PDF(Pubmed)
Abstract：
Introduction Acute lymphoblastic leukemia (ALL) constitutes a significant portion of pediatric malignancies, with central nervous system (CNS) relapse posing a considerable threat to patient outcomes. While cranial radiation therapy (CRT) has been utilized to mitigate CNS relapse, it is associated with neurocognitive (NC) side effects. This study explores the feasibility and safety of using volumetric arc therapy (VMAT) with hippocampal sparing (HS) during cranial radiation therapy for ALL patients, aiming to reduce these side effects. Methodology This prospective observational study included pediatric and young adult patients with ALL who were in remission. HS was achieved using VMAT, and NC assessments were performed at baseline, six months, one year, and, to a limited extent, four years posttreatment. Results VMAT enabled precise hippocampal-sparing CRT with minimal dose to the hippocampus. Dosimetric analysis revealed that patients receiving 18 Gy had mean doses to planning target volume (PTV) and bilateral hippocampus of 18.9 and 9 Gy, respectively. Those receiving 12 Gy had corresponding doses of 13.3 and 7 Gy, respectively. Conformity and homogeneity indices were 0.9 and 0.1, and no brain relapses were observed among the patients in this study. NC assessments demonstrated no decline in intelligence quotient (IQ) scores over time, while only a subset of patients could be assessed at the four-year mark; telephone interviews suggested no significant cognitive decline. Conclusions This study highlights the potential of VMAT with HS as a promising approach to CRT for ALL patients in reducing the risk of NC side effects. The absence of brain relapses and preservation of NC function are encouraging findings, though larger studies are necessary to establish conclusive evidence.
摘要：
简介急性淋巴细胞白血病（ALL）构成儿科恶性肿瘤的重要部分，中枢神经系统（CNS）复发对患者预后构成相当大的威胁。虽然颅骨放射治疗（CRT）已被用于减轻中枢神经系统复发，它与神经认知（NC）副作用有关。这项研究探讨了在对所有患者进行头颅放射治疗期间使用容量电弧疗法（VMAT）与海马保留（HS）的可行性和安全性。旨在减少这些副作用。方法这项前瞻性观察性研究包括儿童和年轻的ALL缓解患者。HS是使用VMAT实现的，和NC评估在基线进行，六个月,一年,and,在有限的程度上,四年后治疗。结果VMAT能够以最小的海马剂量实现精确的海马保留CRT。剂量学分析显示，接受18Gy的患者的计划目标体积（PTV）和双侧海马的平均剂量为18.9和9Gy，分别。接受12Gy的患者的相应剂量为13.3和7Gy，分别。符合性和同质性指数分别为0.9和0.1，在本研究的患者中未观察到脑复发。NC评估显示智商（IQ）分数随时间没有下降，虽然只有一部分患者可以在4年时进行评估,但电话访谈显示没有显著的认知能力下降.结论本研究强调了VMAT伴HS作为ALL患者CRT降低NC副作用风险的有希望的方法的潜力。没有脑复发和保持NC功能是令人鼓舞的发现，虽然更大规模的研究是必要的，以建立确凿的证据。
