立体定位放射治疗在儿童头颈部横纹肌肉瘤综合治疗中的应用和疗效分析

  目的  分析综合治疗中立体定位放疗技术应用于儿童头颈部横纹肌肉瘤的初治或复发病例的临床意义和价值。  方法  回顾性分析本院儿科2002年1月至2009年1月应用立体定位放疗技术作为规范化综合治疗措施, 用于儿童头颈部横纹肌肉瘤术后辅助治疗或局部复发、进展的补救治疗, 对总体生存率和肿瘤局部控制率的影响。全部24例儿童头颈部横纹肌肉瘤患儿中22例曾接受立体定位放射治疗(包括三维适形放疗、调强放疗和X刀、射波刀治疗), 放射总剂量28~60Gy, 标准治疗剂量50.4Gy, 中位随访时间为42个月。  结果  22例可分析病例中男12例, 女10例, 中位年龄6.5岁; 临床分期Ⅰ期1例, Ⅱ期6例, Ⅲ期14例, Ⅳ期1例。所有病例治疗后2年总生存率68.18%(15/22), 肿瘤局部控制率77.27%(17/22);局部复发、进展病例再次治疗后2年总生存率55.56%(5/9), 肿瘤局部控制率66.67%(6/9)。6例患儿死于脑或其他部位的转移, 大部分患儿仅出现局部水肿、黏膜溃疡等放射反应, 均未影响放疗进程, 患儿视力、听力等功能无明显影响, 目前未见第二癌的发生。  结论  儿童头颈部横纹肌肉瘤应用立体定位放射治疗安全有效, 对邻近器官的功能保护优于普通放疗技术。 

Curative Effect and Role of Three-Dimensional Radiotherapy as a Part of Combined Therapy for Pediatric Head-and-Neck Rhabdomyosarcoma

  Objective  To analyze the clinical significance and value of three-dimensional radiotherapy in comprehensive treatment of initial or recurring pediatric head-and-neck rhabdomyosarcoma.  Methods  Retrospective analysis of 24 patients diagnosed with head-and-neck rhabdomyosarcoma between January 2002 and January 2009 was conducted. Twenty two of these patients (12 males and 10 females) received three-dimensional radiotherapy, intensity-modulated radiotherapy, and cyberknife radiotherapy as part of a multimodal therapy. The median prescribed dose was 50.4 Gy (28 Gy to 60 Gy). The median duration of follow-up for surviving patients was 42 months.  Results  The postoperative clinical grouping of these 22 patients is 1 patient in Group I, 6 in Group II, 14 in Group III, and 1 in Group IV. Median age at the time of radiation therapy was 6.5 years old. All patients were treated with multipie-agent chemotherapy and external beam radiotherapy. The 2-year overall survival and local control rates were 68.18% (15/22) and 77.27% (17/22). The 2-year overall survival and local control rates of recurrence or metastasis in patients were 55.56% (5/9) and 66.67% (6/9), respectively. Six patients died from distant metastases. Most of the patients only suffered from local edema mucosa ulcer. No late toxicities were observed and no secondary malignancies occurred as of the writing of this paper.  Conclusion  Three-dimensional conformal radiotherapy can lead to better outcome compared with common radiotherapy technique in children with head-and-neck RMS. Moreover, high local control rates and a low incidence of treatment-related side effects can be achieved.