预防性照射对儿童急性淋巴细胞白血病中枢神经系统的影响。

Effects of prophylactic irradiation of acute lymphoblastic leukemia in the central nervous system of children.

作者信息

Sanuki E, Kamata R, Satoh K, Kumagai Y, Hashiba M, Takashima H, Saitoh T, Inana I, Fujii H

出版信息

Radiat Med. 1984 Jan-Mar;2(1):76-83.

Abstract

The development of prophylactic therapy for acute lymphoblastic leukemia (ALL) in the central nervous system in children has resulted in an improvement of the prognosis and prolongation of patients' lives. On the other hand, late irradiation effects have increased with the improvement of the prognosis. Therefore, there is now an important need to lessen these late effects without deteriorating the prognosis. We have investigated the recurrence rate, the survival rate and the cause of death of ALL patients who were divided into a none prophylactic irradiation group and 15 Gy, 20 Gy and 24 Gy irradiation groups. The results show that the effect of prophylactic irradiation has been more effective in the 20 Gy group than that of the 24 Gy group. Furthermore, brain atrophy and leukoencephalopathy, which were investigated by X-ray CT in long-term survivors of post-prophylactic irradiation without recurrence, have been less in the 20 Gy group than in that of the 24 Gy group. This report presents the result that the most favorable dose for prophylactic irradiation for central nervous system leukemia of ALL in children is 20 Gy by a step-up method.

摘要

儿童急性淋巴细胞白血病（ALL）中枢神经系统预防性治疗的发展已使预后得到改善，患者寿命得以延长。另一方面，随着预后的改善，晚期放疗效应有所增加。因此，目前迫切需要在不恶化预后的情况下减轻这些晚期效应。我们对分为非预防性照射组以及15 Gy、20 Gy和24 Gy照射组的ALL患者的复发率、生存率和死亡原因进行了调查。结果表明，预防性照射在20 Gy组比24 Gy组更有效。此外，在无复发的预防性照射后的长期存活者中，通过X线CT检查发现的脑萎缩和白质脑病在20 Gy组比24 Gy组更少。本报告呈现的结果是，采用逐步递增法，儿童ALL中枢神经系统白血病预防性照射的最适剂量为20 Gy。