Ducassou Anne, Gambart Marion, Munzer Caroline, Padovani Laetitia, Carrie Christian, Haas-Kogan Daphne, Bernier-Chastagner Valérie, Demoor Charlotte, Claude Line, Helfre Sylvie, Bolle Stéphanie, Leseur Julie, Huchet Aymeri, Rubie Hervé, Valteau-Couanet Dominique, Schleiermacher Gudrun, Coze Carole, Defachelles Anne-Sophie, Marabelle Aurélien, Ducassou Stéphane, Devalck Christine, Gandemer Virginie, Munzer Martine, Laprie Anne
Département de radiothérapie, Institut Claudius Regaud, 31059, Toulouse, France,
Strahlenther Onkol. 2015 Jul;191(7):604-12. doi: 10.1007/s00066-015-0837-z. Epub 2015 Apr 21.
Neuroblastoma (NB) is the most frequent indication for extracranial pediatric radiotherapy. As long-term survival of high-risk localized NB has greatly improved, we reviewed treatment-related late toxicities in pediatric patients who received postoperative radiotherapy (RT) for localized NB within two French prospective clinical trials: NB90 and NB94.
From 1990-2000, 610 children were enrolled. Among these, 35 were treated with induction chemotherapy, surgery, and RT. The recommended RT dose was 24 Gy at ≤ 2 years, 34 Gy at > 2 years, ± a 5 Gy boost in both age groups.
The 22 patients still alive after 5 years were analyzed. The median follow-up time was 14 years (range 5-21 years). Late effects after therapy occurred in 73 % of patients (16/22), within the RT field for 50 % (11/22). The most frequent in-field effects were musculoskeletal abnormalities (n = 7) that occurred only with doses > 31 Gy/1.5 Gy fraction (p = 0.037). Other effects were endocrine in 3 patients and second malignancies in 2 patients. Four patients presented with multiple in-field late effects only with doses > 31 Gy.
After a median follow-up of 14 years, late effects with multimodality treatment were frequent. The most frequent effects were musculoskeletal abnormalities and the threshold for their occurrence was 31 Gy.
神经母细胞瘤（NB）是儿童颅外放疗最常见的适应症。随着高危局限性NB的长期生存率显著提高，我们在两项法国前瞻性临床试验（NB90和NB94）中，回顾了接受局限性NB术后放疗（RT）的儿科患者的治疗相关晚期毒性。
1990年至2000年，共纳入610名儿童。其中，35名接受了诱导化疗、手术和放疗。推荐的放疗剂量为2岁及以下儿童24Gy，2岁以上儿童34Gy，两个年龄组均±5Gy的增强剂量。
对5年后仍存活的22例患者进行分析。中位随访时间为14年（范围5 - 21年）。73%（16/22）的患者出现治疗后的晚期效应，其中50%（11/22）发生在放疗区域内。最常见的放疗区域内效应是肌肉骨骼异常（n = 7），仅在剂量>31Gy/1.5Gy分次时出现（p = 0.037）。其他效应包括3例内分泌问题和2例第二原发恶性肿瘤。4例患者仅在剂量>31Gy时出现多个放疗区域内晚期效应。
中位随访14年后，多模式治疗后的晚期效应很常见。最常见的效应是肌肉骨骼异常，其发生阈值为31Gy。
