24例儿童高危神经母细胞瘤调强适形放疗的近期疗效分析

目的 总结分析高危神经母细胞瘤患儿调强适形放疗（intensity-modulated radiotherapy，IMRT）疗效、安全性及相关经验。方法 回顾性选取2018年4月至2020年12月于湖南省人民医院儿童血液肿瘤科进行诊治并完成IMRT的高危组神经母细胞瘤患儿24例，收集相关资料，包括年龄、放疗剂量、放疗次数、实验室检查结果、不良反应、生存情况，分别进行归纳总结。结果 24例患儿均接受IMRT，其中男14例、女10例；平均年龄（65±23）个月，中位年龄59个月；原发瘤灶23例位于腹部，1例位于纵隔。放疗时患儿中位年龄41.5个月。放疗辐射剂量范围为14.4~36.0 Gy，平均剂量为（22±3）Gy，每日剂量为1.8~2.0 Gy，总次数8~20次，平均次数11.9次。其中6例接受了残留灶或转移灶放疗。放疗过程中3例出现咳嗽，2例出现腹泻，1例出现呕吐。放疗后2周，血肌酐范围值2.3~70.1 μmol/L，丙氨酸氨基转移酶范围值9.1~65.3 U/L，放疗开始后1~2周出现骨髓抑制Ⅲ度10例，Ⅳ度2例；放疗开始后3~4周出现骨髓抑制Ⅲ度4例，Ⅳ度1例。随访中位时间为13.5个月，其中23例（96%）疾病稳定，1例死亡，截至随访日期，未发现第2次恶性肿瘤及脏器功能异常。结论 IMRT能有效提高神经母细胞瘤局部控制率。IMRT治疗神经母细胞瘤患儿，短期内无明显不良反应，安全性高。

Short-term effect of intensity-modulated radiotherapy for children with high-risk neuroblastoma: an analysis of 24 cases

Objective To study the efficacy and safety of intensity-modulated radiotherapy (IMRT) in children with high-risk neuroblastoma (NB). Methods A retrospective analysis was performed on the medical data of 24 children with high-risk NB who were diagnosed and treated with IMRT in the Department of Hematology and Oncology, Hunan Provincial People's Hospital, from April 2018 to December 2020. The medical data included age, radiotherapy dose, times of radiotherapy, laboratory examination results, adverse reactions, and survival. Results All 24 children (14 boys and 10 girls) received IMRT, with a mean age of (65±23) months and a median age of 59 months. The primary tumor was located in the abdomen in 23 children and 1 child had primary tumor in the mediastinum. The median age was 41.5 months at the time of radiotherapy. The radiation dose of radiotherapy ranged from 14.4 to 36.0 Gy, with a mean dose of (22±3) Gy and a daily dose of 1.8-2.0 Gy. The radiotherapy was performed for a total number of 8-20 times, with a mean number of 11.9 times. Among these children, 6 received radiotherapy for the residual or metastatic lesion. Of all the 23 children, 3 experienced cough, 2 experienced diarrhea, and 1 experienced vomiting during radiotherapy. At 2 weeks after radiotherapy, serum creatinine ranged from 2.3 to 70.1 μmol/L and alanine aminotransferase ranged from 9.1 to 65.3 μ/L. Ten children experienced grade Ⅲ bone marrow suppression and 2 experienced grade Ⅳ bone marrow suppression 1 to 2 weeks after radiotherapy. Four children experienced grade Ⅲ bone marrow suppression and 1 experienced grade Ⅳ bone marrow suppression 3 to 4 weeks after radiotherapy. During a median follow-up time of 13.5 months, 23 children (96%) achieved stable disease and 1 died. Up to the follow-up date, second malignant tumor or abnormal organ function was not observed. Conclusions IMRT can improve the local control rate of NB. IMRT appears to be safe in the treatment of children with NB.