Packer R J, Zimmerman R A, Kaplan A, Wara W M, Rorke L B, Selch M, Goldwein J, Allen J A, Boyett J, Albright A L
Children's National Medical Center, Department of Neurology, Washington, DC.
Cancer. 1993 Apr 15;71(8):2666-74. doi: 10.1002/1097-0142(19930415)71:8<2666::aid-cncr2820710836>3.0.co;2-k.
A higher total dose of radiation therapy administered in fractionated lower individual doses twice daily (hyperfractionated radiation therapy) has been reported to improve survival for children with brain stem gliomas. However, this higher dose of radiation therapy may cause more sequelae.
Eighty-eight children with brain stem gliomas were treated with 100 cGy twice daily to a total dose of 7200 cGy. Patients were carefully followed up for treatment-related clinical or radiographic worsening.
Thirteen (15%) had intralesional cystic/necrotic changes within 8 weeks of completion of treatment. Children with these changes had a variable clinical course, including steady deterioration in one child; initial improvement, followed by progressive deterioration in three; and initial improvement, followed by deterioration, with subsequent improvement or prolonged stabilization of condition without additional antineoplastic treatment in nine.
This latter "triphasic" course suggests that "early" worsening after hyperfractionated radiation therapy at 7200 cGy may be a sequelae of therapy, rather than a symptom of progressive tumor growth. This has substantial implications for patient care and evaluation of the efficacy of treatment.
据报道，对于脑干胶质瘤患儿，每日两次以较低的单次剂量进行分割照射（超分割放射治疗）的总辐射剂量更高，可提高生存率。然而，这种更高剂量的放射治疗可能会导致更多后遗症。
88例脑干胶质瘤患儿接受每日两次100厘戈瑞的照射，总剂量达7200厘戈瑞。对患者进行密切随访，观察与治疗相关的临床或影像学恶化情况。
13例（15%）在治疗结束后8周内出现瘤内囊性/坏死性改变。有这些改变的患儿临床病程各异，包括1例患儿病情持续恶化；3例患儿最初病情改善，随后逐渐恶化；9例患儿最初病情改善，随后恶化，之后病情改善或长期稳定，无需额外的抗肿瘤治疗。
后一种“三相”病程表明，7200厘戈瑞超分割放射治疗后的“早期”恶化可能是治疗的后遗症，而非肿瘤进展性生长的症状。这对患者护理和治疗效果评估具有重要意义。
