| 侯栋梁,房彤,宋丽楠,孙保锦,陈力.儿童髓母细胞瘤术后全脑全脊髓放疗的血液学不良反应及近期疗效观察[J].中华放射医学与防护杂志,2016,36(3):198-201 |
| 儿童髓母细胞瘤术后全脑全脊髓放疗的血液学不良反应及近期疗效观察 |
| Hematological toxicity of craniospinal irradiation and the short-term clinical efficacy in medulloblastoma |
| 投稿时间：2015-08-30 |
| DOI：10.3760/cma.j.issn.0254-5098.2016.03.007 |
| 中文关键词: 髓母细胞瘤 全脑全脊髓放疗 血液学不良反应 预后 |
| 英文关键词:Medulloblastoma Craniospinal irradiation Hematological toxicity Prognosis |
| 基金项目:首都卫生发展科研专项(2011-5021-05) |
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| 中文摘要: |
| 目的 分析儿童髓母细胞瘤术后行全脑全脊髓放疗的疗效及影响预后的因素,并分析放疗期间血液学不良反应对预后的影响。方法 回顾性分析髓母细胞瘤术后行全脑全脊髓放疗的儿童87例。血液学不良反应按美国肿瘤放射治疗协作组(RTOG)早期放射反应标准评分进行评价。分析性别、年龄、肿瘤部位、手术与放疗的时间间隔、放疗间断时间以及全脑全脊髓和后颅窝的照射顺序对生存率的影响。结果 本组患者1、2、3年的总生存率(OS)分别为95.0%,92.4%和84.9%,无进展生存率(PFS)分别为93.7%,89.8%和80.8%。90.8%的患者出现2~3级的白细胞下降。70.1%的患者出现1~2级的血小板下降。1.1%的患者出现3级的血小板下降。16.1%的患者出现1~2级的血红蛋白下降,未出现3~4级的血红蛋白下降。Kaplan-Meier生存分析显示,血小板分级在0~1级和2~4级的3年PFS分别为84.1%和49.2%,差异有统计学意义(χ2=3.936, P<0.05)。血红蛋白分级在0级和1~4级的3年PFS分别为86.6%和29.1%,差异有统计学意义(χ2=10.269, P<0.05);3年OS分别为91.6%和58.2%,差异有统计学意义(χ2=9.336, P<0.05)。中断放疗时间<3 d和≥3 d的两组患者3年PFS分别为84.6%和68.6%,差异有统计学意义(χ2=4.413, P<0.05)。结论 儿童髓母细胞瘤术后行全脑全脊髓放疗期间的血液学不良反应以及由此导致的放疗中断均对预后有一定的影响。 |
| 英文摘要: |
| Objective To evaluate the hematological toxicity of craniospinal irradiation, and determine the short-term clinical efficacy and prognostic factors in medulloblastoma. Methods Eight-seven patients who underwent craniospinal irradiation were retrospectively analyzed with respect to the changes in hematology during craniospinal irradiation. The effect of sex, age, tumor location, interval between surgery and radiation, interval time during radiation and radiation sequence on survival were also studied. Results The 1, 2, 3-year overall survival (OS) and progress-free survival (PFS) rate were 95.0%, 92.4%, 84.9% and 93.7%, 89.8%, 80.8%, respectively. The incidence of 2-3 grade leucopenia was 90.8%, while the incidence of 1-2 grade thrombocytopenia was 70.1%, and the incidence of 3 grade thrombocytopenia was 1.1%. The incidence of 1-2 grade hemoglobin reduction was 16.1%. No patient had grade 3-4 hemoglobin reduction. Kaplan-Meier analysis shows that more favorable prognoses in terms of 3-year PFS were evident for 0-1 grade thrombocytopenia compared with 2-4 grade thrombocytopenia (χ2=3.936, P<0.05). And 3-year PFS and 3-year OS were evident for 0 grade hemoglobin reduction compared with 1-4 grade hemoglobin reduction (χ2=10.269, 9.336, P<0.05). The 3-year PFS between interval time during radiation<3 days and≥3 days was 84.6% and 68.6%(χ2=4.413, P<0.05). Conclusions Hematological toxicity during craniospinal irradiation and the interval time during radiation were prognostic factors. |
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