Beyzadeoglu Murat, Dirican Bahar, Oysul Kaan, Arpaci Fikret, Pak Yucel
Department of Radiation Oncology, Gulhane Military Medical School, Ankara, Turkey.
Haematologia (Budap). 2002;32(1):25-30. doi: 10.1163/156855902760262736.
To assess dose rate effect on cataractogenesis in allogeneic or autologous bone marrow transplanted patients conditioned with fractionated total-body irradiation (FTBI).
Between 1987 and 2001, a total of 105 patients have received TBI conditioning for Bone Marrow Transplantation (BMT) for hematological malignancies at Gulhane Military Medical School. 12 Gy FTBI was applied in 6 fractions over 3 consecutive days with a Co60 teletherapy machine. 46 patients who have survived and were followed up after more than one year were evaluated for cataractogenesis in relation to dose rate. Conditioning therapy included only cyclophosphamide (60 mg/kg/day for two days) + TBI with no steroid and veno-occlusive disease prophylaxis.
The median follow-up is 32 months. Posterior subcapsular cataract developed in 5 eyes of three patients out of 46 patients. The 5-year and 10-year estimated cataract incidence in the high-dose rate (> 0.04 Gy/min) group was 29% and 43% respectively while no cataracts occurred in the low-dose rate (< or = 0.04 Gy/min) group. Cataract development in the high-dose rate group versus low-dose rate group was statistically significant (p < 0.039).
Cataract is a late side effect of TBI. Low-dose rate fractionated TBI is a reliable conditioning program in BMT with effective lens sparing to avoid cataractogenesis.
评估在接受分次全身照射（FTBI）预处理的异基因或自体骨髓移植患者中，剂量率对白内障形成的影响。
1987年至2001年间，共有105例患者在古尔汗军事医学院接受了用于血液系统恶性肿瘤骨髓移植（BMT）的全身照射预处理。使用钴60远距离治疗机在连续3天内分6次给予12 Gy的FTBI。对46例存活且随访超过1年的患者进行了与剂量率相关的白内障形成评估。预处理治疗仅包括环磷酰胺（60 mg/kg/天，共2天）+全身照射，未使用类固醇和预防肝静脉闭塞病。
中位随访时间为32个月。46例患者中有3例患者的5只眼睛发生了后囊下白内障。高剂量率（> 0.04 Gy/分钟）组的5年和10年估计白内障发生率分别为29%和43%，而低剂量率（≤ 0.04 Gy/分钟）组未发生白内障。高剂量率组与低剂量率组的白内障发生情况具有统计学显著性差异（p < 0.039）。
白内障是全身照射的晚期副作用。低剂量率分次全身照射是骨髓移植中一种可靠的预处理方案，能有效保护晶状体以避免白内障形成。
