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頁籤選單縮合
題名 | Retrospective Study of Pediatric Acute Leukemia=兒童急性白血病例的回溯研究 |
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作 者 | 黃旼儀; 黃志仁; 連熙隆; 湯人仰; 何耀輝; | 書刊名 | 放射治療與腫瘤學 |
卷期 | 5:1 1998.03[民87.03] |
頁次 | 頁37-44 |
分類號 | 417.5515 |
關鍵詞 | 白血病; 預防性全腦照射; 中樞性白血病復發; Leukemia; Prophylactic cranial irradiation; CNS relapse; |
語文 | 英文(English) |
中文摘要 | 目的:研究有關本院兒童急性白血病預防性全腦照射的治療結果以及這些病童 的預後影響因子。 材料與方法:自l987年9月至l996年3月,共有22位患有急性白血病兒童(17位為急性淋巴 性白血病,5位為急性非淋巴性白血病)於本科接受預防性全腦照射。其中男孩佔9位,女 孩佔13位,年齡介於1.6至17.4歲之間,對於存活病童的平均追蹤時間為4.8年(範圍從2. 7到7.16年)。放射治療總劑量為1800cGy。經由回溯整理其治療記錄與病歷資料來研究其 各項預後因子與存活情況。 結果:本文分析相關的預後因子,發現淋巴腺腫為影響預後的主要因素。所有病童的五年 存活率為50%,而目前存活的病童已經結束化學治療療程超過三年以上。放射治療中主要 的反應為嘔吐、頭痛。所有病童只有一人在預防性全腦照射十一個月後發生中樞性的白血 病復發。而死亡病童的主要致死原因為敗血病。 結論:白血病童若發生中樞性白血病會影響到白血病的治療與預後,而且由於中樞神經系 統內的白血球母細胞有機會再度植入已經化學治療緩解的骨髓中,結果也可能會導致白血 病的血液復發。而根據本文,預防性全腦照射可獲得很好的中樞性白血病預防結果。白血 病治療的模式中,於化學治療程中均應加入全腦預防性照射是值得考慮的方式。至於其他 預後因子之分析則有待未來更多資料病歷的收集。 |
英文摘要 | Purpose: To evaluate the therapeutic result and analyze the prognostic variables of pediatric acute leukemia treated with chemotherapy and prophylactic cranial irradiation (PCI) at KMCH over the past 1 0 years. Materials and Methods: From September 1987 to March 1996, twenty-two patients with acute leukemia received PCI at Kaohsiung Medical College Hospital. There were 9 boys and 13 girls between 1.6 and 17.4 years of age at diagnosis. According to French-American-British (FAB) classification, seventeen patients had acute lymphoblastic leukemia (ALL) and 5 patients had acute non-lymphoblastic leukemia (ANLL). The radiation dose was 1800 cGy given in 10 to 15 fractions. Prognostic factors such as leukemia subtype, age, sex, hemogram, hepatospienomegaly, lymphoadenopathy and radiotherapy fraction were analyzed by retrospective review of the medical records. All patients were followed up regularly. The median follow-up time for patients still alive were 4.8 years (range 2.7 to 7.16 years). Results: The common acute reactions were vomiting and headache. The 5-year disease-free survival rate was 50%. Overall median survival time was 6 years; ALL was 6.16 years and ANLL was 2 years. Only one patient (5%) suffered from CNS relapse 1 year after PCI. The major cause of death was sepsis (55%) . Adenopathy was the significant prognostic factors in this study. Conclusion: Leukemia involvement of the CNS remains a major clinical problem despite the improved disease control provided by mordern treatment regimens. In this study, excellent CNS prophylactic result (95%) was achieved in our cases, and we recommend that PCI should be incorporated in the management of pediatric acute leukemia. Besides, the most significant prognostic factor was adenopathy. |
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