" sizes=\"auto, (max-width: 550px) 100vw, 550px\" \/><\/a><\/p>\n<h5>\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b<\/h5>\n<p>\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u304a\u3044\u3066\u306fanaplasty\u304c\u751f\u5b58\u7387\u306b\u5927\u304d\u306a\u5f71\u97ff\u3092\u4e0e\u3048\u306a\u3044\u3068\u3044\u3046\u5831\u544a\u3082\u3042\u308a\u307e\u3057\u305f\u304c\u305d\u308c\u306f\u8aa4\u308a\u3067\u3057\u305f\u3002\u3053\u306e\u75c5\u7406\u50cf\u3092\u6709\u3059\u308b\u9ac4\u82bd\u816b\u306e\u4e88\u5f8c\u306f\u60aa\u3044\u3067\u3059\u3002<br \/>\n<a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo31.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-3060\" title=\"anplamedullo3\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo31-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo41.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-3061\" title=\"anplamedullo4\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo41-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><\/p>\n<p>7\u6b73\u5150\u306e\u5c0f\u8133\u534a\u7403\u306b\u3042\u308b\u6a19\u6e96\u30ea\u30b9\u30af\u306e\u9ac4\u82bd\u816b\u3067\u3059\u3002\u753b\u50cf\u3092\u4e00\u898b\u3059\u308c\u3070\u3053\u306e\u9ac4\u82bd\u816b\u306f\u6cbb\u308b\u3067\u3042\u308d\u3046\u3068\u4e88\u6e2c\u3057\u307e\u3059\u3002<a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo4.jpg\"><br \/>\n<\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-3062\" title=\"anplamedullo2\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo2-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-3063\" title=\"anplamedullo1\" src=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo1-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/><\/a><a href=\"\/sawamura\/wp\/wp-content\/uploads\/2012\/04\/anplamedullo4.jpg\"><br \/>\n<\/a><\/p>\n<p>\u624b\u8853\u3067\u5b8c\u5168\u6458\u51fa\u3057\uff0c\u9000\u5f62\u6210\u6027\u9ac4\u82bd\u816b\u306e\u75c5\u7406\u8a3a\u65ad\u3067\uff0c\u8133\u810a\u9ac4\u7167\u5c04\u3068\u5c40\u6240\u7167\u5c0454\u30b0\u30ec\u30a4\uff0c\u30b7\u30b9\u30d7\u30e9\u30c1\u30f3\u30d9\u30fc\u30b9\u306e\u5316\u5b66\u7642\u6cd5\u30926\u30b3\u30fc\u30b9\u52a0\u3048\u307e\u3057\u305f\u304c\uff0c\u534a\u5e74\u5f8c\u306b\u6fc0\u3057\u3044\u64ad\u7a2e\u518d\u767a\u3092\u751f\u3058\u307e\u3057\u305f\u3002<\/p>\n<h4>\u75c7\u5019\u3068\u8a3a\u65ad<\/h4>\n<p>\u5c0f\u8133\u306b\u767a\u751f\u3057\u8133\u5e79\u3092\u5727\u8feb\u3059\u308b\u305f\u3081\uff0c\u5c40\u6240\u795e\u7d4c\u75c7\u5019\u3068\u3057\u3066\u306f\u4f53\u5e79\u5931\u8abf\u3068\u3057\u3066\u306e\u6b69\u884c\u6642\u306e\u3075\u3089\u3064\u304d\u3084\u773c\u7403\u904b\u52d5\u969c\u5bb3\u304c\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002\u307e\u305f\uff0c\u7b2c\uff14\u8133\u5ba4\u3092\u9589\u585e\u3057\u3066\u6c34\u982d\u75c7\u3092\u751f\u305a\u308b\u305f\u3081\uff0c\u982d\u75db\u3084\u5614\u5410\u306a\u3069\u306e\u982d\u84cb\u5185\u5727\u4ea2\u9032\u75c7\u72b6\u306b\u3066\u767a\u75c7\u3057\u307e\u3059\u3002<\/p>\n<p>\u5358\u7d14CT\u3067\u306f\uff0c\u816b\u760d\u306f\u6bd4\u8f03\u7684\u5883\u754c\u660e\u77ad\u3067\u77f3\u7070\u5316\u3082\u9ad8\u983b\u5ea6\u306b\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002\u5145\u5b9f\u6027\u816b\u760d\u3067\u3042\u308b\u3053\u3068\u304c\u591a\u3044\u306e\u3067\u3059\u304c\uff0c\u306e\u3046\u80de\u3042\u308b\u3044\u306f\u58ca\u6b7b\u5f62\u6210\u3082\u898b\u3089\u308c\u307e\u3059\u3002\u7d30\u80de\u5bc6\u5ea6\u304c\u9ad8\u3044\u816b\u760d\u3067\u3042\u308b\u306e\u3067CT\u7b49\u5438\u53ce\u57df\u3082\u3057\u304f\u306f\u9ad8\u5438\u53ce\u57df\u3068\u3057\u3066\u63cf\u51fa\u3055\u308c\uff0c\u9020\u5f71\u5264\u3067\u306f\u5747\u4e00\u306b\u5f37\u304f\u5897\u5f37\u3055\u308c\u307e\u3059\u3002MRI\u3067\u306f\uff0cT1\u5f37\u8abf\u753b\u50cf\u3067\u4f4e\u4fe1\u53f7\u57df\u3068\u3057\u3066\u63cf\