The Experience of Total Body Irradiation in Bone Marrow Transplantation Patients Referred to the Chai-Yi Christian Hospital-A Preliminary Report

轉診至嘉義基督教醫院做骨髓移植執行全身照射之經驗初步報告

王裕文(Rubin Yu-Wen Wang) ； 陳彩雲(Tsai-Yun Chen) ； 陳建旭(Jian-Shiuh Chen) ； 郭浩然(How-Ran Guo) ； 盧彥哲(Yin-Che Lu) ； 黃叔牧(Shu-Mu Huang) ； 阮昭銘(Chao-Ming Jaun)

《放射治療與腫瘤學》 14卷1期 (2007/03) Pp. 11-18

https://doi.org/10.6316/TRO/200714(1)11

摘要

目的：評估轉至嘉義基督教醫院來做全身放射治療的骨髓移植病患的初步療效。
材料與方法：從2002年8月到2004年8月計有12位白血病或淋巴瘤要骨髓移植的病患被轉來嘉義基督教醫院做全身放射治療。當中有10位完成了做全身放射治療，另外兩位則只做完了模擬定位。全身放射治療患者當中，9位接受了1200cGy，在3天內分6次照射完畢；還有一位兒童則接受了1320cGy，在3天內分6次照射完畢。我們使用從加速器射源焦點到病患中軸的距離為600cm的技術。用的機器是瓦里安的加速器，6百萬電子伏特的光子，劑量卛為每分鐘300到400監測單位。所有的病患都在部分消毒的條件做全身放射治療，並住在本院的骨髓移植病房。我們在病患的胸部的前後順型殼鎖上1公分的遮擋合金，並採用前後方向的照射技術，並在入射方向離患者約10公分處裝置了2公分厚的壓克力平板。
結果：到2005年1月止，完成了做全身放射治療的10位患者中，有5位還存活。存活患者之中只有1位患有植入體對抗宿主疾病而有慢性的口腔黏膜炎，其他的存活患者則無復發或有併發症的問題，當中甚至還有一位未分化的T細胞淋巴瘤化療後只有部分緩解的。在5位死亡的患者中，4位沒有達到完全的緩解並在兩個月內因為植體沒長成功、早期復發、與和全身放射治療無關的次發性感染死去。當中還有兩位還有靜脈阻塞性的肝病。達到完全緩解的死亡病例是一位急性淋巴性白血病的患者，骨髓移植後3個月他得了黴菌感染，之後又有腫瘤復發，之後死於15年後。只做完模擬定位的患者則因為持續的復發和感染而無法真正的來做全身放射治療。
结論：我們的結果顯示，與旅途有關的感染問題在轉來的骨髓移植做全身放射治療的患者的預後參考價值並不重要。雖然患者數少且追蹤時間不長，我們仍認為初步結果可以接受。慎選合適的患者會有更好的結果，但對之前化療只有部分反應並不代表移植一定失敗。

關鍵字

全身放射治療 ； 骨髓移植 ； 直線加速器

並列摘要

Purpose: The objective of this study is to evaluate the initial treatment outcome of total body irradiation (TBI) in patients with bone marrow transplantation (BMT) who were referred to the Chai-Yi Christian Hospital (CYCH).
Materials and Methods: From August 2002 to August 2004, 12 patients of leukemia or lymphoma were referred to the Chai-Yi Christian Hospital for TBI before BMT. Ten received TBI, and the other two received the simulation procedure only. For TBI, nine received 1200 cGy in 6 fractions over three days, and a child received 1320 cGy in 6 fractions over three days. The distance from focus of linear accelerator (LA) to middle abdomen of patients was 600cm. We used 6MeV photon at the dose rates of 300 and 400 monitor unit (MU) per minute with a Varian LA, but without a compensator. All patients were admitted to the BMT ward under partial aseptic environment. We placed a 1cm lung partial block over thermoplastic shell on the patient's chest and applied the APPA projection technique with a 2cm-thick acrylic sheet around 10cm ahead of the patient.
Results: Of the ten patients who received TBI, five survived till January 2005. Only one patient experienced chronic graft vursus host disease with oral mucositis, and the others had no relapse or complications, including a patient with T-anaplastic cell lymphoma who had only partial remission after the chemotherapy. Of the five expired patients, four failed to achieve complete remission and died within two months due to graft failure, secondary infections not related to TBI, or early relapse. Two of them also had venous occlusive liver disease. The patient who had complete remission was a case of acute lymphoblastic leukemia who acquired fungal infection three months after the BMT followed by the relapse and died 1.5 years later. The two patients who went through simulation alone had persistent relapse, and infection episodes hindered them from receiving TBI.
Conclusion: Our results suggest that infections related to the transportation of patients did not appear to be a key prognostic factor in TBI of BMT patients referred from other hospitals. Although the follow-up time is short and patient number is small, we consider the initial outcome satisfactory. Selection of patients is essential for better result, but partial remission from initial chemotherapy may not necessarily destine to failure.

並列關鍵字

Total body irradiation ； Bone marrow transplantation ； Linear accelerator