Igaki Hiroshi, Karasawa Katsuyuki, Sakamaki Hisashi, Saito Hiroshi, Nakagawa Keiichi, Ohtomo Kuni, Tanaka Yoshiaki
Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Strahlenther Onkol. 2005 Nov;181(11):704-8. doi: 10.1007/s00066-005-1405-8.
A retrospective analysis was conducted on the outcome of total-body irradiation (TBI) followed by bone marrow transplantation (BMT) on leukemia patients. Also studied was the risk of renal dysfunction after TBI/BMT with or without the use of selective renal shielding blocks.
The cases of 109 leukemia patients who received TBI as a component of the conditioning regimen for their BMT were reviewed. They received 12 Gy of TBI in six fractions over 3 consecutive days. Doses to eyes and lungs were reduced to 7 Gy and 8 Gy, respectively, by customized organ shielding blocks. After March 1999, renal shielding blocks were used to constrain the renal dose to 10 Gy. The patients were followed for a median period of 16.6 months (range: 0.3-180.1 months).
The 2-year and 5-year overall survival rates were 55.4% and 43.2%, respectively. Renal dysfunction-free rates were different between those with and without renal shielding blocks: 100% and 78.5%, respectively, at 2 years. Overall survivals were not significantly different among these patients: 60.4% and 52.9%, respectively, at 2 years in patients with and without renal shielding blocks (p = 0.53).
The use of selective renal shielding blocks provided evidence for reducing radiation-induced renal toxicities without decreasing the overall survival rate.
对白血病患者全身照射（TBI）后进行骨髓移植（BMT）的结果进行回顾性分析。同时研究了在使用或不使用选择性肾脏屏蔽块的情况下，TBI/BMT后肾功能不全的风险。
回顾了109例接受TBI作为BMT预处理方案一部分的白血病患者的病例。他们在连续3天内分6次接受12 Gy的TBI。通过定制的器官屏蔽块，眼睛和肺部的剂量分别降至7 Gy和8 Gy。1999年3月以后，使用肾脏屏蔽块将肾脏剂量限制在10 Gy。对患者进行了为期16.6个月的中位随访（范围：0.3 - 180.1个月）。
2年和5年总生存率分别为55.4%和43.2%。使用和未使用肾脏屏蔽块的患者肾功能不全发生率不同：2年时分别为100%和78.5%。这些患者的总生存率无显著差异：使用和未使用肾脏屏蔽块的患者2年时分别为60.4%和52.9%（p = 0.53）。
使用选择性肾脏屏蔽块为降低辐射诱导的肾脏毒性且不降低总生存率提供了证据。
