Vriesendorp H M
Johns Hopkins Oncology Center, Baltimore, MD.
Radiother Oncol. 1990;18 Suppl 1:37-50. doi: 10.1016/0167-8140(90)90177-x.
Total body irradiation (TBI) is an important but toxic element in the preparation of patients for bone marrow transplantation. TBI can be delivered in many different ways and analysed for many different endpoints. The published clinical and large animal experiences are reviewed to economise the search for more optimal irradiation schedules. Currently, the immunosuppressive effects and potentially lethal side effects of TBI appear to be the dominant determinants in the therapeutic ratio of TBI. Radiation survival curve parameters are estimated for bone marrow, intestines, lung and immune system in an effort to predict fractionation effects of TBI. Predictions are in reasonable agreement with retrospective clinical observations in patients and animals. High dose rate TBI, fractionated in doses greater than 2 Gy and given over 4 days or less are recommended. Further optimization attempts depend on patient's diagnosis, available bone marrow donor, lymphocyte depletion of bone marrow and prior sensitisation of recipient. Deliberate TBI dose inhomogeneities might improve the therapeutic ratio of TBI, but remain to be explored in greater detail. The proposed model for predicting TBI effects can be adapted and remain useful for future use, when more quantitative information on additional important transplant variables becomes available.
全身照射（TBI）是骨髓移植患者预处理中的一个重要但具有毒性的环节。TBI可以通过多种不同方式进行，并且可针对许多不同的终点进行分析。本文回顾了已发表的临床和大型动物实验经验，以便更高效地寻找更优化的照射方案。目前，TBI的免疫抑制作用和潜在的致死性副作用似乎是其治疗比的主要决定因素。为预测TBI的分次照射效应，对骨髓、肠道、肺和免疫系统的辐射存活曲线参数进行了估算。这些预测与患者和动物的回顾性临床观察结果合理相符。推荐采用高剂量率TBI，分次剂量大于2 Gy，且在4天或更短时间内给予。进一步的优化尝试取决于患者的诊断、可用的骨髓供体、骨髓的淋巴细胞清除情况以及受体先前的致敏状态。故意造成的TBI剂量不均匀性可能会提高TBI的治疗比，但仍有待更详细地探索。当获得更多关于其他重要移植变量的定量信息时，所提出的预测TBI效应的模型可以进行调整并继续用于未来。
