Debbi K, Janoray G, Scher N, Deutsch É, Mornex F
Clinique d'oncologie radiothérapie, centre Henry-S.-Kaplan, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
Clinique d'oncologie radiothérapie, centre Henry-S.-Kaplan, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
Cancer Radiother. 2017 Oct;21(6-7):604-612. doi: 10.1016/j.canrad.2017.07.042.
The liver is an essential organ that ensures many vital functions such as metabolism of bilirubin, glucose, lipids, synthesis of coagulation factors, destruction of many toxins, etc. The hepatic parenchyma can be irradiated during the management of digestive tumors, right basithoracic, esophagus, abdomen in toto or TBI. In addition, radiotherapy of the hepatic area, which is mainly stereotactic, now occupies a central place in the management of primary or secondary hepatic tumors. Irradiation of the whole liver, or part of it, may be complicated by radiation-induced hepatitis. It is therefore necessary to respect strict dosimetric constraints both in stereotactic and in conformational irradiation in order to limit the undesired irradiation of the hepatic parenchyma which may vary according to the treatment techniques, the basic hepatic function or the lesion size. The liver is an organ with a parallel architecture, so the average tolerable dose in the whole liver should be considered rather than the maximum tolerable dose at one point. The purpose of this article is to propose a development of dose recommendations during conformation or stereotactic radiotherapy of the liver.
肝脏是一个重要器官，它确保许多重要功能，如胆红素、葡萄糖、脂质的代谢，凝血因子的合成，多种毒素的清除等。在消化系统肿瘤、右胸下部、食管、全腹部或全身照射的治疗过程中，肝实质可能会受到照射。此外，主要为立体定向的肝脏区域放疗，目前在原发性或继发性肝脏肿瘤的治疗中占据核心地位。对整个肝脏或其部分进行照射，可能会并发放射性肝炎。因此，在立体定向放疗和适形放疗中都必须严格遵守剂量限制，以限制对肝实质的不必要照射，这种照射可能因治疗技术、肝脏基本功能或病变大小而有所不同。肝脏是一个具有平行结构的器官，所以应考虑整个肝脏的平均耐受剂量，而不是某一点的最大耐受剂量。本文的目的是提出在肝脏适形放疗或立体定向放疗期间剂量建议的进展。