u51fa\u3055\u308c\uff0cT2\u5f37\u8abf\u753b\u50cf\u3067\u7b49\u4fe1\u53f7\u304b\u3089\u9ad8\u4fe1\u53f7\u3092\u5448\u3059\u3057\u307e\u3059\u3002\u30ac\u30c9\u30ea\u30cb\u30a6\u30e0\u5897\u5f37\u52b9\u679c\u306f\u75c7\u4f8b\u306b\u3088\u308a\u69d8\u3005\u3067\u3042\u308a\uff0c\u5f37\u3044\u5747\u4e00\u306a\u5897\u5f37\u52b9\u679c\u3092\u793a\u3059\u4f8b\u304b\u3089\uff0c\u307b\u3068\u3093\u3069\u5897\u5f37\u3055\u308c\u306a\u3044\u75c7\u4f8b\u307e\u3067\u3042\u308a\u307e\u3059\u3002\u9ac4\u6db2\u64ad\u7a2e\u306e\u983b\u5ea6\u304c\u9ad8\u3044\u306e\u3067\uff0c\u5168\u8133\u810a\u9ac4\u306b\u308f\u305f\u308bMRI\u691c\u67fb\u304c\u5fc5\u9808\u3067\u3059\u3002\u307e\u305f\uff0cMRI\u3067\u9ac4\u8154\u8ee2\u79fb\u304c\u8a8d\u3081\u3089\u308c\u306a\u304f\u3068\u3082\u9ac4\u6db2\u7d30\u80de\u8a3a\u3067\u967d\u6027\u3068\u306a\u308b\u3053\u3068\u304c\u3042\u308b\u306e\u3067\uff0c\u3082\u3057\u3067\u304d\u308c\u3070\u8170\u690e\u7a7f\u523a\u3042\u308b\u3044\u306f\u8133\u5ba4\u5185\u9ac4\u6db2\u306b\u3088\u3063\u3066\u7d30\u80de\u8a3a\u3092\u884c\u3044\u307e\u3059\u3002<\/p>\n<h4><span style=\"color: #000000;\">\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u6b74\u53f2<\/span><\/h4>\n<p>\u73fe\u5728\u306b\u304a\u3044\u3066\u3082\uff0c\u9ac4\u82bd\u816b\u3092\u6cbb\u7652\u306b\u5c0e\u304f\u78ba\u5b9f\u6027\u304c\u6700\u3082\u9ad8\u3044\u6cbb\u7642\u6cd5\u306f\u8133\u810a\u9ac4\u7167\u5c04\u3067\u3059\u3002\u304b\u3064\u3066\u306f\uff0c\u5316\u5b66\u7642\u6cd5\u3092\u4f75\u7528\u305b\u305a\u8133\u810a\u9ac4\u7167\u5c0436Gy\u3068\u5f8c\u982d\u84cb\u7aa9\u7167\u5c0454Gy\u306e\u307f\u304c\u6a19\u6e96\u6cbb\u7642\u7dda\u91cf\u3068\u3055\u308c\uff0c\u3053\u306e\u653e\u5c04\u7dda\u5358\u72ec\u6cbb\u7642\u3067\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306e\uff15\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f60-70\uff05\u304f\u3089\u3044\u3067\u3057\u305f\u3002<\/p>\n<p>1980\u5e74\u4ee3\u306bCOG\u3068CCG\u3067\u884c\u308f\u308c\u305f\u8133\u810a\u9ac4\u7167\u5c04\u306e\u7121\u4f5c\u70ba\u6bd4\u8f03\u8a66\u9a13\u306e\u6700\u7d42\u7d50\u679c\u304c\uff0c2000\u5e74\u306bJ Clin Oncol\u306b\u767a\u8868\u3055\u308c\u307e\u3057\u305f (Thomas et al. 2000)\u3002\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4126\u4eba\u309236Gy\u306823.4Gy\u306e\u8133\u810a\u9ac4\u7167\u5c04\u304crondamize\u3057\u305f\u7d50\u679c\u300123.4Gy\u306e\u4f4e\u7dda\u91cf\u8133\u810a\u9ac4\u7167\u5c04\u3067\u306f\u65e9\u671f\u518d\u767a\u3068\u64ad\u7a2e\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u304f\u3001\u304b\u30645\u5e74\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408 (52%) \u3068\u5168\u751f\u5b58\u5272\u5408\u3082\u4f4e\u304b\u3063\u305f\u306e\u3067\u3059\u3002 \u653e\u5c04\u7dda\u6cbb\u7642\u5358\u72ec23.4Gy\u3067\u306f\u534a\u6570\u306e\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u968f\u82bd\u816b\u3067\u3055\u3048\u5236\u5fa1\u3067\u304d\u306a\u3044\u3053\u3068\u304c\u89e3\u308a\u3001\u3053\u308c\u4ee5\u964d\u306f\u5316\u5b66\u7642\u6cd5\u306e\u4f75\u7528\u304c\u5fc5\u9808\u3067\u3042\u308b\u3068\u3044\u3046\u65b9\u5411\u3078\u3068\u5411\u304b\u3044\u307e\u3057\u305f\u3002<\/p>\n<p>2009\u5e74\u6642\u70b9\u3067\u6a19\u6e96\u30ea\u30b9\u30af\u7fa4\u306b\u5bfe\u3057\u3066\u57fa\u672c\u306b\u306a\u308b\u306e\u306f\uff0c\u5316\u5b66\u7642\u6cd5\u3092\u4f75\u7528\u3057\u305f23.4\u30b0\u30ec\u30a4\u306e\u8133\u810a\u9ac4\u7167\u5c04\u3068\u7dcf\u7dda\u91cf55.8Gy\u306e\u5f8c\u982d\u7aa9\u7167\u5c04\u3067\u3059\u3002\uff13\u6b73\u4ee5\u4e0a\u306e\u60a3\u5150\u306b\u5bfe\u3057\u3066\u306e\u7167\u5c04\u306f\uff11\u65e5\u7dda\u91cf1.8Gy\uff0c\u9031\uff15\u56de\u7167\u5c04\u304c\u6a19\u6e96\u7684\u3067\u3059\u3002\u4e00\u65b9\u3001\u9ad8\u30ea\u30b9\u30af\u7fa4\u306b\u306f\u306a\u304a\u8133\u810a\u9ac4\u7167\u5c0435-36Gy\u304c\u7528\u3044\u3089\u308c\u307e\u3057\u305f\u304c\u3001