Matsumoto K, Takahashi S, Sato A, Imaizumi M, Higano S, Sakamoto K, Asakawa H, Tada K
Department of Radiology, Tohoku University, School of Medicine, Japan.
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):913-8. doi: 10.1016/0360-3016(95)00565-g.
The main purpose of this study was to determine influential factors related to minor leukoencephalopathy (LEP) caused by moderate-dose methotrexate (MTX) and prophylactic cranial radiotherapy (CRT) in childhood hematopoietic malignancies. We also compared the incidence of LEP following this treatment to that reported in the literature following treatment with high-dose MTX alone.
Thirty-eight pediatric patients of hematopoietic malignancies (37 acute lymphoblastic leukemias, 1 non-Hodgkin lymphoma) who were given CRT (18-24 Gy) as well as prophylactic intrathecal and per os MTX were studied for leukoencephalopathy by magnetic resonance (MR) imaging. All the patients were free from grave neuropsychiatric disturbances. The data were examined to elucidate the influential ones of five factors (patients' age, doses of intrathecal and per os MTX, dose of CRT, interval between treatment, and MR study) to develop LEP using multiple regression analysis. To compare the effect of moderate-dose MTX and prophylactic CRT on LEP to that of high-dose MTX alone, we conducted literature review.
Seven out of 38 patients (18%) developed LEP. From multiple regression analysis and partial correlation coefficients, the age and CRT dose seemed influential in the subsequent development of LEP. The incidence of LEP following treatment with moderate-dose MTX and prophylactic CRT appears to be less than that reported in the literature following treatment with intravenous high-dose MTX. However, even moderate-dose MTX in combination with CRT can result in a significant incidence of MR-detectable LEP, particularly in children 6 years of age or younger receiving 24 Gy.
Leukoencephalopathy was caused by moderate-dose MTX and prophylactic CRT in pediatric patients, probably less frequently than by high-dose MTX treatment alone. The influential factors were patient's age and CRT dose.
本研究的主要目的是确定儿童造血系统恶性肿瘤中，与中等剂量甲氨蝶呤（MTX）和预防性颅脑放疗（CRT）所致轻度白质脑病（LEP）相关的影响因素。我们还将这种治疗后LEP的发生率与文献中单独使用高剂量MTX治疗后的发生率进行了比较。
对38例接受CRT（18 - 24 Gy）以及鞘内和口服MTX预防治疗的儿童造血系统恶性肿瘤患者（37例急性淋巴细胞白血病，1例非霍奇金淋巴瘤）进行磁共振（MR）成像检查以评估白质脑病。所有患者均无严重神经精神障碍。通过多元回归分析检查数据，以阐明五个因素（患者年龄、鞘内和口服MTX剂量、CRT剂量、治疗间隔和MR检查）中对发生LEP有影响的因素。为了比较中等剂量MTX和预防性CRT对LEP的影响与单独使用高剂量MTX的影响，我们进行了文献综述。
38例患者中有7例（18%）发生了LEP。通过多元回归分析和偏相关系数，年龄和CRT剂量似乎对随后LEP的发生有影响。中等剂量MTX和预防性CRT治疗后LEP的发生率似乎低于文献中静脉注射高剂量MTX治疗后的发生率。然而，即使是中等剂量MTX联合CRT也可导致MR可检测到的LEP有显著发生率，特别是在接受24 Gy照射的6岁及以下儿童中。
小儿患者的白质脑病是由中等剂量MTX和预防性CRT引起的，可能比单独使用高剂量MTX治疗的频率低。影响因素是患者年龄和CRT剂量。
