Clinical investigations in the treatment of meningeal leukemia: radiation therapy regimens vs. conventional intrathecal methotrexate.
Clinical investigations in the treatment of meningeal leukemia: radiation therapy regimens vs. conventional intrathecal methotrexate.
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脑膜白血病治疗的临床研究：放射治疗方案与传统鞘内甲氨蝶呤。
DOI：
10.1182/blood.v34.3.301.301
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发表时间：
1969
期刊：
影响因子：
20.3
通讯作者：
W. L. Watkins
中科院分区：
文献类型：
--
作者：
Margaret P. Sullivan;Teresa J. Vietti;Teresa J. Vietti;Donald J. Fernbach;Kenneth M. Griffith;Theresa B. Haddy;W. L. Watkins;W. L. Watkins
1.使用IT MTX作为CNS白血病的标准疗法，由西南癌症化疗研究组的儿科部门确定了三种放射治疗方案和联合放射-IT MTX方案的比较有效性。2. IT MTX，0.5 mg/ Kg.每隔2-3天，直到脊髓液单核细胞计数降至10个/mm 3或更低，在51名首次发生CNS白血病的儿童中，78%的脊髓液缓解。缓解持续时间范围为6-414天（中位数87天）。这些数字与先前报告的IT抗真菌治疗相当。3.使用500 rads和1000 rads的肿瘤剂量对整个颅骨进行放射治疗对CSF正常化无效，尽管症状通常得到缓解。4.使用1000拉德的肿瘤剂量对整个脑脊液轴进行辐射，导致92%的脊髓液缓解率，缓解持续13-527天（中位数52天）。在接受放射治疗时，七分之六的骨髓缓解儿童表现出骨髓抑制的证据。5.一个联合治疗方案，两次注射MTX前辐射的整个脑脊液轴（750-1000拉德肿瘤剂量的儿童在骨髓缓解和250-500拉德肿瘤剂量的儿童在骨髓复发）和一次注射MTX鞘内辐射后导致脊髓液缓解100%的可评估的儿童在治疗组。94%的儿童症状缓解。然而，缓解的持续时间与常规IT MTX治疗相似。骨髓抑制的证据出现在一半的儿童在骨髓缓解。6.当考虑以下参数时，没有一种放射方案上级IT MTX：（1）CNS缓解的持续时间;（2）现有骨髓缓解的持续时间;（3）脑膜白血病发作后的生存率;（4）CNS复发的次数。
1. Using IT MTX as standard therapy for CNS leukemia, the comparative effectiveness of three radiation therapy regimens and a combination radiation-IT MTX regimen was determined by the Pediatric Division of the Southwest Cancer Chemotherapy Study Group. 2. IT MTX, 0.5 mg./Kg. every 2-3 days until the spinal fluid mononuclear cell count decreased to 10/mm 3 or less, produced spinal fluid remissions in 78 per cent of 51 children experiencing their first episode of CNS leukemia. The duration of remission ranged from 6-414 days (median 87 days). These figures are comparable to those previously reported for IT antifol therapy. 3. Radiation therapy to the entire cranium using tumor doses of 500 rads and 1000 rads was ineffective in normalizing the CSF, although symptomatic relief was often obtained. 4. Radiation of the entire cerebrospinal axis using a tumor dose of 1000 rads resulted in a spinal fluid remission rate of 92 per cent. Remissions persisted for 13-527 days (median 52 days). Six of seven children in marrow remission when radiation therapy was administered showed evidence of myelosuppression. 5. A combination therapy regimen with two injections of MTX preceding radiation of the entire cerebrospinal axis (750-1000 rads tumor dose for children in marrow remission and 250-500 rads tumor dose for children in marrow relapse) and one injection of MTX intrathecally following radiation resulted in spinal fluid remission in 100 per cent of the evaluable children in the treatment group. Symptomatic remissions occurred in 94 per cent of the children. The duration of remission, however, was similar to that obtained with conventional IT MTX therapy. Evidence of myelosuppression appeared in half of the children in bone marrow remission. 6. None of the radiation regimens was superior to IT MTX when the following parameters were considered: (1) duration of CNS remission; (2) duration of existing bone marrow remission; (3) survival from onset of meningeal leukemia; and (4) number of CNS relapses.