Henke M, Bechtold C, Momm F, Dörr W, Guttenberger R
Abteilung Strahlentherapie, Radiologische Universitätsklinik, Freiburg, Germany.
Int J Radiat Oncol Biol Phys. 2000 Sep 1;48(2):339-45. doi: 10.1016/s0360-3016(00)00595-2.
To evaluate the influence of blood hemoglobin concentration on the radiosensitivity of acutely reacting normal tissues.
Weekly scores (EORTC/RTOG criteria) for acute reactions of skin and mucosa are available for 60 patients with cancer of the head and neck undergoing a standard conventional radiotherapy. The prognostic significance of blood hemoglobin levels on the development of acute reactions is studied by multivariate analysis (Cox Proportional Hazards Model). Further, the incidence and the time to development of these reactions is looked at in cohorts of patients with different mean blood hemoglobin concentrations during radiotherapy. Patients are therefore classified into a "severely anemic group" (hemoglobin < 11.0 g/100 mL), and into a cohort with a blood hemoglobin value equal or above 11.0 g/100 mL.
Normal tissue scoring and monitoring of blood hemoglobin levels allows for a detailed analysis of possible correlations. A decrease in the mean blood hemoglobin value of 1 g/100 mL predicts a reduced risk to develop a skin reaction of Grade 2 or 3 (RR = 0.9; p = 0.08; RR = 0.8; p = 0.26, respectively) or a mucosa reaction of Grade 3 (RR = 0.8; p = 0.16), independent from the radiation dose, the treatment time and from previous surgery within the radiation volume (multivariate analysis). Likewise, patients with severe anemia develop grade 3 mucositis or dermatitis less often (0%; 13%) as compared to those with blood hemoglobin concentrations equal or above 11.0 g/100 mL (21%; 19%). Skin and mucosa reactions further tend to occur later in the course of radiation. The observations are not statistically significant and possible reasons will be discussed.
A decreased blood hemoglobin concentration may-perhaps by an impaired tissue oxygenation-reduce the radiosensitivity of normal tissue such as skin and mucosa. However, the data is preliminary and needs further confirmation.
评估血液血红蛋白浓度对急性反应正常组织放射敏感性的影响。
60例接受标准常规放疗的头颈部癌患者可获得皮肤和黏膜急性反应的每周评分（欧洲癌症研究与治疗组织/放射肿瘤学协作组标准）。通过多因素分析（Cox比例风险模型）研究血液血红蛋白水平对急性反应发生的预后意义。此外，观察放疗期间不同平均血液血红蛋白浓度患者队列中这些反应的发生率和发生时间。因此，患者被分为“重度贫血组”（血红蛋白<11.0 g/100 mL）和血液血红蛋白值等于或高于11.0 g/100 mL的队列。
正常组织评分和血液血红蛋白水平监测有助于详细分析可能的相关性。平均血液血红蛋白值每降低1 g/100 mL，预测发生2级或3级皮肤反应（RR = 0.9；p = 0.08；RR = 0.8；p = 0.26，分别）或3级黏膜反应（RR = 0.8；p = 0.16）的风险降低，与放射剂量、治疗时间以及放射野内既往手术无关（多因素分析）。同样，与血液血红蛋白浓度等于或高于11.0 g/100 mL的患者（21%；19%）相比，重度贫血患者发生3级黏膜炎或皮炎的频率更低（0%；13%）。皮肤和黏膜反应在放疗过程中往往出现得更晚。这些观察结果无统计学意义，将讨论可能的原因。
血液血红蛋白浓度降低可能——或许通过组织氧合受损——降低皮肤和黏膜等正常组织的放射敏感性。然而，数据是初步的，需要进一步证实。