\u3053\u306e\u7dda\u91cf\u306f\u5c0f\u5150\u306e\u8a8d\u77e5\u6a5f\u80fd\u306e\u767a\u9054\u306b\u304b\u306a\u308a\u306e\u9045\u6ede\u3092\u751f\u3058\u307e\u3057\u305f\u3002<\/p>\n<p>\u8133\u810a\u9ac4\u7167\u5c04\u3067\u306f\u3001\u8133\u7167\u5c04\u3068\u810a\u9ac4\u7167\u5c04\u3092\u540c\u65e5\u306b\u884c\u3046\u3053\u3068\u3001\u3064\u306a\u304e\u76ee\u306e\u90e8\u4f4d\u3078\u306e\u7dda\u91cf\u306e\u8abf\u7bc0\uff0c\u524d\u982d\u84cb\u5e95\u306e\u7be9\u677f\u5468\u56f2\u3078\u306e\u7167\u5c04\uff0c\u810a\u690e\u690e\u9593\u5b54\u3084\u5f8c\u982d\u7aa9\u5c40\u6240\u7167\u5c04\u3067\u306e\u9818\u57df\u8a2d\u5b9a\u306a\u3069\uff0c\u6cbb\u7642\u8a08\u753b\u306b\u7d30\u5fc3\u306e\u6ce8\u610f\u3068\uff13\u6b21\u5143\u6cbb\u7642\u8a08\u753b\u6280\u8853\u304c\u767a\u9054\u3057\u3066\u3082\u3044\u307e\u3059\u3002<\/p>\n<p>\u66f4\u306b\u7167\u5c04\u88c5\u7f6e\u306e\u767a\u9054\uff0c\u6cbb\u7642\u8a08\u753b\u306e\u9ad8\u5ea6\u5316\uff0c\u5f8c\u982d\u7aa9\u7167\u5c04\u306e\u5ec3\u6b62\u306a\u3069\u5e38\u306b\u5909\u5316\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4>\u653e\u5c04\u7dda\u6cbb\u7642\u306e\u306b\u3088\u308b\u9045\u767a\u6027\u8a8d\u77e5\u6a5f\u80fd\u969c\u5bb3<\/h4>\n<p>1990\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\u307e\u3057\u305f\u30022001\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\u3053\u3068\u3067\u3059\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\u3053\u3068\u3067\u3057\u305f\u3002\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\u307e\u3057\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\u3066\u3044\u307e\u3059\u3002\u9006\u306b\uff0c\u3053\u308c\u3089\u306e\u77e5\u898b\u304c\u9ac4\u82bd\u816b\u306e\u5316\u5b66\u7642\u6cd5\u306b\u5bfe\u3059\u308b\u3084\u3084\u904e\u5ea6\u306e\u671f\u5f85\u3092\u9ad8\u3081\u305f\u3068\u3082\u3044\u3048\u307e\u3059\u3002<\/p>\n<h4><strong><span style=\"color: #ff0000;\">\u9ac4\u6ce8MTX\u5316\u5b66\u7642\u6cd5<\/span><\/strong><\/h4>\n<p>\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\u64ad\u7a2e\u306e\u4e88\u9632\u3068\u8133\u810a\u9ac4\u7167\u5c04\u306e\u8ca0\u62c5\u3092\u8efd\u6e1b\u3059\u308b\u3068\u3044\u3046\u7406\u8ad6\u7684\u6839\u62e0\u3067\uff0c\u9ac4\u8154\u5185\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u6ce8\u5165\u306b\u3088\u308b\u5316\u5b66\u7642\u6cd5\u304c\u4f7f\u7528\u3055\u308c\u308b\u3053\u3068\u304c\u3042\u308a\u307e\u3059\u3002\u3057\u304b\u3057\uff0c\u73fe\u6642\u70b9\u3067\u64ad\u7a2e\u3092\u6291\u5236\u3067\u304d\u308b\u3068\u3044\u3046\u79d1\u5b66\u7684\u6839\u62e0\u306f\u3042\u308a\u307e\u305b\u3093\u3057\uff0c\u5c06\u6765\u306b\u308f\u305f\u3063\u3066\u3082\u76f8\u5f53\u306e\u6839\u62e0\u304c\u306a\u3044\u9650\u308a\uff0c\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u3088\u3046\u306a\u795e\u7d4c\u6bd2\u6027\u306e\u3042\u308b\u85ac\u5264\u306f\u7528\u3044\u308b\u3079\u304d\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u6cbb\u7642\u5f8c\u306e\u8a8d\u77e5\u6a5f\u80fd\u4f4e\u4e0b\u304c\u3055\u3089\u306b\u60aa\u5316\u3059\u308b\u304b\u3089\u3067\u3059\u3002\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\u304c\u691c\u8a0e\u3055\u308c\u307e\u3057\u305f\u304c\u63a8\u5968\u3059\u308b\u30ec\u30d9\u30eb\u306e\u7d50\u679c\u306f\u51fa\u307e\u305b\u3093\u3067\u3057\u305f \u3002<\/p>\n<h4><span style=\"color: #000080;\"><strong>\u521d\u767a\u6642\u306b\u9ac4\u6db2\u64ad\u7a2e\u3092\u4f34\u3046\u75c7\u4f8b\u306b\u624b\u8853\u3092\u884c\u306a\u308f\u306a\u3044<\/strong><\/span><\/h4>\n<p>M2, M3\u306e\u4f8b\u3067\u3042\u3063\u3066\u3082\u958b\u982d\u624b\u8853\u306b\u3088\u308b\u539f\u767a\u5de3\u306e\u7a4d\u6975\u7684\u6458\u51fa\u304c\u884c\u306a\u308f\u308c\u308b\u3053\u3068\u304c\u591a\u3044\u3057\u6a19\u6e96\u6cbb\u7642\u6cd5\u3068\u8a00\u3048\u307e\u3059\u3002\u75c5\u7406\u78ba\u5b9a\u8a3a\u65ad\u3082\u5f97\u3089\u308c\u308b\u304b\u3089\u3067\u3059\u3002\u3057\u304b\u3057\uff0c\u660e\u3089\u304b\u306a\u9ac4\u6db2\u64ad\u7a2e\u304c\u3042\u308b\u75c7\u4f8b\u3067\u306f\uff0c\u3044\u305a\u308c\u306b\u3057\u3066\u3082\u9ad8\u60aa\u6027\u5ea6\u816b\u760d\u3067\u3042\u308b\u3053\u3068\u306b\u7591\u3044\u306f\u306a\u304f\uff0c\u3044\u308f\u3086\u308b\u5168\u6458\u51fa\u306f\u4e0d\u53ef\u80fd\u3067\u3042\u308a\uff0c\u307e\u305f\u64ad\u7a2e\u3092\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3067\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3067\u304d\u306a\u3051\u308c\u3070\u751f\u5b58\u306e\u671b\u307f\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<p>\u5f93\u3063\u3066\uff0c\u3042\u3048\u3066\u958b\u982d\u816b\u760d\u6458\u51fa\u8853\u3068\u3044\u3046\u30ea\u30b9\u30af\u3092\u53d6\u3089\u305a\uff0c\u307e\u305f\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u306e\u958b\u59cb\u3092\u9045\u3089\u305b\u306a\u3044\u305f\u3081\u306b\u3082\uff0c\u753b\u50cf\u8a3a\u65ad\u5f8c\u306b\u9ac4\u6db2\u7ba1\u7406\u306e\u9577\u671f\u7559\u7f6e\u578b\u306e\u4f53\u5916\u30c9\u30ec\u30ca\u30fc\u30b8\u306e\u307f\u3092\u8a2d\u7f6e\u3057\u3066\uff0c\u5316\u5b66\u7642\u6cd5\u3042\u308b\u3044\u306f\u8133\u810a\u9ac4\u7167\u5c04\u304b\u3089\u6cbb\u7642\u3092\u958b\u59cb\u3059\u308b (neoadjuvant therapy) \u3053\u3068\u3082\u6709\u529b\u306a\u624b\u6bb5\u3067\u3059\u3002<\/p>\n<p>\u753b\u50cf\u8a3a\u65ad\u3067\u9451\u5225\u3059\u308b\u3079\u304d\u3082\u306e\u306f\uff0c\u64ad\u7a2e\u6027\u683c\u3092\u6709\u3059\u308b\u4e0a\u8863\u816b\uff0c\u9000\u5f62\u6210\u6027\u4e0a\u8863\u816b\uff0cAT\/RT\uff0cPNET\uff0c\u6bdb\u69d8\u7d30\u80de\u6027\u661f\u7d30\u80de\u816b\u306a\u3069\u3067\u3059\u304c\uff0c\u5c0f\u8133\u306e\u6bdb\u69d8\u7d30\u80de\u6027\u661f\u7d30\u80de\u816b\u304c\u64ad\u7a2e\u3059\u308b\u3053\u3068\u306f\u5b9f\u969b\u306b\u306f\u307b\u3068\u3093\u3069\u3042\u308a\u307e\u305b\u3093\u3002\u4ed6\u306e\u3044\u305a\u308c\u306e\u816b\u760d\u306b\u304a\u3044\u3066\u3082\u64ad\u7a2e\u304c\u3042\u308c\u3070\u8133\u810a\u9ac4\u7167\u5c04\u306f\u907f\u3051\u5f97\u306a\u3044\u3082\u306e\u3067\u3042\u308a\uff0c\u307e\u305f\u5316\u5b66\u7642\u6cd5\u3082\u985e\u4f3c\u306e\u3082\u306e\u304c\u4f7f\u7528\u3055\u308c\u307e\u3059\u3002\u9ac4\u82bd\u816b\u4ee5\u5916\u306e\u3053\u308c\u3089\u306e\u5c0f\u8133\u539f\u767a\u60aa\u6027\u816b\u760d\u306f\u5316\u5b66\u7642\u6cd5\u62b5\u6297\u6027\u3067\u3042\u308b\u78ba\u7387\u306f\u9ad8\u3044\u306e\u3067\u3059\u304c\uff0c\uff11\u30b3\u30fc\u30b9\u306e\u4f4e\u7528\u91cf\u5316\u5b66\u7642\u6cd5\u3067\u611f\u53d7\u6027\u3092\u898b\u6975\u3081\u308b\u3053\u3068\u304b\u3089\u5165\u308b\u3053\u3068\u3082\u3067\u304d\u308b\u3067\u3057\u3087\u3046\u3057\uff0c\u5316\u5b66\u7642\u6cd5\u306b\u62b5\u6297\u6027\u3068\u5224\u65ad\u3055\u308c\u308c\u3070\u8133\u810a\u9ac4\u7167\u5c04\u306b\u79fb\u884c\u3067\u304d\u307e\u3059\u3002<\/p>\n<p>\u539f\u767a\u5de3\u304c\u5927\u304d\u304f\u521d\u671f\u306e\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u3067\u7e2e\u5c0f\u3057\u306a\u3051\u308c\u3070\uff0c\u305d\u306e\u6642\u70b9\u3067\u958b\u982d\u816b\u760d\u6458\u51fa\u8853\u3092\u8003\u616e\u3057\u3066\u3082\u9045\u304f\u306f\u3042\u308a\u307e\u305b\u3093\u3057\uff0c\u64ad\u7a2e\u3082\u3042\u308a\u539f\u767a\u5de3\u304c\u5de8\u5927\u3067\uff0c\u306a\u304a\u304b\u3064\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u306b\u53cd\u5fdc\u3057\u306a\u3044\u3068\u3044\u3046\uff0c\u305d\u306e\u69d8\u306a\u75c5\u614b\u3067\u306f\u624b\u8853\u9069\u5fdc\u3082\u306a\u304f\uff0c\u7de9\u548c\u30b1\u30a2\u3092\u3057\u305f\u307b\u3046\u304c\u3044\u3044\u3068\u3044\u3046\u9078\u629e\u80a2\u3082\u3042\u308a\u5f97\u308b\u3082\u306e\u3067\u3057\u3087\u3046\u3002<\/p>\n<h3>\u65e5\u672c\u3067\u306e\u65b9\u5411\u6027<\/h3>\n<p>\u4e0a\u8a18\u306e\u8a18\u8ff0\u306f\u5168\u3066\u6b27\u7c73\u304b\u3089\u306e\u81e8\u5e8a