Selch M T, Parker R G
Department of Radiation Oncology, UCLA Center for the Health Sciences 90024.
Med Pediatr Oncol. 1990;18(2):97-102. doi: 10.1002/mpo.2950180203.
Twenty-two patients with Langerhans cell histiocytosis (LCH) were managed in the UCLA Department of Radiation Oncology from 1974 to 1987. Their median age was 17 years (range 1-42 years) and median followup 4.5 years (range 1-13 years). Fourteen patients had disease localized to a bone (13) or a soft tissue (one). Eight patients had LCH involving multiple bones (3) or soft tissues plus bones (5). Nine of 10 patients less than 19 years old had disease confined to bone(s) compared to 7 of 12 older patients. Fifty-six sites of LCH (40 bone, 16 soft tissue) were irradiated. Pediatric patients received therapy to 15 sites (14 bone, 1 soft tissue) and adults 41 sites (26 bone, 15 soft tissue). Median dose for bone lesions was 900 cGy (range 600-1,500) and for soft tissue 1,500 cGy (range 600-2,600). Local control was achieved in 46 of 56 sites (82%). Control rates for bone and soft tissue lesions were 35 of 40 (88%) and 11 of 16 (69%), respectively. Fifteen of 15 sites in pediatric patients were controlled compared to 29 of 41 (72%) in adults. Ten sites (18%) recurred 10 months to 4 years after irradiation. Recurrences were in-field and noted only in adults with involvement of multiple soft tissues plus bones. All recurrent soft tissue lesions had been treated with orthovoltage. Five patients developed new foci of LCH subsequent to irradiation. Four of these patients had disease involving soft tissues and bones. One patient with progressive LCH initially presented with a single bone lesion. The acute and chronic effects of radiation therapy were minimal. One patient suffered transient enlargement of adenopathy. An elevated serum TSH level was detected 9 years after irradiation of a cervical vertebra in another patient.
1974年至1987年期间，加州大学洛杉矶分校放射肿瘤学系对22例朗格汉斯细胞组织细胞增多症（LCH）患者进行了治疗。他们的中位年龄为17岁（范围1 - 42岁），中位随访时间为4.5年（范围1 - 13年）。14例患者的疾病局限于骨骼（13例）或软组织（1例）。8例患者的LCH累及多块骨骼（3例）或软组织加骨骼（5例）。10例年龄小于19岁的患者中有9例疾病局限于骨骼，而12例年龄较大的患者中有7例。共对56个LCH部位（40个骨骼部位、16个软组织部位）进行了放射治疗。儿科患者接受治疗的部位有15个（14个骨骼部位、1个软组织部位），成人有41个部位（26个骨骼部位、15个软组织部位）。骨骼病变的中位剂量为900 cGy（范围600 - 1500），软组织为1500 cGy（范围600 - 2600）。56个部位中有46个（82%）实现了局部控制。骨骼和软组织病变的控制率分别为40个中的35个（88%）和16个中的11个（69%）。儿科患者的15个部位全部得到控制，而成人41个部位中有29个（72%）得到控制。10个部位（18%）在放疗后10个月至4年复发。复发发生在照射野内，仅见于累及多个软组织加骨骼的成人患者。所有复发性软组织病变均接受了深部X线治疗。5例患者在放疗后出现了新的LCH病灶。其中4例患者的疾病累及软组织和骨骼。1例进行性LCH患者最初表现为单个骨骼病变。放射治疗的急性和慢性影响极小。1例患者出现淋巴结短暂肿大。另1例患者在颈椎放疗9年后检测到血清促甲状腺激素水平升高。
