Hokken-Koelega A C, van Doorn J W, Hählen K, Stijnen T, de Muinck Keizer-Schrama S M, Drop S L
Department of Pediatrics, Sophia Children's Hospital/Erasmus University, Rotterdam, The Netherlands.
Pediatr Res. 1993 Jun;33(6):577-82. doi: 10.1203/00006450-199306000-00008.
We investigated the comparative effect on long-term growth of CNS prophylactic treatment for acute lymphoblastic leukemia (ALL) with either 25-Gy cranial irradiation or moderate-dose i.v. methotrexate. In 80 children with complete continuous first remission, data on growth and pubertal development were investigated up to 11 y from ALL diagnosis. Forty patients had 25-Gy cranial irradiation, 16 of them with high-risk factors and 24 without. Another 40 non-high-risk ALL patients had moderate-dose methotrexate. Chemotherapy lasted 3 1/4 y for high-risk ALL patients and 2 1/4 y for those not at high risk. Pubertal development and final height were assessed separately for girls diagnosed before or after age 7 and for boys before or after age 9. All patients had a similar decline in height SD score during the first 6 mo of treatment, which persisted in irradiated children only. The nonirradiated group had no further decline. Catch-up growth only started when chemotherapy ended for irradiated and non-irradiated patients alike. Five y after cessation of treatment, changes in height SD score for nonirradiated children remained within the range for healthy children against a significant decline in height SD scores for irradiated children. Pubertal development in irradiated girls diagnosed before age 7 was within normal range, but their final height was disappointing due to a blunted growth spurt. In contrast, irradiated girls diagnosed later had a delayed onset of puberty but satisfactory final height. Comparable results were found in boys.(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了25Gy颅脑照射或中等剂量静脉注射甲氨蝶呤对急性淋巴细胞白血病（ALL）进行中枢神经系统预防性治疗的长期生长的比较效果。在80例首次完全持续缓解的儿童中，从ALL诊断开始至11年，对生长和青春期发育数据进行了调查。40例患者接受了25Gy颅脑照射，其中16例有高危因素，24例无高危因素。另外40例非高危ALL患者接受了中等剂量甲氨蝶呤治疗。高危ALL患者化疗持续3 1/4年，非高危患者化疗持续2 1/4年。分别对7岁之前或之后诊断的女孩以及9岁之前或之后诊断的男孩的青春期发育和最终身高进行评估。所有患者在治疗的前6个月身高标准差评分均有类似下降，且仅在接受照射的儿童中持续存在。未接受照射的组没有进一步下降。仅当照射和未照射患者的化疗结束时，追赶生长才开始。治疗停止5年后，未接受照射儿童的身高标准差评分变化仍在健康儿童范围内，而接受照射儿童的身高标准差评分则显著下降。7岁之前诊断的接受照射女孩的青春期发育在正常范围内，但由于生长突增减弱，她们的最终身高令人失望。相比之下，后来诊断的接受照射女孩青春期开始延迟，但最终身高令人满意。在男孩中也发现了类似结果。（摘要截断于250字）
