Stauder Michael C, Laack Nadia N I, Moir Christopher R, Schomberg Paula J
Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
J Pediatr Hematol Oncol. 2011 Jul;33(5):350-5. doi: 10.1097/MPH.0b013e3182148dad.
Use of external beam radiotherapy (EBRT) for pediatric solid malignancies is generally limited by the tolerance of normal tissue in developing organs. Intraoperative electron radiotherapy (IOERT) allows a more focal delivery of radiation dose because vital organs can be displaced and avoided during treatment. From February 1983 to July 2003, 20 children underwent IOERT for treatment of locally advanced or recurrent malignancies of the extremity or abdominopelvic area. All patients underwent EBRT and received IOERT doses of 7.5 to 25 Gy with 6-MeV to 15-MeV electrons. At a median follow-up of 11.6 years (range, 2.1 to 25.5 y), 13 patients (65%) were alive and without evidence of disease. Patients who underwent gross total resection had better local control (88% vs. 67%) and survival (71% vs. 33%) than patients for whom the resection was not achieved. Among 7 patients, 11 grade 3 toxicity events were reported. No grade >3 toxicities or second malignancies were observed during follow-up. Use of IOERT in combination with surgery and EBRT in management of pediatric solid malignancies provides excellent local control with reasonable toxicity. IOERT should be considered as an integral part of a multimodality regimen for pediatric solid malignancies, especially for patients with abdominopelvic malignancies.
对于小儿实体恶性肿瘤，外照射放疗（EBRT）的应用通常受到发育中器官正常组织耐受性的限制。术中电子放疗（IOERT）能够更精准地给予辐射剂量，因为在治疗过程中重要器官可以被移位并避开。从1983年2月至2003年7月，20名儿童接受了IOERT治疗，用于治疗肢体或腹部盆腔区域的局部晚期或复发性恶性肿瘤。所有患者均接受了EBRT，并接受了7.5至25 Gy的IOERT剂量，使用6 MeV至15 MeV的电子。中位随访11.6年（范围2.1至25.5年），13名患者（65%）存活且无疾病证据。接受根治性切除的患者比未实现切除的患者具有更好的局部控制率（88%对67%）和生存率（71%对33%）。在7名患者中，报告了11起3级毒性事件。随访期间未观察到>3级毒性或第二原发性恶性肿瘤。IOERT与手术和EBRT联合用于小儿实体恶性肿瘤的治疗，可提供良好的局部控制且毒性合理。IOERT应被视为小儿实体恶性肿瘤多模式治疗方案的一个组成部分，特别是对于腹部盆腔恶性肿瘤患者。
