螺旋断层放疗全身照射剂量的分布评价及不良反应

目的：观察螺旋断层放疗系统进行骨髓移植前全身照射的剂量评价及急性毒副反应。方法：2011年8月至2012年8月采用螺旋断层放疗对6例白血病患者在异基因造血干细胞移植预处理期间实施全身照射,其中4例为急性淋巴细胞白血病（ ALL）、1例为急性混合细胞白血病（ MAL）、1例为T细胞性淋巴细胞白血病/T淋巴母细胞性淋巴瘤（ T-LBL）。毒副反应的评价按CTCAE v3.0。结果：全部患者按计划完成全身照射。截至2013年12月1日,2例生存、4例死亡。急性毒副反应：腹泻4例,口腔黏膜炎4例,恶心、呕吐6例,未发现放射性肺炎和皮肤毒性。结论：应用螺旋断层放疗技术进行全身照射的剂量分布评价直观简便。肺的剂量限制对胸部和上腹部器官的剂量分布有明显影响。胃肠道3级或3级以上副反应常见。

Toxicity and distribution evaluation of exposure dose of whole body irradiation using helical tomotherapy

Objective：To observe the acute toxicity and dose evaluation of whole body irradiation using helical tomotherapy before bone marrow transplantation. Methods： Between August 2011 and August 2012, 6 patients with leukaemia （ acute lymphoblastic leukemia in 4, acute mixed leukemia in 1 and T cells lymphoblastic lymphoma in 1） received whole body irradiation before allogeneic hematopoietic stem cell transplantation using helical tomotherapy. The toxicity was evaluated by CTCAE v3. 0. Result： All patients completed whole body irradiation. 2 patients were still alive, 4 patients had died until December 1st, 2013. Acute toxicity：4 cases with diarrhea, 4 cases with stomatitis, 6 cases with nausea and emesis, and there was no case with radiation pneumonitis and dermal toxicity. Conclusion： The application of helical tomotherapy for the dose distribution evaluation of whole body irradiation is clear and effective. The dose limitation of lung has significant effects on the dose distribution of chest and upper abdominal organs. Grade 3 or higher level gastrointestinal side-effects were common.