\u8a66\u9a13\u5831\u544a\u3067\u3042\u308a\u65e5\u672c\u56fd\u5185\u306b\u306f\u5927\u898f\u6a21\u306a\u8a66\u9a13\u306e\u5831\u544a\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u5c0f\u898f\u6a21\u306a\u5171\u540c\u7814\u7a76\u306f\u6563\u898b\u3055\u308c\u307e\u3059\u304c\uff0c\u3044\u305a\u308c\u306e\u30b0\u30eb\u30fc\u30d7\u3082\u4fe1\u983c\u3059\u308b\u306b\u5024\u3059\u308b\u30c7\u30fc\u30bf\u3068\u3057\u3066\u306e\u7121\u5897\u60aa\uff15\u5e74\u751f\u5b58\u5272\u5408\u3092\u8ad6\u6587\u767a\u8868\u3057\u3066\u3044\u307e\u305b\u3093\u3002\u65e5\u672c\u306e\u5b66\u4f1a\u3067\uff0c\u512a\u308c\u3066\u3044\u308b\u3068\u6210\u679c\u304c\u5f37\u8abf\u3055\u308c\u308b\u306e\u306f\u521d\u671f\u6210\u7e3e feasibility study \u3070\u304b\u308a\u3067\u3042\u308b\u3053\u3068\u3092\u8a8d\u8b58\u3059\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002\u3042\u308b\u30b0\u30eb\u30fc\u30d7\u306b\u3088\u308b\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u4e0a\u3067\u306e\u9ac4\u82bd\u816b\u6cbb\u7642\u306e\u55a7\u4f1d\u3082\u6065\u305a\u304b\u3057\u3044\u3053\u3068\u3067\u3059\u3002\u65e5\u672c\u3067\u306e\u5171\u540c\u7814\u7a76\u3092\u53ef\u80fd\u3068\u3059\u308b\u305f\u3081\u306b\u306f\uff0c\u307e\u305a\u5168\u75c7\u4f8b\u767b\u9332\u5236\u3092\u5b9f\u73fe\u3057\u306a\u3051\u308c\u3070\uff0c\u4eca\u5f8c\u3082\u5148\u304c\u898b\u3048\u306a\u3044\u72b6\u614b\u304c\u7d99\u7d9a\u3059\u308b\u306e\u3067\u3057\u3087\u3046<\/p>\n<p>\u9ac4\u82bd\u816b\u306b\u304a\u3044\u3066\u306f\uff0c\u526f\u4f5c\u7528\u304c\u3044\u304b\u306b\u9ad8\u5ea6\u3067\u3042\u308d\u3046\u3068\u3082\u60a3\u5150\u3092\u6cbb\u7652\u306b\u5c0e\u304f\u6700\u3082\u6709\u52b9\u306a\u624b\u6bb5\u306f\u3044\u307e\u3060\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u3042\u308b\u3053\u3068\u306f\u78ba\u56fa\u305f\u308b\u4e8b\u5b9f\u3067\u3059\u3002\u5316\u5b66\u7642\u6cd5\u306e\u85ac\u5264\u3092\u9078\u629e\u3057\u5927\u91cf\u6295\u4e0e\u3057\u3066\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u7701\u7565\u3057\u3088\u3046\u3068\u3059\u308b\u904e\u53bb\u306e\u5e7e\u5ea6\u304b\u306e\u8a66\u307f\u306f\u5931\u6557\u306b\u7d42\u308f\u3063\u305f\u3053\u3068\u3092\u8a18\u61b6\u3057\u3066\u304a\u304b\u306a\u3051\u308c\u3070\u306a\u308a\u307e\u305b\u3093\u3002<\/p>\n<p>\u4e00\u65b9\u3067\uff0c<span style=\"color: #000080;\"><strong>medulloblastoma with extensive nodularity<\/strong><\/span>\u306e\u3088\u3046\u306a\u75c5\u7406\u6240\u898b\u3092\u6709\u3059\u308b\u9ac4\u82bd\u816b\u304c\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u907f\u3051\u305f\u5927\u91cf\u5316\u5b66\u7642\u6cd5\u306e\u307f\u3067\u6cbb\u7652\u3059\u308b\u3053\u3068\u3082\u77e5\u3089\u308c\u3066\u6765\u3066\u3044\u307e\u3059\u3002\u60a3\u5150\u306e\u5e74\u9f62\u3068\u75c5\u614b\u306b\u3088\u3063\u3066\uff0c\u624b\u8853\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\uff0c\u5316\u5b66\u7642\u6cd5\u3092\u5168\u3066\u542b\u3081\u3066\uff0c\u30d0\u30e9\u30f3\u30b9\u3088\u304f\u6700\u4f4e\u9650\u306e\u4fb5\u8972\u624b\u6bb5\u3067\u6cbb\u7642\u3059\u308b\u3053\u3068\u304c\u3088\u308a\u6c42\u3081\u3089\u308c\u308b\u6642\u3067\u3059\u3002\u3044\u308f\u3086\u308b\u30c6\u30a4\u30e9\u30fc\u30e1\u30a4\u30c9\u6cbb\u7642\u3068\u3044\u3046\u3053\u3068\u306b\u306a\u308a\uff0c\u3053\u306e\u3053\u3068\u306f\u9006\u306b\u81e8\u5e8a\u7814\u7a76\u306e\u5927\u304d\u306a\u59a8\u3052\u306b\u306a\u308b\u3068\u3044\u3046\u77db\u76fe\u3092\u306f\u3089\u3093\u3067\u884c\u304d\u307e\u3059\u3002<\/p>\n<p>\u751f\u7269\u5b66\u7684\u57fa\u790e\u7814\u7a76\u306e\u9032\u6b69\u306b\u3088\u308a\uff0c\u9ac4\u82bd\u816b\u304c\u653e\u5c04\u7dda\u5316\u5b66\u7642\u6cd5\u62b5\u6297\u6027\u3067\u3042\u308b\u304b\u5426\u304b\u3068\u3044\u3046\u3068\u3044\u3046\u8a3a\u65ad\u306f\uff0c\u816b\u760d\u7d30\u80de\u306e\u767a\u751f\u8d77\u6e90\u3068\u816b\u760d\u5897\u6b96\u306b\u95a2\u9023\u3059\u308b\u7d30\u80de\u5185\u30b7\u30b0\u30ca\u30eb\u4f1d\u9054\u306e\u89e3\u660e\u306b\u3088\u3063\u3066\u5f90\u3005\u306b\u660e\u3089\u304b\u306b\u306a\u3063\u3066\u3044\u307e\u3059\u3002\u307e\u305f\u5206\u5b50\u75c5\u7406\u8a3a\u65ad\u306b\u57fa\u3065\u304d\u6cbb\u7642\u4fb5\u8972\u304c\u30c6\u30a4\u30e9\u30fc\u30e1\u30a4\u30c9\u3067\u9078\u629e\u53ef\u80fd\u306a\u6642\u4ee3\u306b\u3082\u306a\u3063\u3066\u304d\u3066\u3044\u308b\u306e\u3067\u3057\u3087\u3046\u3002<\/p>\n<\/div>\n<div