Goodman Karyn A, Wolden Suzanne L, LaQuaglia Michael P, Alektiar Kaled, D'Souza David, Zelefsky Michael J
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Brachytherapy. 2003;2(3):139-46. doi: 10.1016/S1538-4721(03)00135-1.
To evaluate the efficacy and toxicity of intraoperative high-dose-rate brachytherapy (IOHDR) in the management of pediatric solid tumors.
The records of 66 pediatric patients who underwent IOHDR for a solid tumor from February 1993 through December 2002 were retrospectively reviewed. The median age was 7 years (range 9 months to 24 years). Thirty-five patients (53%) were treated for recurrent disease and 24 (36%) had documented metastatic disease. Twenty-nine patients (44%) received both EBRT and IOHDR. The IOHDR dose was prescribed to a depth of 0.5 cm from the surface of a multichannel tissue-equivalent applicator. The median prescription dose was 12 Gy (range, 4-15 Gy).
After a median follow-up of 12 months, the 2-year actuarial rates of local control and overall survival were 56% and 54%, respectively, with a median survival of 29 months. Post-operative EBRT significantly improved (p=0.002) 2-year local control (83% v. 29%). Perioperative complications occurred in 8 of 66 patients while late complications occurred in only 3. The actuarial 2-year late complication rate was 12%. Late events that occurred in or near the IOHDR treatment site included small bowel obstruction, broncho-esophageal fistula, and bone growth retardation.
IOHDR is emerging as an integral part of multimodality therapy for pediatric solid tumors as an adjunct to EBRT for local control. IOHDR alone may not be appropriate in the majority of patients. Subacute toxicities occurred rarely and may be related to the combination of extensive surgery, EBRT, and multi-agent chemotherapy in this population.
评估术中高剂量率近距离放射治疗（IOHDR）在小儿实体瘤治疗中的疗效和毒性。
回顾性分析1993年2月至2002年12月期间66例接受IOHDR治疗实体瘤的小儿患者的病历。中位年龄为7岁（范围9个月至24岁）。35例患者（53%）接受复发性疾病治疗，24例（36%）有记录的转移性疾病。29例患者（44%）接受了外照射放疗（EBRT）和IOHDR。IOHDR剂量是根据多通道组织等效施源器表面0.5厘米深处来规定的。中位处方剂量为12 Gy（范围4 - 15 Gy）。
中位随访12个月后，2年局部控制和总生存的精算率分别为56%和54%，中位生存期为29个月。术后EBRT显著提高了（p = 0.002）2年局部控制率（83%对29%）。66例患者中有8例发生围手术期并发症，而只有3例发生晚期并发症。2年晚期并发症精算率为12%。IOHDR治疗部位或其附近发生的晚期事件包括小肠梗阻、支气管食管瘘和骨生长迟缓。
IOHDR正成为小儿实体瘤多模式治疗的一个组成部分，作为EBRT用于局部控制的辅助手段。单独使用IOHDR在大多数患者中可能不合适。亚急性毒性很少发生，可能与该人群广泛的手术、EBRT和多药化疗联合有关。
