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目的以间歇性放射治疗＋鞘内注射方法治疗曾接受全颅、全脊髓放射治疗和（或）鞘内注射后中枢神经系统白血病（ＣＮＳＬ）复发的急性淋巴细胞性白血病（ＡＬＬ）患儿，以便建立一种在达到治疗目的的前提下尽量减少第２次放射治疗引起的晚期并发症的放射治疗方案。方法应用国产８ＭＶ直线加速器，选择１３例曾接受全颅、全脊髓放射治疗和（或）鞘内注射后ＣＮＳＬ复发的急性淋巴细胞性白血病患儿进行全颅、全脊髓间歇性放射治疗，并联合鞘内注射。治疗方案为：全颅１５０ｃＧｙ／次＋全脊髓７５ｃＧｙ／次，每日１次照射３天。第１天鞘内注射甲氨喋呤（ＭＴＸ）８～１２ｍｇ／ｍ２，阿糖胞苷（ＡｒａＣ）２５ｍｇ／ｍ２，地塞米松（ＤＸＭ）２～５ｍｇ／次，以后每８周全颅１５０ｃＧｙ＋全脊髓７５ｃＧｙ照射１次，当天鞘内注射，用药剂量同前。总疗程为２年２个月。结果９例患儿随访５年以上，４例随访３年以上。１３例患儿中２例分别于放射治疗结束后５个月、１２个月因骨髓复发死亡。生存者均未再发生ＣＮＳＬ。结论间歇性放射治疗过程中未发现明显急性副反应。随访期间发现２例记忆力差、注意力不易集中现象。间歇性放射治疗对于曾接受全中枢神经系统放射治疗和（或）鞘内注射后ＣＮＳＬ复发的急?
Objective To treat patients with acute lymphoblastic leukemia (ALL) who have undergone total craniocerebral radiotherapy and / or intrathecal CNS remission after intermittent radiotherapy + intrathecal injection in order to Establish a radiotherapy program that minimizes the complications of late radiotherapy-induced complications while achieving the goal of treatment. Methods Thirteen patients with acute lymphoblastic leukemia who had undergone CNS recurrent craniocerebral radiotherapy and / or intrathecal injection were treated with whole-craniotomy and whole-spinal cord intermittent radiotherapy with a home-made 8 MV linear accelerator. Intrathecal injection. Treatment options are: total cranial 150cGy / times + full spinal cord 75cGy / time, 1 day 3 days. The first day intrathecal methotrexate (MTX) 8 ~ 12mg / m2, cytarabine (Ara C) 25mg / m2, dexamethasone (DXM) 2 ~ 5mg / times, every 8 weeks after the whole cranial 150cGy + The whole spinal cord 75cGy irradiation 1, intrathecal injection, the same dose. The total course of treatment is 2 years and 2 months. Results Nine cases were followed up for more than 5 years and 4 cases were followed up for more than 3 years. Two of the 13 children died of recurrence of bone marrow at 5 months and 12 months after the end of radiotherapy, respectively. No survivors CNSL. Conclusion No significant acute side effects were found during intermittent radiation therapy. During follow-up found 2 cases of poor memory, attention is not easy to focus on. Intermittent radiotherapy For those who have received CNS radiotherapy and / or intrathecal injection of CNSL recurrence of emergency?