class=\"setumei\">\n<h5>\u904e\u53bb\u306e\u9ac4\u82bd\u816b\u306e\u5206\u5b50\u6a19\u7684\u6cbb\u7642\u306e\u305f\u3081\u306e\u7814\u7a76<\/h5>\n<h4>c-myc signaling<\/h4>\n<p>c-myc\u306f\u764c\u907a\u4f1d\u5b50\u3068\u3057\u3066\u5e83\u304f\u77e5\u3089\u308c\u3066\u3044\u307e\u3059\u3002c-Myc\u306e\u904e\u5270\u767a\u73fe\u306f\u9ac4\u82bd\u816b\u306b\u304a\u3044\u3066\u3082\u3057\u3070\u3057\u3070\u8a8d\u3081\u3089\u308c\uff0c\u3053\u306ec-myc\u907a\u4f1d\u5b50\u306e\u6d3b\u6027\u5316\u306fSHH\u3068Wnt signaling\u306e\u6d3b\u6027\u5316\u306b\u3088\u3063\u3066\u751f\u3058\u308b\u3068\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u81e8\u5e8a\u7684\u306b\u306fanaplastic \/ large cell medulloblastoma\u3067\u306e\u767a\u73fe\u304c\u77e5\u3089\u308c\uff0cErbB2\u3068\u540c\u69d8\u306b\u4e88\u5f8c\u4e0d\u826f\u56e0\u5b50\u3068\u3055\u308c\u307e\u3057\u305f\u3002\u4e88\u5f8c\u306e\u60aa\u3044<span style=\"color: #000080;\"><strong>\u30b0\u30eb\u30fc\u30d73\u9ac4\u82bd\u816b\u3067Myc oncogene \u306e\u9ad8\u3044\u767a\u73fe\u304c\u3042\u308b<\/strong><\/span>\u3053\u3068\u304c\u77e5\u3089\u308c\u3066\u304d\u307e\u3057\u305f\u3002<br \/>\n\u3055\u3089\u306b\uff0chistone deacetylase inhibitors (HDACIs) \u3068 phosphatidylinositol 3-kinase inhibitors (PI3KIs)\u304c\uff0cMTC\u6d3b\u6027\u5316\u9ac4\u82bd\u816b\u306b\u6bba\u7d30\u80de\u52b9\u679c\u304c\u3042\u308b\u3053\u3068\u304c\u5831\u544a\u3055\u308c\u307e\u3057\u305f\u3002panobinostat (HDACIs\u306e\u4e00\u7a2e)\u3068PI3KI\u3092\u4f75\u7528\u3059\u308b\u81e8\u5e8a\u8a66\u9a13\u304c\u671f\u5f85\u3055\u308c\u3066\u3044\u307e\u3059\u3002<br \/>\n\u3057\u304b\u3057\uff0c\u3082\u3057\u3053\u308c\u3089\u306e\u85ac\u5264\u304c\u96e3\u6cbb\u6027\u30b0\u30eb\u30fc\u30d73\u9ac4\u82bd\u816b\u306b\u52b9\u679c\u304c\u3042\u308b\u3068\u308f\u304b\u3063\u3066\u3082\uff0c\u305d\u308c\u3067\u201d\u6cbb\u7652\u201d\u304c\u5f97\u3089\u308c\u308b\u304b\u306f\u5225\u554f\u984c\u3067\uff0c\u306a\u304a\u304b\u3064\u3082\u306e\u3059\u3054\u304f\u9ad8\u984d\u306a\u85ac\u5264\u8cbb\u3068\u306a\u308b\u3067\u3057\u3087\u3046\u3002<\/p>\n<\/div>\n<div class=\"setumei\">\n<h4>nuclear accumulation of beta-catenin<\/h4>\n<p>\u7d30\u80de\u6838\u3067\u306ebeta-catenin\u67d3\u8272\u967d\u6027\u304c\uff0c\u4e88\u5f8c\u826f\u597d\u306a\u9ac4\u82bd\u816b\u306e\u75c5\u7406\u7d44\u7e54\u30de\u30fc\u30ab\u30fc\u3068\u3057\u3066\u6709\u7528\u3067\u3042\u308b\u3068\u3059\u308b\u5831\u544a\u304c\u3042\u308a\u307e\u3057\u305f\u3002 beta-catenin\u306e\u7d30\u80de\u6838\u96c6\u7a4d\u306fWnt (Wingless\/Wg) signaling pathway \u306e\u6d3b\u6027\u5316\u3068\u95a2\u9023\u3057\uff0c\u3053\u306e\u7d4c\u8def\u306b\u5f71\u97ff\u3059\u308b\u907a\u4f1d\u5b50\u5909\u7570(beta-catenin, APC, AXIN2, survivin, SOX, CTNNB1)\u306f\u591a\u304f\u306e\u9ac4\u82bd\u816b\u306b\u691c\u51fa\u3055\u308c\u307e\u3059\u3002109\u9ac4\u82bd\u816b\u75c7\u4f8b\u306e\u3046\u306127\u4f8b\u304c\u6838beta-catenin\u967d\u6027\u3067\u3042\u308a\uff0c\u305d\u306e\uff15\u5e74\u5168\u751f\u5b58\u5272\u5408\u3068\u7121\u5897\u60aa\u751f\u5b58\u5272\u5408\u306f92%\u306889% \u3067\u3042\u3063\u305f\uff0c\u9006\u306b\u6838\u306ebeta-catenin\u975e\u67d3\u8272\u4f8b\u3067\u306f\uff0c\u305d\u308c\u305e\u308c65%\u306860%\u3067\u3042\u308a\u6709\u610f\u306a\u5dee(p=0.0015, 