Mak Kimberley S, Lee Stephanie W, Balboni Tracy A, Marcus Karen J
Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA.
Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA.
Pediatr Blood Cancer. 2018 Jan;65(1). doi: 10.1002/pbc.26764. Epub 2017 Aug 29.
Few reports of palliative radiotherapy (RT) for pedialltric malignancies have been published. We described clinical indications, outcomes, and toxicities for children who received palliative RT.
Pediatric patients (age ≤18 years) treated with palliative RT for incurable cancer from January 1 2008 to February 26, 2014 were included. Diagnosis, details of RT, treatment response, toxicity, and survival were retrospectively reviewed.
Forty-six patients received 76 RT courses. Fifteen patients (33%) had ≥2 courses. Median age at palliative RT was 10.3 years; 54% were male. The most common diagnoses were neuroblastoma (20%) and diffuse intrinsic pontine glioma (17%). The most common indications for RT were oligometastatic disease in asymptomatic patients (39%) and pain (25%). The most common treatment sites were brain (32%) and bone (29%). Median RT dose was 30 Gy. Median number of RT fractions was 12. Sixty-five treatment courses (86%) were delivered with fraction sizes ≥2.5 Gy. Twenty-seven treatment courses (36%) were given under general anesthesia. Median follow-up was 3.9 months. Grade 1-2 RT-related toxicity occurred in 21% of treatment courses and 4-8% up to 12 months after RT. Two patients had Grade 3 toxicity during RT (esophagitis). Of symptomatic patients, 91%, 73%, 58%, and 43% had improved or stable symptoms during RT and 0-3, 3-6, and 6-12 months afterwards, respectively. Median survival after palliative RT was 4.2 months. Four of 21 surviving patients (19%) had hospice care at last follow-up.
Palliative RT was well tolerated in children with incurable malignancies, with most cases associated with acceptable toxicity, and improved or stable symptoms.
关于儿童恶性肿瘤姑息性放疗（RT）的报道很少。我们描述了接受姑息性放疗的儿童的临床指征、治疗结果和毒性反应。
纳入2008年1月1日至2014年2月26日期间接受姑息性放疗以治疗无法治愈癌症的儿科患者（年龄≤18岁）。对诊断、放疗细节、治疗反应、毒性反应和生存情况进行回顾性分析。
46例患者接受了76个放疗疗程。15例患者（33%）接受了≥2个疗程的放疗。姑息性放疗时的中位年龄为10.3岁；54%为男性。最常见的诊断是神经母细胞瘤（20%）和弥漫性脑桥内生型胶质瘤（17%）。放疗最常见的指征是无症状患者的寡转移疾病（39%）和疼痛（25%）。最常见的治疗部位是脑（32%）和骨（29%）。中位放疗剂量为30 Gy。中位放疗分次次数为12次。65个治疗疗程（86%）的分次剂量≥2.5 Gy。27个治疗疗程（36%）在全身麻醉下进行。中位随访时间为3.9个月。1-2级放疗相关毒性反应出现在21%的治疗疗程中，放疗后12个月内为4%-8%。2例患者在放疗期间出现3级毒性反应（食管炎）。有症状的患者中，分别有91%、73%、58%和43%在放疗期间以及放疗后0-3个月、3-6个月和6-12个月症状改善或稳定。姑息性放疗后的中位生存期为4.2个月。21例存活患者中有4例（19%）在最后一次随访时接受了临终关怀。
无法治愈的恶性肿瘤患儿对姑息性放疗耐受性良好，大多数病例的毒性反应可接受，且症状改善或稳定。
