Neurological Surgery 脳神経外科47巻9号

2019年09月発行

症例

Optic pathway/hypothalamic gliomaに対するビンブラスチン治療—2症例報告

著者： 山崎文之¹ 髙野元気¹ 米澤潮¹ 田口慧¹ 高安武志¹ 杉山一彦² 栗栖薫¹

所属機関： ¹広島大学病院脳神経外科 ²広島大学病院がん化学療法科

ページ範囲：P.977 - P.984

Ⅰ．はじめに
　Optic pathway glioma（OPG），そしてOPGにhypothalamic gliomaを併せたoptic pathway/hypothalamic glioma（OPHG）などの，完全切除が不能な部位に発生した小児低悪性度神経膠腫の治療・管理における化学療法の役割は，過去20年間で劇的に変化した¹²⁾．当初，化学療法は手術や放射線療法後の再発に対する救済療法としての選択肢であったが，放射線療法は晩期障害のリスクが高く，一方で，有効な化学療法レジメンが開発された結果，現在では，放射線学的または症候性に進行する切除不能なOPHGを含む小児低悪性度神経膠腫の第一選択治療は，化学療法と考えられている¹²⁾．
　ビンブラスチン単剤を毎週注射投与する治療法（weekly vinblastine［以下，ビンブラスチンの毎週投与］）は，OPHGを含む小児低悪性度神経膠腫における有効な治療法として海外で報告された^3,9,12)．最初は，カルボプラチンのアレルギーにて治療継続が困難になった患者への治療法として報告され⁹⁾，続いて，再発・進行性の低悪性度神経膠腫に対するphase Ⅱ studyで有効性が報告された³⁾．さらに，低悪性度神経膠腫に対するファーストラインの化学療法としての有効性も示されたが¹²⁾，本邦での治療報告論文は，われわれが渉猟し得た限りでは認められない．本稿では保険適用外薬として，1例ごとに院内institutional review board（IRB）で審査を受けて承認後に使用した，OPHGに対するビンブラスチンの毎週投与の治療経験を報告する．

参考文献

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