0.0025)\u304c\u8a8d\u3081\u3089\u308c\u305f\u3068\u3044\u3046\u5831\u544a\u304c\u3042\u308a\u307e\u3059\u3002\u307e\u305f\u6ce8\u76ee\u3059\u3079\u304d\u3053\u3068\u306b\uff0c\u6838beta-catenin\u967d\u6027\u4f8b\u3067\u3042\u308a\u304b\u3064large cell medulloblastoma\u3042\u308b\u3044\u306f\u64ad\u7a2e\u304c\u3042\u308b\u5168\u3066\u306e\u75c7\u4f8b\u304c\u8a3a\u65ad\u304b\u3089\uff15\u5e74\u306e\u6642\u70b9\u3067\u751f\u5b58\u3057\u3066\u3044\u305f\u3068\u306e\u3053\u3068\u3067\u3059\u3002<\/p>\n<h4>sonic hedgehog (SHH) signaling\u3068Notch signaling<\/h4>\n<p>SSH signaling\u306f\u5c0f\u8133\u306e\u5916\u9846\u7c92\u5c64\u7d30\u80de\u306e\u5897\u6b96\u3092\u4fc3\u3059\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u9ac4\u82bd\u816b\u3067\u306f\u3053\u306e\u30b7\u30b0\u30ca\u30eb\u4f1d\u9054\u306b\u95a2\u4e0e\u3059\u308b\u907a\u4f1d\u5b50 (PTCH1, Smo) \u306e\u7570\u5e38\u304c30%\u307b\u3069\u306b\u8a8d\u3081\u3089\u308c\u307e\u3059\u3002Notch signaling\u3082\u5c0f\u8133\u306e\u9846\u7c92\u5c64\u7d30\u80de\u306e\u5897\u6b96\u306b\u95a2\u4e0e\u3057\uff0c\u3053\u306e\u30b7\u30b0\u30ca\u30eb\u4f1d\u9054\u6a5f\u69cb\u306b\u95a2\u9023\u3059\u308b\u907a\u4f1d\u5b50\u306e\u7570\u5e38\u304c\u3042\u308b\u9ac4\u82bd\u816b\u60a3\u8005\u306e\u4e88\u5f8c\u306f\u4e0d\u826f\u3068\u3059\u308b\u5831\u544a\u3082\u3042\u308a\u307e\u3059\u3002Wnt signaling, SHH signaling, Notch signaling pathway\u306f\u304a\u4e92\u3044\u306b\u5e72\u6e09\u3057\u3042\u3046\u7d4c\u8def\u3067\u3059\u3002\u307e\u305f\uff0cErbB signaling\u306fSHH signaling\u306b\u3088\u3063\u3066\u5236\u5fa1\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u3053\u308c\u3089\u306e\u77e5\u898b\u306b\u672a\u3060\u306b\u81e8\u5e8a\u7684\u5fdc\u7528\u306e\u5177\u4f53\u6027\u306f\u3042\u308a\u307e\u305b\u3093\u304c\uff0c\u5b9f\u9a13\u7684\u306b\u306fSSH pathway\u3042\u308b\u3044\u306fNotch pathway\u3092\u6291\u5236\u3059\u308b\u3053\u3068\u306b\u3088\u308a\u9ac4\u82bd\u816b\u306b\u5bfe\u3059\u308b\u5206\u5b50\u6a19\u7684\u6cbb\u7642\u306e\u958b\u767a\u304c\u671f\u5f85\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n<h4>\u3053\u3053\u306b\u66f8\u3044\u3066\u3042\u308b\u3053\u3068\u3068\u5b9f\u969b\u306b\u6fa4\u6751\u304c\u884c\u3063\u3066\u304d\u305f\u3053\u3068\u306e\u77db\u76fe<\/h4>\n<p><strong>\u958b\u982d\u624b\u8853<\/strong>\uff1a\u9ac4\u82bd\u816b\u306e\u5b50\u4f9b\u3092\u8a3a\u65ad\u3057\u305f\u3089\uff0c\u958b\u982d\u624b\u8853\u306b\u3088\u308b\u816b\u760d\u6458\u51fa\u306f\u306a\u308b\u3079\u304f\u3057\u306a\u3044\u3088\u3046\u306b\u3057\u3066\uff0c\u5316\u5b66\u7642\u6cd5\u3068\u653e\u5c04\u7dda\u6cbb\u7642\u3067\u6cbb\u7642\u958b\u59cb\u3057\u3066\u3044\u307e\u3057\u305f\u3002\u4e16\u754c\u6a19\u6e96\u306f\uff0c\u9ac4\u82bd\u816b\u3092\u898b\u3064\u3051\u305f\u3089\u307e\u305a\u958b\u982d\u624b\u8853\u3067\u3067\u304d\u308b\u9650\u308a\u6458\u51fa\u3059\u308b\u3068\u3044\u3046\u3053\u3068\u306f\u77e5\u3063\u3066\u3044\u307e\u3059\u3002\u307e\u305f\uff0c\u79c1\u81ea\u8eab\u306f\u5c0f\u5150\u306e\u8133\u816b\u760d\u306e\u624b\u8853\u3092\u3068\u3066\u3082\u305f\u304f\u3055\u3093\u7d4c\u9a13\u3057\u3066\u3044\u308b\u8133\u5916\u79d1\u533b\u3067\u3059\u306e\u3067\u5927\u304d\u304f\u77db\u76fe\u3057\u3066\u3044\u307e\u3059\u3002\u7406\u7531\u306f\uff0c\u521d\u56de\u624b\u8853\u306b\u3088\u3063\u3066M0\u306e\u3082\u306e\u3092M1\u306b\u9032\u884c\u3055\u305b\u308b\u3053\u3068\u306b\u306a\u308a\uff0c\u64ad\u7a2e\u3092\u8a98\u767a\u3059\u308b\u3053\u3068\u3092\u6050\u308c\u3066\u3044\u305f\u304b\u3089\u3067\u3059\u3002\u9006\u306b\uff0c\u653e\u5c04\u7dda\u3068\u5316\u5b66\u7642\u6cd5\u306e\u5f8c\u3067\u3082\u6b8b\u3063\u305f\u9ac4\u82bd\u816b\u306f\uff0c\u7a4d\u6975\u7684\u306b\u958b\u982d\u624b\u8853\u3067\u6458\u51fa\u3057\u3066\u3044\u307e\u3057\u305f\u3002\u3053\u308c\u306f\u6b8b\u5b58\u816b\u760d\u304c\u3042\u308c\u3070\u305d\u3053\u304b\u3089\u518d\u767a\u3059\u308b\u78ba\u7387\u304c