Waber D P, Shapiro B L, Carpentieri S C, Gelber R D, Zou G, Dufresne A, Romero I, Tarbell N J, Silverman L B, Sallan S E
Division of Psychology, The Children's Hospital, Boston, Massachusetts 02115, USA.
Cancer. 2001 Jul 1;92(1):15-22. doi: 10.1002/1097-0142(20010701)92:1<15::aid-cncr1286>3.0.co;2-w.
In the current study, the authors evaluated late neuropsychologic effects 7 years after diagnosis and the long-term survival in a cohort of patients treated for high-risk childhood acute lymphoblastic leukemia (ALL) with cranial radiation therapy. Efficacy and toxicity were evaluated in relation to patient age at diagnosis (age < or > or = 36 months).
Two hundred and one patients treated for high-risk ALL on the Dana-Farber Cancer Institute Consortium Protocol 87-01 were included, 147 of whom were in continuous complete disease remission and were eligible for cognitive testing. Sixty-one patients consented to undergo testing. All patients received 18 grays (Gy) of cranial radiation as a component of central nervous system treatment.
For all 201 patients, the 5-year overall survival (% +/- the standard error) was 82% +/- 2 and the 5-year event-free survival (% +/- the standard error) was 75% +/- 3. Only two patients developed a central nervous system recurrence. Intelligence quotient (IQ) and memory were at the expected mean for age, but performance on a complex figure drawing task was found to be reduced. Children who were age < 36 months at the time of diagnosis were found to have an IQ in the average range, but showed verbal deficits.
The results of the current study demonstrate excellent efficacy of therapy and relatively limited late neurotoxicity on a childhood ALL therapy protocol in which all evaluated patients had received 18 Gy of cranial radiation. Efficacious therapy that includes cranial radiation does not appear to necessarily incur a heightened risk for significant cognitive impairment.
在本研究中，作者评估了高危儿童急性淋巴细胞白血病（ALL）患者接受颅脑放射治疗后7年的晚期神经心理学效应及长期生存率。根据诊断时的患者年龄（年龄＜或≥36个月）评估疗效和毒性。
纳入201例按照达纳-法伯癌症研究所联盟方案87-01接受高危ALL治疗的患者，其中147例处于持续完全疾病缓解状态且符合认知测试条件。61例患者同意接受测试。所有患者均接受18格雷（Gy）的颅脑放射治疗，作为中枢神经系统治疗的一部分。
对于所有201例患者，5年总生存率（%±标准误）为82%±2，5年无事件生存率（%±标准误）为75%±3。仅2例患者出现中枢神经系统复发。智商（IQ）和记忆力处于预期的年龄均值水平，但复杂图形绘制任务的表现有所下降。诊断时年龄＜36个月的儿童智商处于平均范围，但存在语言缺陷。
本研究结果表明，在所有评估患者均接受18 Gy颅脑放射治疗的儿童ALL治疗方案中，治疗效果极佳，晚期神经毒性相对有限。包括颅脑放射治疗的有效治疗似乎不一定会增加显著认知障碍的风险。
