Goshen Yacov, Stark Batia, Kornreich Liora, Michowiz Shalom, Feinmesser Meora, Yaniv Isaac
Department of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Pediatr Blood Cancer. 2007 Sep;49(3):294-7. doi: 10.1002/pbc.21153.
Most survivors of childhood acute lymphoblastic leukemia (ALL) and T-cell lymphoma (T-NHL) treated before 1990 received cranial radiation. This study assessed the occurrence of second tumors in irradiated and non-irradiated survivors.
Two hundred and ten survivors of ALL and T-NHL were treated between 1974 and 1997 by several protocols. Imaging (MRI, CT) was performed every 3-6 years in 76/88 irradiated and 74/122 non-irradiated patients for the last 20 years.
From January 1998 through 2004, meningiomas were detected in 16 survivors (8 female, 8 male) at age 20-39 years (median 28.7); 15 were asymptomatic. Cranial imaging done 2-8 years previously in 11 revealed no abnormalities. Fifteen had been diagnosed with ALL or T-NHL 10-29 years earlier (median 21) and received cranial irradiation (24 Gy in 14) at age 2-14 years (median 7.6). Fifteen tumors arose in the convexity. Three patients had multiple lesions. Complete resection was performed in 12 patients, with one complication. One patient had a recurrence, and four with small tumors are under surveillance. Only one low-grade glioma and two basal-cell carcinomas were found. Only one of the 74 non-irradiated patients (median follow-up 14 years) developed meningioma. The Kaplan-Meier estimate of incidence of meningioma was 14.8+/-7.6 at 20 years.
Survivors of childhood ALL treated with cranial radiation require prolonged surveillance because of a high incidence of late meningiomas. Early detection, when the tumor is still small, facilitates resection and may reduce complications.
1990年以前接受治疗的大多数儿童急性淋巴细胞白血病（ALL）和T细胞淋巴瘤（T - NHL）幸存者都接受了颅脑放疗。本研究评估了接受放疗和未接受放疗的幸存者中二次肿瘤的发生情况。
1974年至1997年间，通过多种方案对210例ALL和T - NHL幸存者进行了治疗。在过去20年中，76/88例接受放疗的患者和74/122例未接受放疗的患者每3 - 6年进行一次影像学检查（MRI、CT）。
从1998年1月至2004年，在20 - 39岁（中位年龄28.7岁）的16名幸存者（8名女性，8名男性）中检测到脑膜瘤；15例无症状。11例患者2 - 8年前进行的颅脑影像学检查未发现异常。15例患者在10 - 29年前（中位时间21年）被诊断为ALL或T - NHL，并在2 - 14岁（中位年龄7.6岁）时接受了颅脑放疗（14例为24 Gy）。15个肿瘤发生在凸面。3例患者有多个病灶。12例患者进行了完整切除，出现1例并发症。1例患者复发，4例小肿瘤患者正在接受监测。仅发现1例低级别胶质瘤和2例基底细胞癌。74例未接受放疗的患者（中位随访14年）中仅1例发生脑膜瘤。20年时脑膜瘤发病率的Kaplan - Meier估计值为14.8±7.6。
由于晚期脑膜瘤的高发病率，接受颅脑放疗的儿童ALL幸存者需要长期监测。在肿瘤仍较小时早期发现便于切除，并可能减少并发症。
