Schneider Ralf A, Schultze Juergen, Jensen J Martin, Hebbinghaus Dieter, Galalae Razvan M
Rinecker Proton Therapy Center, München, Germany.
Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):194-202. doi: 10.1016/j.ijrobp.2007.05.035. Epub 2007 Sep 14.
To report the long-term outcome after total body irradiation with intensity-modulating compensators and allogeneic/autologous transplantation, especially in terms of therapy-related toxicity in pediatric and adult cohorts.
A total of 257 consecutive patients (40 children and 217 adults) have been treated since 1983 with TBI using static intensity-modulated radiotherapy for hematologic malignancies. The total dose of 12 Gy was applied in six fractions within 3 days before allogeneic (n = 174) or autologous (n = 83) transplantation. The median follow-up was 9.2 years.
The 5-year overall survival rate was 47.9% (49.8% for the adults and 37.5% for the children, p = 0.171). The 5-year tumor-related mortality rate was 23%, and the 5-year treatment-related mortality rate 29.2% (29.5% in the adults and 27.5% in the pediatric patients). Interstitial pneumonitis developed in 28 (10.9%) of 257 patients and in 12.5% of the pediatric cohort. The interstitial pneumonitis rate was 25% in pediatric patients treated with a 12-Gy lung dose compared with 4.2% for those treated to an 11-Gy lung dose. The overall survival rate stratified by lung dose was 26.7% for 12 Gy and 52.4% for 11 Gy (p = 0.001). The incidence of veno-occlusive disease and cataract was 5.8% and 6.6% in all patients and 12.5% and 15% in the pediatric patients, respectively (p < 0.05). Secondary malignancies were found in 4.3% of all patients, all in the adult cohort at transplantation.
Static intensity-modulated total body irradiation with a total dose of 12 Gy before allogeneic/autologous transplantation is a successful treatment with good long-term outcome and acceptable therapy-related toxicities. Constraining the lung dose to 11 Gy substantially lowered the actuarial treatment-related mortality. This effect was especially striking in the pediatric patients.
报告采用调强补偿器进行全身照射及异体/自体移植后的长期结果，尤其是儿科和成人队列中与治疗相关的毒性。
自1983年以来，共有257例连续患者（40名儿童和217名成人）接受了使用静态调强放疗治疗血液系统恶性肿瘤的全身照射。在异体移植（n = 174）或自体移植（n = 83）前3天内分6次给予12 Gy的总剂量。中位随访时间为9.2年。
5年总生存率为47.9%（成人49.8%，儿童37.5%，p = 0.171）。5年肿瘤相关死亡率为23%，5年治疗相关死亡率为29.2%（成人29.5%，儿科患者27.5%）。257例患者中有28例（10.9%）发生间质性肺炎，儿科队列中发生率为12.5%。肺部剂量为12 Gy的儿科患者间质性肺炎发生率为25%，而肺部剂量为11 Gy的患者为4.2%。按肺部剂量分层的总生存率，12 Gy组为26.7%，11 Gy组为52.4%（p = 0.001）。所有患者中静脉闭塞性疾病和白内障的发生率分别为5.8%和6.6%，儿科患者中分别为12.5%和15%（p < 0.05）。所有患者中有4.3%发生继发性恶性肿瘤，均发生在移植时的成人队列中。
在异体/自体移植前采用总剂量为12 Gy的静态调强全身照射是一种成功的治疗方法，具有良好的长期结果和可接受的与治疗相关的毒性。将肺部剂量限制在11 Gy可显著降低精算治疗相关死亡率。这种效果在儿科患者中尤为显著。