\u9ad8\u3044\u3053\u3068\u306f\u5e83\u304f\u77e5\u3089\u308c\u3066\u3044\u308b\u304b\u3089\u3067\u3059\uff0c\u3053\u306e\u6839\u62e0\u306f\u3042\u308a\u307e\u3059\u3002<\/p>\n<p><strong>\u5316\u5b66\u7642\u6cd5<\/strong>\uff1aICE\u5316\u5b66\u7642\u6cd5\u306f\u9ac4\u82bd\u816b\u306b\u3068\u3066\u3082\u52b9\u679c\uff08\u594f\u529f\u5272\u5408\uff09\u304c\u9ad8\u3044\u3067\u3059\u30021992\u5e74\u304b\u3089\u4f7f\u7528\u3057\u3066\u3044\u3066\u73fe\u5728\u3067\u3082\u307e\u3060\u6700\u3082\u6709\u52b9\u306a\u5316\u5b66\u7642\u6cd5\u306e\u3072\u3068\u3064\u3060\u3068\u8003\u3048\u3066\u3044\u307e\u3059\u3002\u9650\u5b9a\u7684\u306a\u6210\u7e3e\u306f\u8ad6\u6587\u306b\u3082\u767a\u8868\u3057\u3066\u3042\u308a\u307e\u3059\u3057\uff0c\u304b\u3064\u3066\u306e\u5c0f\u5150\u8133\u816b\u760d\u306e\u5168\u56fd\u7814\u7a76\u3067\u3082\u4f7f\u7528\u3055\u308c\u3066\u3044\u307e\u3057\u305f\u3002\u6b27\u7c73\u3067\u3082\u3053\u308c\u3068\u307b\u307c\u540c\u69d8\u306e\u5316\u5b66\u7642\u6cd5\u306f\u4f7f\u7528\u3055\u308c\u3066\u3044\u307e\u3059\u306e\u3067\u6839\u62e0\u306f\u3042\u308a\u307e\u3059\u3002\u3057\u304b\u3057\uff0c\u30d1\u30c3\u30ab\u30fc\u5148\u751f\u305f\u3061\u306e\u8ad6\u6587\u306f\u6a29\u5a01\u304c\u9ad8\u3044\u306e\u3067\uff0c\u73fe\u6642\u70b9\u3067\u306f\u3042\u306e\u5316\u5b66\u7642\u6cd5\u304c\u6a19\u6e96\u3068\u3044\u308f\u3056\u308b\u3092\u5f97\u307e\u305b\u3093\u3002\u5c0f\u5150\u306e\u60aa\u6027\u816b\u760d\u306f\u3059\u3079\u3066\u304c\u6a19\u6e96\u6cbb\u7642\u3067\u6cbb\u7642\u3067\u304d\u308b\u308f\u3051\u3067\u3082\u306a\u3044\u306e\u3067\u3057\u3087\u3046\u3057\uff0c\u3042\u308b\u7a0b\u5ea6\u306e\u6839\u62e0\u3068\u5b9f\u7e3e\u306b\u57fa\u3065\u304f\u6cbb\u7642\u306f\u5bb9\u8a8d\u3055\u308c\u308b\u3067\u3057\u3087\u3046\u3002\u3057\u304b\u3057\uff0c\u601d\u3044\u3064\u304d\u306e\u72ec\u81ea\u306e\u30e6\u30cb\u30fc\u30af\u306a\u5316\u5b66\u7642\u6cd5\u306f\u8a31\u3055\u308c\u308b\u4e16\u754c\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002<\/p>\n<p><strong>\u6cbb\u7642\u958b\u59cb\u6642\u671f<\/strong>\uff1a\u591a\u304f\u306e\u8ad6\u6587\u3067\u306f\uff0c\u8853\u5f8c\uff13\u9031\u9593\u304f\u3089\u3044\u307e\u3067\u306b\u88dc\u52a9\u7642\u6cd5\u306e\u958b\u59cb\u3092\u3059\u308b\u3079\u304d\u3060\u3068\u66f8\u3044\u3066\u3044\u307e\u3059\u3002\u30d1\u30c3\u30ab\u30fc\u5148\u751f\u306e\u8ad6\u6587\u3067\u306f\uff0c31\u65e5\u4ee5\u5185\u306b\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u958b\u59cb\u3059\u308b\u3068\u3042\u308a\u307e\u3059\u3002\u3067\u30821992\u5e74\u9803\u304b\u3089\u79c1\u306f\uff0c\u9ac4\u82bd\u816b\u3068\u8a3a\u65ad\u3057\u305f\u3089\u5373\u523b\uff0c\u305d\u306e\u65e5\u306e\u3046\u3061\u306b\u3067\u3082\u624b\u8853\u6458\u51fa\u3057\u3066\uff0c\u8853\u5f8c\uff11\u9031\u9593\u304f\u3089\u3044\u307e\u3067\u306b\u306f\u5316\u5b66\u7642\u6cd5\u3042\u308b\u3044\u306f\u653e\u5c04\u7dda\u6cbb\u7642\u3092\u958b\u59cb\u3057\u3066\u304d\u307e\u3057\u305f\u3002\u75c5\u7406\u306f\u51cd\u7d50\u6a19\u672c\u3067\u307f\u3066\u78ba\u5b9a\u8a3a\u65ad\u524d\u306b\u88dc\u52a9\u7642\u6cd5\u3092\u958b\u59cb\u3057\u305f\u3053\u3068\u304c\u591a\u3044\u3067\u3059\u3002\u307e\u305f\uff0c2000\u5e74\u4ee5\u964d\u3067\u306f\u7a4d\u6975\u7684\u306b\u306f\u958b\u982d\u624b\u8853\u3092\u3057\u306a\u304b\u3063\u305f\u306e\u3067\uff0c\u9ac4\u82bd\u816b\u3068\u753b\u50cf\u8a3a\u65ad\u3057\u305f\u3089\uff11\u9031\u9593\u4ee5\u5185\u304f\u3089\u3044\u306b\u5316\u5b66\u7642\u6cd5\u3092\u958b\u59cb (neoadjuvant therapy) \u3057\u3066\uff0c\u653e\u5c04\u7dda\u6cbb\u7642\u306f\u3055\u307e\u3056\u307e\u306b\u7d44\u307f\u5408\u308f\u305b\u3066\u3044\u307e\u3057\u305f\u3002<\/p>\n<h4>\u6587\u732e<\/h4>\n<ul>\n<li>Ashley DM, et al.: Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children&#8217;s Oncology Group study P9934. 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