Asklid A, Nilsson M P, Engellau J, Kristensen I, Blomstrand M, Fröjd C, Agrup M, Flejmer A, Martinsson U, Svärd A-M, Almhagen E, Embring A
Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
Clin Oncol (R Coll Radiol). 2025 Jan;37:103667. doi: 10.1016/j.clon.2024.103667. Epub 2024 Oct 28.
Reirradiation is becoming more frequently used in paediatric tumours of the central nervous system (CNS). To fill the void of clinical guidelines, the Swedish Working Group of Paediatric Radiotherapy compiled consensus guidelines on reirradiation in 2019. The aim of this study was to evaluate the outcome of children reirradiated for CNS tumours since implementing the guidelines.
All children in Sweden who were reirradiated for CNS tumours between 2019 and 2023 were retrospectively analysed. Data were collected on patient and treatment characteristics, outcome, and severe side effects. Radiation treatment plans were reviewed, and cumulative doses to organs at risk at reirradiation were extracted following rigid registration.
Thirty-one patients (male 55%, female 45%) were included, and the median age at start of reirradiation was 10.2 years. The median time between primary irradiation and reirradiation was 19 months (range 2-141). The most common treatment intent at reirradiation was palliative (68%), followed by curative (32%). With a median follow-up of 8.5 months (range 0-49), the median overall survival from the end of reirradiation was 11.4 months. In the 8 patients where the treatment goal at reirradiation was symptom relief, 6 patients (75%) had relief of symptoms. The median cumulative near maximum doses (D2%) to the brain, brainstem, and chiasm/optic nerves were 71 Gy (range 44-102), 72 Gy (range 0-94), and 40 Gy (range 0-76), respectively. Following reirradiation, only 2 patients had grade ≥3 side effects. One with transient neurological deficit and one with rapid onset of blindness that persisted.
The implementation of national guidelines has harmonised the way paediatric patients are reirradiated for CNS tumours in Sweden. A structured follow-up shows that severe side effects are rare despite high cumulative doses to organs at risk, and that reirradiation can offer relief of symptoms and/or local control for selected patients.
再程放疗在儿童中枢神经系统（CNS）肿瘤中的应用越来越频繁。为填补临床指南的空白，瑞典儿科放疗工作组于2019年编制了关于再程放疗的共识指南。本研究的目的是评估自实施该指南以来接受CNS肿瘤再程放疗儿童的治疗结果。
对2019年至2023年间在瑞典接受CNS肿瘤再程放疗的所有儿童进行回顾性分析。收集患者和治疗特征、治疗结果及严重副作用的数据。审查放射治疗计划，并在严格配准后提取再程放疗时危及器官的累积剂量。
纳入31例患者（男性55%，女性45%），再程放疗开始时的中位年龄为10.2岁。初次放疗与再程放疗的中位间隔时间为19个月（范围2 - 141个月）。再程放疗最常见的治疗目的是姑息性治疗（68%），其次是根治性治疗（32%）。中位随访时间为8.5个月（范围0 - 49个月），再程放疗结束后的中位总生存期为11.4个月。在8例再程放疗治疗目的为缓解症状的患者中，6例（75%）症状得到缓解。脑、脑干及视交叉/视神经的中位累积接近最大剂量（D2%）分别为71 Gy（范围44 - 102 Gy）、72 Gy（范围0 - 94 Gy）和40 Gy（范围0 - 76 Gy）。再程放疗后，仅2例患者出现≥3级副作用。1例出现短暂神经功能缺损，1例迅速失明且持续存在。
国家指南的实施使瑞典儿童CNS肿瘤再程放疗的方式趋于统一。结构化随访显示，尽管危及器官的累积剂量较高，但严重副作用罕见，且再程放疗可为部分患者缓解症状和/或实现局部控制。
