Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S36-41. doi: 10.1016/j.ijrobp.2009.08.078.
Publications relating brainstem radiation toxicity to quantitative dose and dose-volume measures derived from three-dimensional treatment planning were reviewed. Despite the clinical importance of brainstem toxicity, most studies reporting brainstem effects after irradiation have fewer than 100 patients. There is limited evidence relating toxicity to small volumes receiving doses above 60-64 Gy using conventional fractionation and no definitive criteria regarding more subtle dose-volume effects or effects after hypofractionated treatment. On the basis of the available data, the entire brainstem may be treated to 54 Gy using conventional fractionation using photons with limited risk of severe or permanent neurological effects. Smaller volumes of the brainstem (1-10 mL) may be irradiated to maximum doses of 59 Gy for dose fractions <or=2 Gy; however, the risk appears to increase markedly at doses >64 Gy.
本文回顾了与基于三维治疗计划的定量剂量和剂量体积参数相关的脑干放射性毒性的文献。尽管脑干毒性具有重要的临床意义，但大多数报道放射性脑损伤的研究中患者数都不足 100 例。对于常规分割放疗，受照体积较小（60-64Gy 以上）与毒性的关系，以及对于更轻微的剂量-体积效应或分割治疗后的效应，仅有有限的证据。根据现有资料，采用光子常规分割放疗，整个脑干可接受 54Gy 的照射，而严重或永久性神经功能障碍的风险有限。脑干较小的体积（1-10ml）可接受 2Gy 以下剂量分割的最大 59Gy 照射，但剂量>64Gy 时风险明显增加。
