Mandell L, Ghavimi F, Peretz T, LaQuaglia M, Exelby P
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
J Clin Oncol. 1990 Sep;8(9):1536-42. doi: 10.1200/JCO.1990.8.9.1536.
In an attempt to evaluate the radiocurability of microscopic disease in childhood rhabdomyosarcoma (RMS) with total tumor doses of less than 4,000 cGy, we performed a retrospective analysis of all patients with microscopic residual RMS who were treated at the Memorial Sloan-Kettering Cancer Center (MSKCC) during the years 1970 to 1987. There were 32 patients ranging in age from 3 months to 22 years (median, 6 years) with microscopic residual of either (1) a localized primary tumor (MSKCC, stage IB; Intergroup Rhabdomyosarcoma Study [IRS] group IIA), 19 patients; or (2) an involved lymph node region with the primary tumor completely resected (MSKCC stage III; IRS group IIC), 13 patients. Twenty-nine of the 32 patients presented with embryonal histology. All patients were treated with combination chemotherapy (CT) and megavoltage external beam radiotherapy (RT). The RT was delivered in either conventional fractionation of 180 to 200 cGy daily (30 patients) or hyperfractionation of 150 cGy twice daily (two patients). Fifteen patients received RT doses of less than 4,000 cGy with a range of 3,000 to 3,600 cGy and a median value of 3,100 cGy; 17 patients received 4,000 cGy or more with a range of 4,000 to 6,000 cGy and a median value of 4,600 cGy. With a median follow-up of 11 years, the relapse-free survival was 25 of 32 patients (less than 4,000 cGy, 12 of 15; greater than or equal to 4,000 cGy, 13 of 17). The RT local control rate was 30 of 32 (less than 4,000 cGy, 14 of 15; greater than or equal to 4,000 cGy, 16 of 17 [P = .94]). Our results suggest that radiation doses of below 4,000 cGy, when combined with effective multiagent CT, may be sufficient for local control of microscopic disease in childhood embryonal RMS.
为了评估总肿瘤剂量低于4000 cGy时儿童横纹肌肉瘤（RMS）微小病灶的放射可治愈性，我们对1970年至1987年期间在纪念斯隆 - 凯特琳癌症中心（MSKCC）接受治疗的所有微小残留RMS患者进行了回顾性分析。共有32例患者，年龄从3个月至22岁（中位数为6岁），存在以下两种微小残留情况之一：（1）局限性原发性肿瘤（MSKCC分期IB；横纹肌肉瘤协作组研究[IRS]IIA组），19例患者；或（2）原发性肿瘤完全切除后的受累淋巴结区域（MSKCC III期；IRS IIC组），13例患者。32例患者中有29例为胚胎组织学类型。所有患者均接受了联合化疗（CT）和兆伏级外照射放疗（RT）。放疗采用每日180至200 cGy的常规分割方式（30例患者）或每日两次每次150 cGy的超分割方式（2例患者）。15例患者接受的放疗剂量低于4000 cGy，范围为3000至3600 cGy，中位数为3100 cGy；17例患者接受4000 cGy或更高剂量，范围为4000至6000 cGy，中位数为4600 cGy。中位随访11年时，32例患者中有25例无复发生存（低于4000 cGy组，15例中有12例；大于或等于4000 cGy组，17例中有13例）。放疗局部控制率为32例中的30例（低于4000 cGy组，15例中有14例；大于或等于4000 cGy组，17例中有16例[P = 0.94]）。我们的结果表明，当与有效的多药联合CT相结合时，低于4000 cGy的放疗剂量可能足以局部控制儿童胚胎性RMS的微小病灶。
