PROPHYLACTIC CRANIAL IRRADIATION DOSE EFFECTS ON LATE COGNITIVE FUNCTION IN CHILDREN TREATED FOR ACUTE LYMPHOBLASTIC-LEUKEMIA
PROPHYLACTIC CRANIAL IRRADIATION DOSE EFFECTS ON LATE COGNITIVE FUNCTION IN CHILDREN TREATED FOR ACUTE LYMPHOBLASTIC-LEUKEMIA
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DOI：
10.1016/0360-3016(92)90976-o
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发表时间：
1992-01-01
影响因子：
7
通讯作者：
ABLIN, AR
中科院分区：
文献类型：
--
作者：
HALBERG, FE;KRAMER, JH;ABLIN, AR
预防性中枢神经系统治疗显著提高了急性淋巴细胞白血病（ALL）儿童的无病生存率。 接受2400 cGy预防性颅照射的儿童记录了长期神经心理后遗症。 剂量降至1800 cGy。 现有的关于发展后果的报告，由于后续行动时间短，结果不一致。 本研究评估了接受2400 cGy与1800 cGy全脑放疗的中枢神经系统预防性治疗的白血病儿童的辐射剂量对认知功能的影响。 所有白血病儿童也接受鞘内注射甲氨蝶呤。 对照组的儿童（接受肾母细胞瘤治疗）没有接受中枢神经系统治疗。 19例接受2400 cGy治疗，16例接受1800 cGy治疗。 12名对照儿童没有接受照射。 所有患者均停止治疗至少70个月。 在随访测试时，1800 cGy和2400 cGy患者组停止治疗的时间相等（范围70-123个月）。 诊断时的平均年龄为49个月，检测时为142个月。 男女比例为1/1。 进行了标准化的心理测试。 用韦氏儿童智力量表（修订版）测量全面智商、言语智商和操作智商。 广泛成就测试评估阅读、拼写和算术能力。 接受1800 cGy治疗的儿童的表现明显优于接受2400 cGy治疗的儿童，与对照组处于同一水平。 在所有测量中，1800 cGy和2400 cGy受试者之间存在统计学显著差异。 2400名cGy患者存在智商和学习成绩缺陷。 1800 cGy患者的得分比2400 cGy儿童高约12分。 11名儿童，对照组2名，1800 cGy组2名，2400 cGy组7名，智商得分低于90。 9名接受过放射治疗的儿童中有8名在5岁之前接受过放射治疗。 这些结果表明，在接受2400 cGy的儿童中存在轻度但弥漫性的信息处理缺陷，但在接受1800 cGy的儿童中则没有。 这些结果以及至少6年的随访提供了关于ALL中CNS预防的晚期效应的新信息。 将颅RT剂量从2400 cGy降低至1800 cGy，将神经毒性降低至可接受水平。
Prophylactic central nervous system treatment has dramatically improved the disease-free survival of children with acute lymphoblastic leukemia (ALL). Long-term neuropsychological sequelae are documented in children who received 2400 cGy prophylactic cranial irradiation. The dose was reduced to 1800 cGy. Available reports on developmental consequences, with short follow-up, have yielded inconsistent results. This study assesses radiation dose effects on cognitive function in children with leukemia who received central nervous system prophylaxis with 2400 cGy versus 1800 cGy whole brain radiotherapy. All leukemic children also received intrathecal methotrexate. A control group of children (treated for Wilms' tumor) received no central nervous system therapy. Nineteen children were treated with 2400 cGy, 16 children with 1800 cGy. The 12 control children received no irradiation. All patients were off therapy for at least 70 months. The 1800 cGy and 2400 cGy patient groups were off therapy for equivalent periods of time (range 70-123 mo) at follow-up testing. Mean age at diagnosis was 49 months, at testing: 142 months. The male to female ratio was 1/1. Standardized psychological tests were administered. Full-Scale, Verbal, and Performance IQ were measured with the Wechsler Intelligence Scale for Children-Revised. Wide Range Achievement Testing evaluated reading, spelling, and arithmetic abilities. Children treated with 1800 cGy performed significantly better than those who received 2400 cGy, and at the same level as controls. There were statistically significant differences between the 1800 cGy and 2400 cGy subjects in all measures. 2400 cGy patients had deficiencies in IQ and academic performance. 1800 cGy patients scored approximately 12 points higher than 2400 cGy children. Eleven children, two in the control group, two in the 1800 cGy, and seven in the 2400 cGy group had IQ scores of less than 90. Eight of the nine irradiated children with deficits had radiotherapy before age 5. These results indicate a mild, but diffuse information processing deficit in children who received 2400cGy, but not in children who received 1800 cGy. These findings with a minimum of 6 years of follow-up provide new information on late effects of CNS prophylaxis in ALL. Reducing the cranial RT dose from 2400 cGy to 1800 cGy reduced neurotoxicity to acceptable levels.