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中枢神经系统(CNS)病变是治疗儿童急性淋巴细胞白血病(简称急淋)的主要障碍,现已设计几种根除脑膜亚临床病灶的方案。作者收集117例急淋患儿,71例在化疗后骨髓诱导缓解时进行中枢神经预防性放疗,9例以化疗为预防性治疗。另37例患儿已发生中枢神经病变,或在一次或多次骨髓病变复发后,其血液学症状均已缓解数月,以放疗或预防治疗中枢神经病变。作者试以中枢神经病变的程度和/或以前的血液学状况进行分组,并以此确定预后标准。若中枢神经病变同时伴有血液学症状,一般仅鞘内滴入氨甲喋呤。作者应用4伏特线性加速器进行头部(或头颈部)放疗,2.5周内照射13次,总量为2,400拉德。
Central nervous system (CNS) lesions are a major hurdle for the treatment of childhood acute lymphoblastic leukemia and several programs have been designed to eradicate subclinical meningeal lesions. The authors collected 117 cases of acute lymphocytic children, 71 cases of central nervous system prophylaxis after bone marrow induction of remission after chemotherapy, 9 cases of chemotherapy for prophylactic treatment. The other 37 patients had CNS lesions, or hematologic symptoms had been relieved for several months after one or more bone marrow lesions had been relapsed, with radiotherapy or prophylaxis of CNS lesions. The authors try to group the extent of CNS lesions and / or previous hematologic status and determine the prognostic criteria. If the CNS lesions accompanied by hematological symptoms, usually only intrathecal methotrexate. The authors applied a 4 volt linear accelerator to head (or head and neck) radiation and irradiated 13 times in 2.5 weeks for a total of 2,400 rads.