Primary management of disseminated neuroblastoma by sequential segmental irradiation.
Primary management of disseminated neuroblastoma by sequential segmental irradiation.
复制标题
通过序贯分段照射对播散性神经母细胞瘤进行初级治疗。
作者：
R. S. Sagerman
初步评估时，哥伦比亚-长老会医学中心儿科联合肿瘤诊所就诊的患者中有 55% (31/56) 患有广泛播散性神经母细胞瘤 (1)。这31人中只有4人存活超过三年。尽管手术、放疗和化疗充满希望，但没有任何化疗方案或联合方案能给出令人满意或可重复的结果。我们无法解释为什么这四个人表现良好，只能依靠自发进化理论，在十二个月以下婴儿的全身化疗和局部放疗的帮助下，走向更成熟和良性的过程。没有一岁以上的儿童通过原发肿瘤部位的局部放疗加全身化疗而获救。适度辐射剂量影响局部肿瘤控制的能力已得到充分证明 (1, 2)。化学试剂可能会杀死数个细胞，但由于细胞受损，大量细胞可能免受药物侵害。
At initial evaluation 55 per cent (31/56) of the patients seen in the Pediatric Combined Tumor Clinic of the Columbia-Presbyterian Medical Center had widely disseminated neuroblastoma (1). Only 4 of these 31 have survived more than three years. Although surgery, radiotherapy, and chemotherapy were employed with hope, no chemotherapeutic regimen or combined program gave satisfactory or reproducible results. We are at a loss to explain why these 4 did well, other than to rely on the theory of spontaneous evolution toward a more mature and benign process, aided by systemic chemotherapy and local radiotherapy in infants under the age of twelve months. No child older than one year has been salvaged by local radiotherapy to the site of the primary tumor plus systemic chemotherapy. The ability of modest radiation doses to effect local tumor control has been amply demonstrated (1, 2). Chemical agents may kill several logs of cells but many cells in a mass may be protected from the drug by virtue of an impaired bl...