白血病人自体骨髓移植前的全身照射及近期临床观察

TOTAL BODY IRRADIATION (TBI) BEFORE BONE MARROW TRANSPLANTATION (BMT) IN LEUKEMIA

1990年7月～1992年3月共收治了8例白血病病人,进行骨髓移植前的全身照射,使用23MevX线,单次照射中心参考点(脐部)剂量8～10Gy,剂量率5～7CGy/分,治疗距离340cm,病人前方10cm之内加3.5cm厚有机玻璃以提高表面剂量,双肺遮挡后剂量在8Gy以下。本组病人随访7～27个月,1例于照射后4个月死于白血病复发,1例于照射后5个月复发存活至今,其余6例均无病存活。远期疗效有待进一步随访。

TBI is taken as an integral part of BMT. It serves as a chemotherapeutic and immunosuppressive agent or both. From July 1990 to March 1992, 8 patients with leukemia received single TBI for BMT, including partial lung shielding, followed by cyclophosphamide for two days. Saturne Ⅱ linear accelerator was used to deliver 800-1000 cGy in a single fraction at dose rates ranging from 6. 9-7. 7 cGy/min-1. Treatment distance was 335 cm. Build-up was used to give maximal doses on the skin. We used lithium fluoride dosimeters and ionization chamber to determine dose distribution in individual patients. Lung dose was restricted to less than 800 cGy to avoid interstitial pneumonitis (IP) at higher doses. Chief acute reaction were nausea and vomiting. They were experienced by all patients, but did not appear before a total dose of at least 225 cGy. Parotitis was present in most patients approximately after 450 cGy. Serious complication was infection. Sedatives and steroids were found helpful. Ondansetron could alleviate vomiting effectively.