目的：研究有關本院兒童急性白血病預防性全腦照射的治療結果以及這些病童的預後影響因子。材料與方法：自l987年9月至l996年3月，共有22位患有急性白血病兒童(17位為急性淋巴性白血病，5位為急性非淋巴性白血病)於本科接受預防性全腦照射。其中男孩佔9位，女孩佔13位，年齡介於1.6至17.4歲之間，對於存活病童的平均追蹤時間為4.8年(範圍從2.7到7.16年)。放射治療總劑量為1800cGy。經由回溯整理其治療記錄與病歷資料來研究其各項預後因子與存活情況。結果：本文分析相關的預後因子，發現淋巴腺腫為影響預後的主要因素。所有病童的五年存活率為50％，而目前存活的病童已經結束化學治療療程超過三年以上。放射治療中主要的反應為嘔吐、頭痛。所有病童只有一人在預防性全腦照射十一個月後發生中樞性的白血病復發。而死亡病童的主要致死原因為敗血病。結論：白血病童若發生中樞性白血病會影響到白血病的治療與預後，而且由於中樞神經系統內的白血球母細胞有機會再度植入已經化學治療緩解的骨髓中，結果也可能會導致白血病的血液復發。而根據本文，預防性全腦照射可獲得很好的中樞性白血病預防結果。白血病治療的模式中，於化學治療程中均應加入全腦預防性照射是值得考慮的方式。至於其他預後因子之分析則有待未來更多資料病歷的收集。

　　　　　Purpose: To evaluate the therapeutic result and analyze theprognostic variables of pediatric acute leukemia treated with chemotherapy andprophylactic cranial irradiation (PCI) at KMCH over the past 1 0 years.Materials and Methods: From September 1987 to March 1996, twenty-twopatients with acute leukemia received PCI at Kaohsiung Medical CollegeHospital. There were 9 boys and 13 girls between 1.6 and 17.4 years of ageat diagnosis. According to French-American-British (FAB) classification,seventeen patients had acute lymphoblastic leukemia (ALL) and 5 patients hadacute non-lymphoblastic leukemia (ANLL). The radiation dose was 1800 cGy givenin 10 to 15 fractions. Prognostic factors such as leukemia subtype, age,sex, hemogram, hepatospienomegaly, lymphoadenopathy and radiotherapyfraction were analyzed by retrospective review of the medical records. Allpatients were followed up regularly. The median follow-up time for patientsstill alive were 4.8 years (range 2.7 to 7.16 years).Results: The common acute reactions were vomiting and headache. The 5-yeardisease-free survival rate was 50%. Overall median survival time was 6years; ALL was 6.16 years and ANLL was 2 years. Only one patient (5%) sufferedfrom CNS relapse 1 year after PCI. The major cause of death was sepsis (55%). Adenopathy was the significant prognostic factors in this study.Conclusion: Leukemia involvement of the CNS remains a major clinical problemdespite the improved disease control provided by mordern treatment regimens.In this study, excellent CNS prophylactic result (95%) was achieved in ourcases, and we recommend that PCI should be incorporated in the management ofpediatric acute leukemia. Besides, the most significant prognostic factorwas adenopathy.