A comparative study of central nervous system irradiation and intensive chemotherapy early in remission of childhood acute lymphocytic leukemia
A comparative study of central nervous system irradiation and intensive chemotherapy early in remission of childhood acute lymphocytic leukemia
复制标题
儿童急性淋巴细胞白血病早期缓解中枢神经系统放疗与强化化疗的对比研究
作者：
R. Aur;J. Simone;H. Hustu;M. Verzosa
一项研究旨在确定为期一周的强化化疗和2400拉德颅脊髓照射是否延长了儿童急性淋巴细胞白血病（ALL）的完全缓解。在入组研究的110例患者中，104例（94%）达到完全缓解，其中94例可用于2次随机化。他们被随机分配接受或不接受一周的高剂量静脉化疗，4周后，再次随机接受或不接受2400拉德钴-60颅脊髓照射。仅当发生中枢神经系统（CNS）白血病时，随机分配不接受放疗的患者才接受相同的放疗。一周的强化化疗对缓解期、复发频率或复发部位没有影响，但放射治疗有显著效果。45名接受“预防性”颅脊髓照射的儿童中只有2名完全缓解，而49名未接受照射的儿童中有27名完全缓解。25名接受治疗性放射治疗的中枢神经系统白血病患儿中有5名尽管血液学持续缓解，但已经复发。在本研究的条件下，我们得出结论，一周的强化化疗并不能延长缓解期，缓解期早期2400拉德的颅脊髓照射可以预防或延迟CNS白血病和完全缓解，一旦CNS白血病发展，2400拉德的颅脊髓照射不足以根除它。
A study was designed to determine whether a one‐week course of intensive chemotherapy and 2400 rads craniospinal irradiation prolonged complete remission of acute lymphocytic leukemia (ALL) in children. Of 110 patients entered into the study, 104 (94%) attained complete remission, 94 of whom were available for the 2 randomizations. They were randomly assigned to receive or not receive one week of high‐dosage intravenous chemotherapy and, 4 weeks later, were again randomized to receive or not receive 2400 rads cobalt‐60 craniospinal irradiation. Patients randomized for no irradiation were to receive identical radiotherapy only if and when central nervous system (CNS) leukemia developed. The one week of intensive chemotherapy had no effect on the duration of remission or on the frequency or site of relapse, but irradiation had a marked effect. Complete remission was terminated by CNS leukemia in only 2 of 45 children who received “prophylactic” craniospinal irradiation compared to 27 of 49 not irradiated. Five of the 25 children who were given “therapeutic” irradiation for demonstrated CNS leukemia have already had recurrences despite continuous hematologic remission. Under the conditions of this study, we conclude that one week of intensive chemotherapy does not prolong remission, that 2400 rads craniospinal irradiation early in remission prevents or delays CNS leukemia and prolongs complete remission, and that once CNS leukemia develops, 2400 rads craniospinal irradiation is not sufficient to eradicate it.