Long-term effects in children treated with radiotherapy for head and neck rhabdomyosarcoma
Long-term effects in children treated with radiotherapy for head and neck rhabdomyosarcoma
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DOI：
10.1016/s0360-3016(00)00799-9
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发表时间：
2000-12-01
影响因子：
7
通讯作者：
Wen, BC
中科院分区：
文献类型：
--
作者：
Paulino, AC;Simon, JH;Wen, BC
目的：探讨儿童头颈部横纹肌肉瘤放疗的远期疗效。方法：1967年至1994年，某机构共30例头颈部横纹肌肉瘤儿童接受兆电压放疗。 17 名患者 (57%) 幸存并进行了至少 5 年的随访。其中男性 11 例，女性 6 例，放疗时中位年龄 5.7 岁（范围 2.2-11.6）。肿瘤位置为眼眶6例，颞下窝4例，鼻旁窦2例，声门上喉2例；鼻咽、翼腭窝和腮腺是其余儿童的部位。除 2 名患者外，所有患者均患有胚胎组织学肿瘤。组间横纹肌肉瘤研究 (IRS) 组中 2 名儿童为 I 组，3 名儿童为 II 组，11 名儿童为 III 组； 1例患者单纯手术后肿瘤复发。放射治疗体积为原发肿瘤或瘤床 13 例，肿瘤和全脑 3 例，肿瘤和颅脊髓轴 1 例。原发部位的中位放疗剂量为 5,040 cGy（范围 4,140-6,500），全脑为 3,000 cGy。除 1 例外，其余均采用 150-200-cGy 分数进行治疗； 1 名患者因喉部肿瘤接受了 250 cGy 剂量治疗。 10 例患者采用长春新碱 (V)、放线菌素 D (A) 和环磷酰胺 (C) 化疗，2 例采用 VAC + 阿霉素，1 例采用 VA，1 例采用 VA + 异环磷酰胺，1 例采用 VC + 阿霉素，2 例不采用化疗。 1 例患者接受了由顺铂和依托泊苷组成的挽救化疗。中位随访时间为 20 年（范围 7.5-33）。结果：所有患者均出现治疗后期效应，包括 11 例患者出现面部生长迟缓、9 例患者出现神经内分泌功能障碍、9 例患者出现视觉/眼眶问题、7 例患者出现牙齿异常、6 例患者听力丧失、3 例患者出现甲状腺功能减退。3 例接受全脑放疗的患者出现智力和学业迟缓。虽然神经内分泌、甲状腺、牙科和认知后遗症主要归因于放疗，但听力损失被认为是肿瘤破坏以及其中一例顺铂化疗的直接结果。放疗后10年或10年以上的晚期效应很少，但很严重，包括软骨坏死、食管狭窄、第二恶性肿瘤和脑出血。结论：接受头颈部横纹肌肉瘤放疗的儿童治疗的晚期效应很常见。尽管放射治疗是神经内分泌、牙齿、甲状腺和认知毒性的重要原因，但它通常与听力损失无关。治疗超过 10 年的迟发毒性并不像治疗 10 年内发生的那样频繁。 (C) 2000 爱思唯尔科学公司。
Purpose: To examine the long-term effects of treatment in children receiving radiotherapy for head and neck rhabdomyosarcoma.Methods: From 1967 to 1994, a total of 30 children with head and neck rhabdomyosarcoma received megavoltage radiotherapy at one institution. Seventeen patients (57%) have survived and have at least a 5-year follow-up. There were 11 males and 6 females, with a median age of 5.7 years (range 2.2-11.6) at the time of radiotherapy. Tumor location was orbit in 6 patients, infratemporal fossa in 4, paranasal sinuses in 2, and supraglottic larynx in 2; the nasopharynx, pterygopalatine fossa, and parotid gland were sites for the remaining children. All but 2 patients had tumors of embryonal histology. The Intergroup Rhabdomyosarcoma Study (IRS) Group was I in 2, II in 3, and III in 11 children; 1 patient had a recurrent tumor after surgery alone. Radiotherapy volume was the primary tumor or tumor bed in 13, tumor and whole brain in 3, and tumor and craniospinal axis in 1. Median radiotherapy dose to the primary site was 5,040 cGy (range 4,140-6,500) and to the whole brain was 3,000 cGy. All but 1 were treated with 150-200-cGy fractions; 1 patient received 250-cGy fractions for a tumor in the larynx. Chemotherapy was vincristine (V), actinomycin-D (A), and cyclophosphamide (C) in 10 patients, VAC + adriamycin in 2, VA in 1, VA + ifosfamide in 1, VC + adriamycin in 1, and none in 2. One patient had salvage chemotherapy consisting of cisplatin and etoposide. Median follow-up time was 20 years (range 7.5-33).Results: Late effects of treatment were seen in all patients and included facial growth retardation in 11, neuroendocrine dysfunction in 9, visual/orbital problems in 9, dental abnormalities in 7, hearing loss in 6, and hypothyroidism in 3. Intellectual and academic delays were documented in 3 patients who had received whole brain radiotherapy. While neuroendocrine, thyroid, dental, and cognitive sequelae were primarily attributed to radiotherapy, hearing loss was thought to be a direct result of tumor destruction and, in 1 case, cisplatin chemotherapy. Late effects at or beyond 10 years from radiotherapy were few, but severe, and included chondronecrosis, esophageal stenosis, second malignancy, and brain hemorrhage.Conclusion: Late effects of treatment in children receiving radiotherapy for head and neck rhabdomyosarcoma are frequent. Although radiotherapy is a significant contributor of neuroendocrine, dental, thyroid, and cognitive toxicity, it is not usually implicated with hearing loss. Late toxicity of treatment beyond 10 years is not as frequent as those occurring within 10 years of therapy. (C) 2000 Elsevier Science Inc.