Skeletal Sequelae of Radiation Therapy for Malignant Childhood Tumors
Skeletal Sequelae of Radiation Therapy for Malignant Childhood Tumors
复制标题
儿童恶性肿瘤放射治疗的骨骼后遗症
DOI：
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发表时间：
1990
影响因子：
4.2
通讯作者：
D. Drummond
中科院分区：
文献类型：
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作者：
M. S. Butler;W. Robertson;W. Rate;G. D'angio;D. Drummond
对143例因儿童肿瘤接受放射治疗并存活至骨骼成熟期的患者进行了肿瘤病历和X线片的回顾性研究。诊断霍奇金淋巴瘤44例，肾母细胞瘤30例，急性淋巴细胞白血病26例，非霍奇金淋巴瘤18例，尤文肉瘤9例，横纹肌肉瘤6例，神经母细胞瘤6例，其他4例。随访检查年龄14~28岁，平均18岁。随访时间2~18年，平均9.9年。这些儿童中有51例(36%)胸部和肋骨不对称。脊柱侧弯50例(35%)，脊柱后凸14例。在两名儿童中，脊柱侧弯接受了支具治疗，而一名儿童在椎板切除后出现了明显的脊柱后凸，并进行了脊柱融合。23名患者(16%)主诉放射部位明显疼痛。其中12名患者出现了腿长不等；其中8名患者出现了症状。3例患者发展为第二原发瘤。目前，严重骨骼后遗症的发生率比1940年至1970年的报告要低，表现也不那么严重。骨骼并发症的减少可能归因于生长中心的保护、对称的野选择、总放射剂量的减少以及化疗顺序的改变。
One hundred forty-three patients who received radiation therapy for childhood tumors, and survived to the age of skeletal maturity, were studied by retrospective review of oncology records and roentgenograms. Diagnoses for the patients were the following: Hodgkin's lymphoma (44), Wilms's tumor (30), acute lymphocytic leukemia (26), non-Hodgkin's lymphoma (18), Ewing's sarcoma (nine), rhabdomyosarcoma (six), neuroblastoma (six), and others (four). Age at the follow-up examination averaged 18 years (range, 14–28 years). Average length of follow-up study was 9.9 years (range, two to 18 years). Asymmetry of the chest and ribs was seen in 51 (36%) of these children. Fifty (35%) had scoliosis; 14 had kyphosis. In two children, the scoliosis was treated with a brace, while one developed significant kyphosing scoliosis after laminectomy and had spinal fusion. Twenty-three (16%) patients complained of significant pain at the radiation sites. Twelve of the patients developed leg-length inequality; eight of those were symptomatic. Three patients developed second primary tumors. Currently, the incidence of significant skeletal sequelae is lower and the manifestations are less severe than reported in the years from 1940 to 1970. The reduction in skeletal complications may be attributed to shielding of growth centers, symmetric field selection, decreased total radiation doses, and sequence changes in chemotherapy.