朗格汉斯组织细胞增生症放射治疗的临床研究

Clinical Study on Radiotherapy in the Treatment of Langerhans′ Cell Histiocytosis(LCH)

目的通过对一组临床资料研究,来探索朗格汉斯组织细胞增生症(LCH)放射治疗的最佳剂量和患者的预后情况。方法回顾性研究笔者所在科室自1986～2008年收治的40例诊断为LCH伴有骨组织病变患者,Ⅰ期患者20例,有20个放疗部位;Ⅱ期患者17例,有22个放疗部位;Ⅲ期患者3例。把以上病例分为高剂量组(≥16Gy)和低剂量组(<16Gy),然后比较两组的疗效。结果Ⅰ期患者局部病灶控制率为100%,5年生存率100%。Ⅱ期的患者局部病灶控制率为86%,5年生存率87%。Ⅲ期的患者局部病灶控制率为100%(3/3),5年生存率67%(2/3)。两组的疗效没有统计学意义(P=0.390)。结论低剂量的放射治疗能够有效地控制局部病灶,而不会导致严重的并发症,三维适形放射治疗是治疗LCH局部骨病变及化疗和手术后残余病灶的一个有效的手段。

Objective langerhans＇cell histiocytosis（LCH） is a rare pathology that affects different structures of the human body, Specially bone tissue. The objective of this study is to explores the best radiotherapy dose and patient＇s prognosis. Methods A retrospec- tive study was conducted from 1986 to 2008 with 40 patients diagnosed and treated for a LCH of the bone at our department. Twenty pa- tients diagnosed were stage I of LCH; 17 patients with 22 bone involvement were diagnosed stage Ⅱ of LCH;and 3 patients were diag- nosed stage Ⅲ of LCH. All patients were divided into two groups：one group was treated by high dose radiotherapy（ ≥ 16Gy） and other group was treated by lower dose radiotherapy（ 〈 16Gy）, The rate of local disease control was compared between two groups. Results In stage I of patients, the rate of local disease control was 100% and 5 - year survival rate was 100%. In stage Ⅱof patients,5 - year sur- vival rate was 87% , and the rate of local disease control was 86%. In stage Ⅲ of patients 5 -year survival rate was 67% （2/3）, and the rate of local disease control was 100% （3/3）. No difference between two groups in rate of local disease control was found （P = 0. 390）.Conclusion The lower dose radiotherapy can effectively control the involvement bone, and wouldn＇t cause the serious complication. 3D radiotherapy was a effective method to treat a LCH of the bone which was residue or recurrence after chemotherapy and surgery.