Nag Subir, Tippin Douglas, Smith Shane, Bauer Connie, Ruymann Frederick B
Division of Radiation Oncology, Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio State University Hospitals, Columbus, Ohio 43210, USA.
Med Pediatr Oncol. 2003 Jun;40(6):360-6. doi: 10.1002/mpo.10296.
To report the result of intraoperative electron beam radiation therapy (IOERT) in patients with extensive pediatric tumors.
From October 1989 through June 2000, 13 children were treated with chemotherapy, maximal surgery, and 10-15 Gy IOERT at a total of 18 sites. IOERT was used for palliative purposes in 5 children with metastatic disease and in 3 others who were previously treated with external beam radiation (EBRT). The remaining five patients received definitive IOERT. Postoperative EBRT of 35.4-45 Gy was given in 5 patients.
After a median follow-up of 42 months (range = 18-63 months), 4 patients were alive and without evidence of disease. Overall and 3 year actuarial survival rates were 31% (4/13) and 26%, respectively. Local control was achieved at 13/18 sites (72%). Poor prognostic factors included metastatic disease, recurrent disease, and the absence of adjuvant EBRT. Two children with Wilms tumors had 100% local control, disease-free survival, and overall survival without the addition of EBRT.
A boost dose of IOERT allows for reduction in the dose of EBRT, thereby limiting growth-related morbidity without compromising local control or disease-free survival. Except for Wilms tumors, which achieved 100% local control and disease-free survival, adjuvant EBRT is necessary for successful local control and survival in children with soft tissue sarcomas. Based on this study and others, intraoperative irradiation should be considered for inclusion in prospective, multi-institutional trials designed to treat localized malignancies in young children.
报告术中电子束放射治疗（IOERT）在患有广泛性儿科肿瘤患者中的治疗结果。
从1989年10月至2000年6月，13名儿童接受了化疗、最大限度的手术治疗，并在总共18个部位接受了10 - 15 Gy的IOERT治疗。IOERT用于5名患有转移性疾病的儿童以及另外3名先前接受过外照射放疗（EBRT）的儿童的姑息治疗。其余5名患者接受了根治性IOERT治疗。5名患者术后接受了35.4 - 45 Gy的EBRT。
中位随访42个月（范围 = 18 - 63个月）后，4名患者存活且无疾病证据。总体生存率和3年精算生存率分别为31%（4/13）和26%。18个部位中有13个（72%）实现了局部控制。不良预后因素包括转移性疾病、复发性疾病以及未进行辅助EBRT。两名患有肾母细胞瘤的儿童在未进行EBRT的情况下实现了100%的局部控制、无病生存和总体生存。
IOERT的追加剂量可减少EBRT的剂量，从而在不影响局部控制或无病生存的情况下限制与生长相关的发病率。除了肾母细胞瘤实现了100%的局部控制和无病生存外，辅助EBRT对于软组织肉瘤患儿成功实现局部控制和生存是必要的。基于本研究及其他研究，术中放疗应考虑纳入旨在治疗幼儿局限性恶性肿瘤的前瞻性多机构试验。
