Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain.
Pediatric Oncology Department, University Hospital Virgen del Rocío, Seville, Spain.
Clin Transl Oncol. 2023 Mar;25(3):786-795. doi: 10.1007/s12094-022-02987-5. Epub 2022 Nov 7.
The objective of this study was to evaluate the renal and hematologic toxicity in paediatric patients with adrenal high-risk neuroblastoma who have received radiation therapy (RT) as part of radical treatment.
Pediatric patients diagnosed with high-risk adrenal neuroblastoma who received RT as part of the definitive treatment between January 2004 and May 2020 in a single institution were selected. Complete blood counts (CBC) and creatinine clearance (CrCl) pre-RT and post-RT were compared through the Wilcoxon signed-rank test and correlated with survival analysis by Cox regression.
Forty-two children with a median age of 3 years at diagnosis and 2.8 years of follow-up were selected. A significant and acute decrease in lymphocytes was found (p = 0.002) 1 month from RT. Patients with a drop higher than 50% of the previous value experimented a significant reduction in overall survival (55 vs 10%; p = 0.031). At the end of the follow-up, a significant increase in all blood counts was observed. With respect to renal function, an acute and significant decrease in CrCl was observed tin patients younger than 4 years who received RT (p = 0.013). However, it was not clinically relevant.
Our data suggest that acute lymphopenia occurs after RT and could be associated with a poorer prognosis. Other blood counts are reduced after RT and all of them are in physiological range at the end of follow-up. Our cohort presented excellent renal outcomes without any case of chronic renal dysfunction.
本研究旨在评估接受根治性治疗中放射治疗（RT）的高危神经母细胞瘤患儿的肾和血液毒性。
选择 2004 年 1 月至 2020 年 5 月在一家机构诊断为高危肾上腺神经母细胞瘤并接受 RT 作为确定性治疗一部分的儿科患者。通过 Wilcoxon 符号秩检验比较 RT 前后的全血细胞计数（CBC）和肌酐清除率（CrCl），并通过 Cox 回归进行相关性生存分析。
共选择了 42 名中位年龄为 3 岁诊断和 2.8 年随访的儿童。在 RT 后 1 个月发现淋巴细胞显著且急性减少（p=0.002）。与前值相比下降超过 50%的患者经历了总生存率的显著降低（55%比 10%；p=0.031）。在随访结束时，所有血细胞计数均显著增加。就肾功能而言，接受 RT 的年龄小于 4 岁的患者 CrCl 急性显著下降（p=0.013）。但是，这并没有临床意义。
我们的数据表明，RT 后会发生急性淋巴细胞减少，并且可能与预后较差相关。RT 后其他血细胞计数减少，随访结束时均在生理范围内。我们的队列没有发生慢性肾功能障碍的病例，结果良好。
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