Vijayakrishnan Rajakrishnan, Shields Carol L, Ramasubramanian Aparna, Emrich Jacqueline, Rosenwasser Robert, Shields Jerry A
Internal Medicine Department, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Arch Ophthalmol. 2010 Nov;128(11):1427-31. doi: 10.1001/archophthalmol.2010.258.
To evaluate irradiation toxic effects from fluoroscopy during intra-arterial chemotherapy for retinoblastoma.
Prospective trial.
Eight patients treated with intra-arterial chemotherapy.
Irradiation toxic effects in vital organs.
The mean patient age was 29 months (range, 10-74 months) and 63% were male. The mean irradiation dose to the skin of the affected eye was 0.19173 Gy, to the contralateral eye was 0.03533 Gy, to the chest wall was 0.00296 Gy, and to the abdominal wall was 0.00104 Gy. The estimated irradiation dose to the lens in the treatment eye was 0.16 Gy, which, in accumulated doses, could be cataractogenic. The estimated irradiation dose from a single fluoroscopy session to other organs, including the brain (0.05560 Gy), thyroid (0.00192 Gy), bone marrow (0.00059 Gy), and gonads (0.00015 Gy), was far lower than the minimal toxic level.
Careful use of fluoroscopy during intra-arterial chemotherapy with limited irradiation exposure is advised. Accumulated irradiation toxic effects following multiple sessions of intra-arterial chemotherapy could be cataractogenic and possibly carcinogenic, especially in irradiation-sensitive patients with retinoblastoma.
评估视网膜母细胞瘤动脉内化疗期间透视检查的辐射毒性作用。
前瞻性试验。
8例接受动脉内化疗的患者。
重要器官的辐射毒性作用。
患者平均年龄为29个月（范围10 - 74个月），63%为男性。患眼皮肤的平均辐射剂量为0.19173 Gy，对侧眼为0.03533 Gy，胸壁为0.00296 Gy，腹壁为0.00104 Gy。治疗眼晶状体的估计辐射剂量为0.16 Gy，累积剂量可能致白内障。单次透视检查对其他器官（包括脑（0.05560 Gy）、甲状腺（0.00192 Gy）、骨髓（0.00059 Gy）和性腺（0.00015 Gy））的估计辐射剂量远低于最小毒性水平。
建议在动脉内化疗期间谨慎使用透视检查，限制辐射暴露。多次动脉内化疗后的累积辐射毒性作用可能致白内障，甚至可能致癌，尤其是对辐射敏感的视网膜母细胞瘤患者。
