高危神经母细胞瘤放疗及相关不良反应研究进展

Research progress on radiotherapy and radiation-associated adverse effects of high-risk neuroblastoma

高危神经母细胞瘤恶性程度高,预后差,目前多采取多学科综合诊治,放疗是巩固治疗的一部分。对于原发灶完整切除者,照射剂量常规选择21~23.4 Gy;肿块不完全切除患者的照射剂量仍需要进一步探讨。初诊已经合并远处转移的患者,复发多见于初诊受累的骨病灶。目前转移灶照射原则是:针对经过诱导化疗后,间位碘代苄胍(MIBG)摄取仍然阳性的转移灶,或者摄取阴性但仍有高危复发风险的转移灶进行放疗。在缺乏MIBG检查手段的前提下,正电子发射型计算机体层成像(PET-CT)可能协助筛选需要照射的转移病灶。放疗晚期不良反应主要是轻度骨肌肉不良事件,第二原发肿瘤发生率短期随访内未观察到明显升高。

High-risk neuroblastoma(NB)is highly aggressive and has poor prognosis.Treatment of NB mainly includes comprehensive therapies,of which radiotherapy serves as a part of consolidation therapy.For patients who receive complete resection of the primary lesion,usually an irradiation dose of 21-23.4 Gy is given;for patients with incomplete resection,further study focused on radiation dose is necessary.Recurrence is most commonly observed in the bone lesions involved at presentation.Currently,the principle of irradiation to the metastatic sites is to treat lesions where metaio-dobenzylguanidine(MIBG)uptake remains positive after induction chemotherapy,or those become negative uptake but still at high risk of recurrence.On the premise of lacking of MIBG imaging,positron emission tomography CT(PET-CT)may assist in screening for metastatic sites requiring irradiation.The late side effects of radiotherapy are mainly mild musculoskeletal abnormalities.No significant increase is observed in the incidence of second primary tumor during short-term follow-up.