摘要
目的观察在造血干细胞移植(HSCT)预处理中实施分次全身调强适形放疗技术的疗效及主要不良反应,探讨其作为移植前预处理方案的优势。方法选取2012年8月至2015年1月在南京明基医院行全身放疗技术(TBI)的恶性血液系统疾病患者15例。TBI采用分割放疗、三维适形调强放疗技术,使用Eclipse^(TM)治疗系统制定放疗计划,其中临床靶区CTV为全身骨骼、主要淋巴链、睾丸及脾脏。计划靶区PTV定义为CTV外扩3 mm。放射剂量为:单次剂量2 Gy,每天2次,每次间隔6~8 h,连续3天,总剂量12 Gy。结果 15例患者随访时间为1~30个月,中位时间为17个月。其中13例患者移植后第9~32天中性粒细胞绝对数≥0.5×109/L,移植后第12~37天的血小板计数≥20×109/L,并且PCR检测提示染色体核型转为供体型,表明移植成功。除1例出现3级放射性肠炎外,其余患者的不良反应轻微,主要为能够耐受的口腔黏膜损伤及轻度腹泻。结论分次全身调强适形放疗在HSCT预处理中有着重要的临床应用价值,其远期疗效和不良反应的发生率仍需进一步随访观察。
Objective To observe the efficacy and major adverse reactions of a novel total body irradiation（ TBI） with an in-tensity？modulated radiation therapy（ IMRT） technique. Methods Fifteen patients who underwent a TBI therapy as a preconditioning regimen of hemapoietic stem cell transplantation（HSCT） at the BenQ Medical Center, between August 1st, 2012 and January 31st, 2015, were recruited in this study. TBI used fractionated radiotherapy and IMRT technique, and EclipseTM Treatment Planning System was employed to perform treatment planning. The clinical target volume（ CTV） contained total narrow, main lymphatic chains, testis and spleen and the external expansion on the CTV（ 3 mm） was defined as planning target volume. In this study, the TBI total dose was up to 12 Gy, 2 Gy twice a day for 3 days. Results With a median follow-up of 17 months（ range 1？30 months） , neutrophils of 13 pa-tients（13/15）had increased, and up to 0？5×109/L in 9？32 days after transplant, and the absolute number of platelet was over 20× 109/L in 12？37 days postransplant. Meanwhile, PCR analyze also showed a donate karyotype, indicating a successful therapy. Except one suffered a severe（ grade 3） radiation enteritis, patients receiving TBI therapy had mild and tolerable adverse reactions, including o-ral mucosal injury and mild diarrhea. Conclusion TBI with fractionated radiotherapy and IMRT technique is useful as a HSCT pre-treatment in clinic, while limited to the short observation period, the long-term efficacy and adverse reactions remains to be studied.
出处
《临床肿瘤学杂志》
CAS
2016年第3期271-274,共4页
Chinese Clinical Oncology
关键词
造血干细胞移植
全身放疗技术
三维适形调强放疗技术
Total body irradiation
Intensity-modulated radiation therapy
Hemapoietic stem cell transplantation
