復發性兒童腦幹腫瘤患者之硼中子捕獲治療

Treatment Policy of Boron Neutron Capture Therapy for Recurrent Pediatric Brainstem Tumor Patients

根據中華民國兒童癌症基金會歷年所登錄台灣地區所有兒童青少年（低於十八歲以下）惡性疾病當中，中樞神經性腫瘤平均一年國內有近100–150位患者左右。在此其中瀰散生長在腦幹部的惡性膠質細胞瘤是一個相當棘手的腫瘤疾病型態，其好發在8 - 9歲兒童。根據2016年世界衛生組織針對該類腫瘤現在的正式名稱為瀰漫性中軸性膠質細胞瘤（Diffuse Midline Glioma）。腦幹性腫瘤最大治療限制在於無法進行根除性手術，僅能以放射性治療為主要治療策略。然受限於正常腦幹組織的劑量限制，放射治療的處置也僅能控制亦無法根除，整體存活僅一年至兩年左右，是現今兒童腦瘤最大的醫療極限與挑戰。臺北榮總兒童神經腫瘤團隊自2017年六月起針對已接受過各式傳統治療之復發性兒童腦瘤患者，採用恩慈模式申請補救性硼中子捕獲治療（Boron Neutron Capture Therapy; BNCT）處置，其中曾針對數位復發性腦幹性腫瘤兒童患者執行過該項治療協助。本文主要針對兩位本院曾經接受過該項新式治療的復發性兒童腦幹腫瘤患者的治療及照護過程進行文獻報告，希望能將此低副作用高生物優勢之標靶性放射治療成效予以推廣。

Based on the cancer report of the Childhood Cancer Foundation R.O.C. for the malignant diseases registry of children and adolescences in Taiwan (below 18 years), tumors arising from the central nervous system (CNS), including both in the brain or spinal cord, occur in 100 to 150 patients every year. Among all pediatric malignant CNS tumors, diffuse gliomas arising from the brainstem present an intractable type of disease with the poorest survival outcomes. It most happens in the age around 8-9 years. Since 2016, the World Health Organization has named this condition as diffuse midline glioma. The greatest treatment limitation for brainstem tumors is that radical surgery is restricted. Radiation therapy is the only treatment policy. However, owing to the limitation of radiation dosage, radiotherapy can only play a palliative role. Overall survival only lasts around two years. Up to now, this type of tumor is the most challenging for modern cancer treatment. The pediatric multidisciplinary neuro-oncology group in Taipei Veterans General Hospital had delivered salvage BNCT (Boron Neutron Capture Therapy) since 2017 for recurrent pediatric CNS tumor patients who have already received all kinds of conventional treatment modalities. Among these patients, some suffer from brainstem tumors. This article aims to report two recurrent pediatric brainstem tumor patients who underwent this new treatment modality and received skillful nursing care. We also hope to promote this modern targeted radiotherapy because it has less treatment toxicities and high biological tumor destruction effectiveness.