Lindberg R D, Jones K, Garner H H, Jose B, Spanos W J, Bhatnagar D
Department of Radiation Oncology, University of Louisville, Brown Cancer Center, KY 40202.
Int J Radiat Oncol Biol Phys. 1988 Apr;14(4):811-5. doi: 10.1016/0360-3016(88)90103-4.
One of the major radiobiological interests has been to maximize the effectiveness of the time-dose relationship in the clinical setting. Current explorations include altered fractionation schedules, multiple daily fractions and hypofractionation. Patient compliance to standard radiotherapy treatment schedules is taken for granted. To evaluate the true rate of compliance, the charts of all new patients treated from July 1, 1984 through June 30, 1985 were reviewed. The overall incidence of unplanned interruptions was 54% (361/668). The frequency of interruptions is significantly higher in patients treated to the primary site as compared to those treated for metastasis (59.8% and 35.6% respectively). The duration of the interruptions varied: 12.7% of the patients missed only 1 day, 25% missed 2 to 5 days, 38% had interruptions totalling 6-15 days, and in 24% the total exceeded 15 days. The most frequent cause of the unplanned interruptions was a rest resulting from unusually adverse tissue reactions (46.8%-169/361). Although this study has documented that unplanned interruptions are a major problem, the impact on local control and survival cannot be determined from our data. A retrospective review of multi-institutional studies such as those conducted by the Patterns of Care or RTOG might show that one of the major causes of failure is unplanned interruptions.
放射生物学的一个主要研究兴趣在于在临床环境中最大化时间-剂量关系的有效性。当前的探索包括改变分割方案、每日多次分割和大分割。患者对标准放疗治疗方案的依从性被视为理所当然。为了评估实际的依从率，我们回顾了1984年7月1日至1985年6月30日期间所有新患者的病历。计划外中断的总体发生率为54%（361/668）。与治疗转移灶的患者相比，治疗原发部位的患者中断频率显著更高（分别为59.8%和35.6%）。中断的持续时间各不相同：12.7%的患者仅错过1天，25%错过2至5天，38%的患者中断总计6 - 15天，24%的患者中断总计超过15天。计划外中断最常见的原因是异常不良组织反应导致的休息（46.8% - 169/361）。尽管这项研究记录了计划外中断是一个主要问题，但从我们的数据中无法确定其对局部控制和生存的影响。对多机构研究（如由治疗模式或放射肿瘤学组进行的研究）的回顾性分析可能会表明，失败的主要原因之一是计划外中断。
