Natalie Boyce, Safia Ahmed, W Scott Harmsen, Sharon Boyce, Robert Dahl, Nadia Laack
{"title":"采用侧对野技术进行全身照射治疗的儿科患者的肺毒性。","authors":"Natalie Boyce, Safia Ahmed, W Scott Harmsen, Sharon Boyce, Robert Dahl, Nadia Laack","doi":"10.1002/pbc.31713","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary toxicity (PT) remains a concern following total body irradiation (TBI). This study describes the incidence and factors associated with PT in a cohort of patients homogeneously treated with the lateral opposed fields technique.</p><p><strong>Methods: </strong>Medical records of 61 patients ≤21 years of age treated with TBI as a component of stem cell transplantation from 1993-2017 were retrospectively reviewed. The incidences of PT, graft-versus-host disease (GVHD), and other toxicities were recorded for each patient. PT was subdivided into its etiologies, and symptomatic PT was established by clinical diagnosis. The association of PT with other variables was examined using chi-square tests, and overall survival (OS) was estimated using Kaplan-Meier.</p><p><strong>Results: </strong>Three-year OS was 65% (54%-79%). Median TBI dose rate was 7.7 cGy/min (4.0-10 cGy/min). PT occurred in 20 patients (33%). A higher rate of PT was observed in patients with GVHD (65% vs. 35%, p ≤ 0.01). TBI dose rate (</≥ 7.7 cGy/min) was not associated with the risk of PT; however, on continuous analysis, a higher dose rate increased the risk of PT (HR = 1.9, p = 0.04). PT (HR = 3.4, p = 0.01), noninfectious PT (HR = 5.0, p ≤ 0.01), and pneumonitis (HR = 4.3, p = 0.01) were associated with inferior OS.</p><p><strong>Conclusions: </strong>This cohort of patients treated with a low dose rate, bilateral technique, and total dose of 1000-1320 cGy experienced an acceptable incidence of PT, comparable to other published studies. Because PT correlated with reduced survival, current practice should seek to address factors associated with PT by aiming to prevent GVHD and by choosing low dose rates, such as in the range of 4.0-10 cGy/min.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e31713"},"PeriodicalIF":2.4000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pulmonary Toxicities in Pediatric Patients Treated With Total Body Irradiation Using the Lateral Opposed Fields Technique.\",\"authors\":\"Natalie Boyce, Safia Ahmed, W Scott Harmsen, Sharon Boyce, Robert Dahl, Nadia Laack\",\"doi\":\"10.1002/pbc.31713\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Pulmonary toxicity (PT) remains a concern following total body irradiation (TBI). This study describes the incidence and factors associated with PT in a cohort of patients homogeneously treated with the lateral opposed fields technique.</p><p><strong>Methods: </strong>Medical records of 61 patients ≤21 years of age treated with TBI as a component of stem cell transplantation from 1993-2017 were retrospectively reviewed. The incidences of PT, graft-versus-host disease (GVHD), and other toxicities were recorded for each patient. PT was subdivided into its etiologies, and symptomatic PT was established by clinical diagnosis. The association of PT with other variables was examined using chi-square tests, and overall survival (OS) was estimated using Kaplan-Meier.</p><p><strong>Results: </strong>Three-year OS was 65% (54%-79%). Median TBI dose rate was 7.7 cGy/min (4.0-10 cGy/min). PT occurred in 20 patients (33%). A higher rate of PT was observed in patients with GVHD (65% vs. 35%, p ≤ 0.01). TBI dose rate (</≥ 7.7 cGy/min) was not associated with the risk of PT; however, on continuous analysis, a higher dose rate increased the risk of PT (HR = 1.9, p = 0.04). PT (HR = 3.4, p = 0.01), noninfectious PT (HR = 5.0, p ≤ 0.01), and pneumonitis (HR = 4.3, p = 0.01) were associated with inferior OS.</p><p><strong>Conclusions: </strong>This cohort of patients treated with a low dose rate, bilateral technique, and total dose of 1000-1320 cGy experienced an acceptable incidence of PT, comparable to other published studies. Because PT correlated with reduced survival, current practice should seek to address factors associated with PT by aiming to prevent GVHD and by choosing low dose rates, such as in the range of 4.0-10 cGy/min.</p>\",\"PeriodicalId\":19822,\"journal\":{\"name\":\"Pediatric Blood & Cancer\",\"volume\":\" \",\"pages\":\"e31713\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-04-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Blood & Cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/pbc.31713\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Blood & Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pbc.31713","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Pulmonary Toxicities in Pediatric Patients Treated With Total Body Irradiation Using the Lateral Opposed Fields Technique.
Purpose: Pulmonary toxicity (PT) remains a concern following total body irradiation (TBI). This study describes the incidence and factors associated with PT in a cohort of patients homogeneously treated with the lateral opposed fields technique.
Methods: Medical records of 61 patients ≤21 years of age treated with TBI as a component of stem cell transplantation from 1993-2017 were retrospectively reviewed. The incidences of PT, graft-versus-host disease (GVHD), and other toxicities were recorded for each patient. PT was subdivided into its etiologies, and symptomatic PT was established by clinical diagnosis. The association of PT with other variables was examined using chi-square tests, and overall survival (OS) was estimated using Kaplan-Meier.
Results: Three-year OS was 65% (54%-79%). Median TBI dose rate was 7.7 cGy/min (4.0-10 cGy/min). PT occurred in 20 patients (33%). A higher rate of PT was observed in patients with GVHD (65% vs. 35%, p ≤ 0.01). TBI dose rate (
Conclusions: This cohort of patients treated with a low dose rate, bilateral technique, and total dose of 1000-1320 cGy experienced an acceptable incidence of PT, comparable to other published studies. Because PT correlated with reduced survival, current practice should seek to address factors associated with PT by aiming to prevent GVHD and by choosing low dose rates, such as in the range of 4.0-10 cGy/min.
期刊介绍：
Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.
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