Hatice Mine ÇAKMAK, Yaşar BİLDİRİCİ, Fuzuli TUĞRUL, Meral BAHAR, Murat BALOĞLU, Müge GÜNDOĞDU

Çocukluk Çağı Lokal Yüksek Risk Ewing Sarkomu’nda Yüksek doz Kemoterapi ve Otolog Kök Hücre Nakli Ne Zaman Yapılmalı?: Olgu Sunumu

Lokalize yüksek risk Ewing sarkomu tanısı olan hastalarda tedavi protokolleri farklıdır. Euro-Ewing 2012 protokolünde sırasıyla indüksiyon kemoterapisi, lokal tedavi ve yüksek doz kemoterapi ve otolog kök hücre nakli yapılırken, COG (Children’s Oncology Group) protokolünde indüksiyon kemoterapisi, lokal tedavi ve sonrasında kemoterapi ile 14 küre tedavi tamamlanmaktadır. Bu hastalıkta standard kemoterapiye eklenecek biyolojik ajanlara ve idame tedavisine ihtiyaç vardır. Burada on beş yaşında, lokalize yüksek risk pelvik kaynaklı (tanıda tümör hacmi >400 ml), Ewing sarkomu tanılı olgumuz tartışıldı. COG kemoterapi protokolü başlandı. Üç kür sonrası denetlemede inoperabl olduğu için radyoterapi uygulandı. Dördüncü kürden sonra kök hücre toplandı. Kemoterapisinin 14 küre tamamlanması planlandı. Nüks olması halinde indüksiyondan sonra, yüksek doz kemoterapi ve otolog kök hücre nakli yapılması planlandı. Tanıda tümör hacmi 400 ml’nin üstünde tümör hacmi olan non-metastatik Ewing sarkomu, yüksek risklidir, ilk remisyonda cerrahi sonrası yüksek doz kemoterapi ve otolog kök hücre transplantasyonunun yapılmasının sağ kalımı arttırdığına dair makaleler mevcuttur. Ancak, rutin olarak uygulanması konusunda fikir birliğine varılamamıştır.

Anahtar Kelimeler:

Anahtar kelimeler: Ewing sarkomu, çocuk, non-metastatik, yüksek risk, periferik kök hücre toplanması, otolog hematopoetik kök hücre nakli

When Should High Dose Chemotherapy and Autologous Stem Cell Transplantation Be Performed in a Pediatric Local High-Risk Ewing Sarcoma?: A Case Report

In local high-risk Ewing Sarcoma, treatment approaches differ between COG (Children’s Oncology Group) and Euro Ewing 2012 protocols. In Euro-Ewing protocol, high-dose chemotherapy and autologous stem cell transplantation is performed after local therapy. COG protocol includes fourteen chemotherapy regimens and local therapy after the fourth chemotherapy regimen. Targeted agents added to standard chemotherapy and novel agents for maintenance are warranted (11-14). Here, we discuss the time of local therapy in stem cell rescue, high-dose chemotherapy, and autologous stem cell transplantation in this aggressive tumor. Our fifteen-year-old patient had right pelvic Ewing sarcoma with a volume higher than 400 ml. After three chemotherapy regimens, the tumor was inoperable and radiotherapy was applied. Stem cell rescue is performed after the fourth chemotherapy regimen. High-dose chemotherapy and autologous stem cell transplantation are planned for relapse consolidation (17). There is no consensus about the indication of high-dose chemotherapy and autologous stem cell transplantation in high risc Ewing sarcoma with an initial tumor volume > 400 ml.

Keywords:

Keywords: Ewing Sarcoma, children, non-metastatic, high risk, stem cell rescue, autologous hematopoetic stem cell transplantation,

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