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Central nervous system leukemia in children treated nine cases of radiation


Injection control nervous system lesions, but often less than ideal due to chemotherapy or toxic reactions,[link widoczny dla zalogowanych], and can not persist, affecting efficacy, our department from 1997 to 1998,[link widoczny dla zalogowanych], 9 cases of CNSL all full-cranial spinal radiation therapy, the effect is satisfactory, is reported below. 1. Materials and Methods 9 patients in this group are children in our hospital pediatric treatment, diagnosis is based in Nanning, Guangxi in 1978, held in collaboration with the National Conference on the Control of leukemia developed diagnostic criteria related to years, mean 65 years, 9 patients with prior radiation therapy intrathecal injection of more than 6 times in 6 patients repeated search to find see the immature cells in cerebrospinal fluid, and 3 cases can not be tolerated because of reactions, including 1 case of paraplegia caused by sheath injection, the stop sheath Note return to normal after 3 months. The other 2 patients showed increased intracranial pressure after intrathecal recurring headache, vomiting and other symptoms. methods using high energy x ray radiation, Siemens 6MVX line external beam linear accelerator, the whole distinction between cranial irradiation + whole spinal cord , children get prone position, vacuum fixed, the whole skull parallel to the wear of 2 wild, on, before and after the sector opened lower bound for the eyebrow ~ 05cm-G after the outer canthus lower edge, and to lead block block eye All 5 cases of spinal cord after two field located in 4 cases, after setting a field, the upper bound of the spinal cord and the whole skull wild wild wild then the lower bound, lower bound for the lower edge of S2, the use of non-coplanar irradiation techniques, transfer bed and turn light bar, so that totally wild up and down the convergence re-sets. Spinal Cord set the second field irradiation, in which two wild pitch of 0.5cm, in order to avoid exposure to the process,[link widoczny dla zalogowanych], produced a dose in the next field at the uneven exposure to 5 times each, moved up at the portal interface up or down 2 ~ 3cm. spinal cord to set up a field irradiation, can reduce the bed, increasing SSD, relaxation of wild-length,[link widoczny dla zalogowanych], full cranial irradiation times the total 20.4 ~ 224Gy/14 3 weeks, the whole spinal cord total exposure of 18 ~ 196Gy] 14 times for 3 weeks. 2. The results were successfully completed 9 down radiotherapy in the treatment of nine cases of varying degrees Afghanistan hair loss, loss of appetite, nausea in 5 patients (56%), vomiting, headache in 3 cases (33 .3%), but all too short,[link widoczny dla zalogowanych], for both symptomatic remission after treatment and disappearance, which set up two field irradiation field of spinal cord in 4 cases, 1 case of a wild, due to decreased blood (WBC <3 × 109), while continuing to give l Since the completion of radiation therapy treatment, follow-up results, 1 patient after 6 months of death due to bone marrow relapse, 8 patients were followed up for more than 2 years, height was significantly lower than peers, and I no obvious abnormalities. 3. discussions from the blood of acute lymphoblastic CNSL proliferation kinetics of disease that occurs in the cerebrospinal fluid after CNSL slow the proliferation of leukemic cells, combined with intrathecal administration of the drug concentration in CSF due to uneven distribution of intracranial arachnoid deep in the low concentration, it is difficult to use intrathecal chemicals, to achieve full kill, and many side effects after intrathecal injection increases, increased intracranial pressure, paralysis and other neurological symptoms can occur, and leukemia cells are sensitive cells in radiation therapy, and radiation therapy can all intracranial nerve tissue in the spinal cord, including the shallow depth of all the arachnoid leukemia cells by anti-, free from the distribution and flow of CSF Moreover, accumulation of brain irradiation <50Gy, repeated exposure with all-cranial spinal irradiation can effectively kill the whole residual leukemia cells from CNSL prolonged remission, reduce relapse and improve prognosis, but this small number of cases, followed not long after radiotherapy and long-term side effects need to be made Further follow-up observation. Discovered in the course of radiotherapy, the whole spinal cord set up two field irradiation is more common around the leukocyte inhibition (4 / 5), and spinal cord to the single-field irradiation is 1 / 4, so I believe that by reducing the treatment bed, increasing the source skin distance, All the spinal cord to the single-field irradiation, can compensate for unequal access and lack of field at the dose, while increasing the pool of music to further reduce the skin facing away from the percentage depth content on the target dose uniformity of the impact of the shortened treatment time reduce bone marrow suppression, more suitable for small children ages, the treatment process, to be in close coordination with the pediatricians can successfully sets the timely processing of radiation therapy.
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