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Die Bedeutung einer präventiven ZNS-Bestrahlung im Rahmen einer antineoplastischen Therapie im Kindesalter hinsichtlich dentogener und mandibulofazialer Spätschäden

The significance of preventive cranial radiotherapy in the course of antineoplastic therapy during childhood and later adverse effects on dental and mandibulofacial development

  • Orginalarbeit-Klinische Untersuchung
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Zusammenfassung

In der vorliegenden Studie wird untersucht, inwieweit die adjuvante ZNS-Bestrahlung bei Kindern, die antileukämisch mit dem BFM-Protokoll (Berlin, Frankfurt, Münster) behandelt wurden, das kraniofaziale Wchstum und die dentogene Entwicklung beeinflußt. Dazu wurden 26 Kinder mit soliden Tumoren ohne ZNS-Bestrahlung und 34 Patienten mit behandelter akuter lymphoblastischer Leukämic (ALL) und ZNS-Bestrahlung nachuntersucht die beide chemotherapeutisch behandelt wurden. Das Erkrankungsalter beider Patieittengruppen lag zwischen drei und 52 Monaten. Die dentogenen Schäden (Wurzelverkutzung, Wurzelzuspitzung Schmelzhypoplasien) sind bei allen Patienten feststellbar, aber bei den öber längere Zeit behandelten Patienten (ALL) ausgepragter, ohne daß ein Einfluß der adjuvanten Schädelbestrahlung statistisch gesichert werden konnte. Das zunachst bestehende kraniofaziale Wachstumsdefizit kann nach neun Jahren offensichilich wieder antgeholt werden so daß die schwersten Dauerschäden im dentogenen Bereich bestehen.

Summary

The aim of the present study was to determine the adverse effects of antineoplastic chemotherapy and radiotherapy on tooth development, i.e. on dentition in general and on craniofacial growth. The patients studied consisted of 26 children with solid tumors treated with chemotherapy alone and 34 patients with acute lymphoblastic leukemia (ALL) who were treated with intensive and follow on radiation therapy (18 and 24 Gy) to the neurocramum as a constituent of central hervous system prophylactics in treatment protocols for ALL The treatment protocol employed in these children is known as the BFM (Berlin, Frankfurt, Munster) protocol. At the time of diagnosis the children ranged in age from 3 to 52 months. All treated patients had microdontia, enamel dysplasia, thinning and tapering of apical roots portions and marked shortening of the roots. These defects were more pronounced in children treated for ALL, but it was not possible to establish stanstically relevant evidence on the influence of adjuvant radiotherapy in this group. This indicates that there is a catch up in craniofacial growth 9 years after therapy and that the most serious long-term adveise effects are on dentition.

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Author notes

  1. E. A. Holtgrave

    Present address: Abteilung für Kieferorthopädie, Universitätsklinikum Benjamin Franklin, Aßmannshauser Straße 4-6, D-14197, Berlin

Authors and Affiliations

  1. Abteilung für Kieferorthopädie, Universitätsklinikum Benjamin Franklin, Aßmannshauser Straße 4-6, D-14197, Berlin

    F. Heinze

  2. Abteilung für Pädiatrie-Hämatologie/Onkologie, Universitätsklinikum Rudolf Virchow, Kinderklinik, der FU Berlin, Berlin, Deutschland

    G. Henze

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  3. G. Henze
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Holtgrave, E.A., Heinze, F. & Henze, G. Die Bedeutung einer präventiven ZNS-Bestrahlung im Rahmen einer antineoplastischen Therapie im Kindesalter hinsichtlich dentogener und mandibulofazialer Spätschäden. Fortschritte der Kieferorthopädie 56, 254–264 (1995). https://doi.org/10.1007/BF02299666

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