Leavey P J, Odom L F, Poole M, McNeely L, Tyson R W, Haase G M
Children's Hospital, Denver, CO 80218, USA.
Med Pediatr Oncol. 1997 Jun;28(6):424-8. doi: 10.1002/(sici)1096-911x(199706)28:6<424::aid-mpo6>3.0.co;2-i.
External beam irradiation (EBRT) has been shown to improve response rates and event-free survival in children with neuroblastoma and regional lymph node metastases. Irradiation during surgical exposure (intra-operative radiotherapy, IORT) with displacement of adjacent radiosensitive organs out of the treatment field allows for more precise delineation of the target volume and significantly reduces the amount of normal tissue exposed to irradiation. We have incorporated IORT into the treatment regimen of 24 children with neuroblastoma between the years of 1983-1991. IORT was directed to any residual tumor or the tumor bed; the median dose of radiation was 1,000 cGY, equivalent to 3,000 cGY of conventional EBRT. There were 11 males and 13 females. Two patients had stage II, 12 patients had stage III, and 10 patients had stage IV disease. Ten children received IORT for suspected recurrent or persistent neuroblastoma. Twelve patients were disease-free survivors following IORT with a median follow-up of 54 months. For those patients with stage III disease, seven children were disease-free survivors, while only three of 10 patients with stage IV disease survived (median follow-up 30 months). Disease-free Survival (DFS) correlated with the achievement of local tumor control in children with both stage III and IV neuroblastoma. There was limited morbidity and no episodes of obstructive uropathy were encountered. We conclude that IORT appears to be well tolerated and may have therapeutic benefit for a select group of patients with neuroblastoma. IORT merits future exploration by prospective study.
体外照射（EBRT）已被证明可提高神经母细胞瘤并伴有区域淋巴结转移患儿的缓解率和无事件生存率。在手术暴露期间进行照射（术中放疗，IORT），将相邻的放射敏感器官移出治疗区域，这样可以更精确地划定靶体积，并显著减少接受照射的正常组织量。我们在1983年至1991年间将IORT纳入了24例神经母细胞瘤患儿的治疗方案中。IORT针对任何残留肿瘤或肿瘤床；中位辐射剂量为1000 cGY，相当于3000 cGY的传统EBRT。其中男性11例，女性13例。2例患者为II期，12例患者为III期，10例患者为IV期疾病。10名儿童因疑似复发性或持续性神经母细胞瘤接受IORT治疗。12例患者在IORT后成为无病生存者，中位随访时间为54个月。对于III期疾病的患者，7名儿童为无病生存者，而IV期疾病的10名患者中只有3名存活（中位随访30个月）。无病生存（DFS）与III期和IV期神经母细胞瘤患儿局部肿瘤控制的实现相关。发病率有限，未遇到梗阻性尿路病发作。我们得出结论，IORT似乎耐受性良好，可能对特定组的神经母细胞瘤患者具有治疗益处。IORT值得通过前瞻性研究进行未来探索。
