Jones B, Hopewell J W, Dale R G
Birmingham Cancer Centre, Queen Elizabeth Medical Centre, University Hospital Birmingham Foundation Trust, Birmingham, USA.
Br J Radiol. 2007 Dec;80(960):1006-10. doi: 10.1259/bjr/52200095.
Unlike radical treatment protocols, in which radiobiological methods have been used in an attempt to overcome the risk of reduced tumour control, the problem of compensation for unintended treatment interruptions during palliative radiotherapy has received little attention. For palliative radiotherapy, unnecessarily extended treatment times could theoretically reduce the duration of tumour regression and symptomatic relief. It can be shown, using a simple argument, that the overall extension of the treatment time is likely to be at least equal to the reduced duration of benefit. In most practical instances, this duration would amount to relatively few days, but it can sometimes be as long as 1-2 weeks. The mechanisms for gap compensations are the same as for radical radiotherapy, although there is greater scope for hypo-fractionated compensation provided that tissue tolerances are respected. It is debatable whether compensation should be applied in all patients, but there might be clinical situations where this would be indicated. Such decisions might influence waiting times for other patients requiring radical radiotherapy, and therefore must be balanced against the available resources.
与采用放射生物学方法试图克服肿瘤控制降低风险的根治性治疗方案不同，姑息性放疗期间非预期治疗中断的补偿问题很少受到关注。对于姑息性放疗，理论上不必要地延长治疗时间可能会缩短肿瘤消退和症状缓解的持续时间。通过一个简单的论证可以表明，治疗时间的总体延长可能至少等于获益持续时间的缩短。在大多数实际情况中，这段持续时间可能只有短短几天，但有时可能长达1 - 2周。间隙补偿的机制与根治性放疗相同，不过只要尊重组织耐受性，超分割补偿的空间更大。是否应对所有患者进行补偿存在争议，但可能存在一些临床情况表明需要这样做。此类决定可能会影响其他需要根治性放疗的患者的等待时间，因此必须与可用资源相平衡。
