Coia L R, Hanks G E
Department of Radiation Therapy, University of Pennsylvania School of Medicine, Philadelphia.
Int J Radiat Oncol Biol Phys. 1988 Jul;15(1):29-35. doi: 10.1016/0360-3016(88)90343-4.
There are only infrequent complications from intermediate dose infradiaphragmatic radiation to the para-aortics or para-aortic and iliac nodal regions as given in Hodgkin's disease or seminoma. Nonetheless, such complications can cause significant debility and may be lifelong. Treatment related factors associated with such complications should be identified and where possible, avoided. We have analyzed the records of 1,026 patients treated nationwide in the Patterns of Care Outcome. Studies including the Hodgkin's national practice survey (387 patients), Hodgkin's large facility survey (253 patients), and Seminoma national practice survey (386 patients). There were 883 patients who received infradiaphragmatic radiation to the para-aortics or para-aortic and iliac regions. Complications which occurred in these patients included gastrointestinal injury, hepatitis, nephritis, gonadal injury, hematopoietic injury, second malignancy, and miscellaneous others. There were 139 complications of any severity and 35 major complications requiring hospitalization for management. The 3-year actuarial complication rates were 14% and 4% for any and major complications, respectively. There was a statistically significant increase in both any complications and major complications with dose (p less than .01). The most frequent complications were those related to gastrointestinal injury such as peptic ulceration, hemorrhage, chronic diarrhea, and intestinal obstruction. Major bowel complications comprised 60% (21/35) of major complications and increased with dose from 1% for doses less than 3,500 cGy to 3% for doses greater than or equal to 3,500 cGy (p = .03). This study indicates that total dose is an important factor in determining complications, particularly gastrointestinal injury, in patients receiving infradiaphragmatic radiation in Hodgkin's disease and seminoma and that prior G.I. disease is associated with an increased risk of radiation related bowel complication. The radiotherapist should seek to optimize the therapeutic ratio in these diseases where gross disease can be controlled with 3500 cGy or less with few exceptions.
对于霍奇金病或精原细胞瘤患者，对腹主动脉旁或腹主动脉旁及髂淋巴结区域进行中等剂量的膈下放疗，并发症并不常见。尽管如此，这类并发症可导致严重的身体虚弱，且可能会持续终生。应识别与这类并发症相关的治疗相关因素，并尽可能避免。我们分析了全国范围内参与“治疗模式结果研究”的1026例患者的记录。这些研究包括霍奇金病全国实践调查（387例患者）、霍奇金病大型机构调查（253例患者）和精原细胞瘤全国实践调查（386例患者）。有883例患者接受了腹主动脉旁或腹主动脉旁及髂区域的膈下放疗。这些患者出现的并发症包括胃肠道损伤、肝炎、肾炎、性腺损伤、造血损伤、二次恶性肿瘤及其他各类并发症。出现了139例任何严重程度的并发症，以及35例需要住院治疗的严重并发症。任何并发症和严重并发症的3年精算发生率分别为14%和4%。并发症的发生率和严重并发症的发生率均随剂量增加而有统计学意义的升高（p小于0.01）。最常见的并发症是与胃肠道损伤相关的并发症，如消化性溃疡、出血、慢性腹泻和肠梗阻。严重肠道并发症占严重并发症的60%（21/35），且随着剂量增加而增多，剂量小于3500 cGy时为1%，剂量大于或等于3500 cGy时为3%（p = 0.03）。本研究表明，总剂量是决定霍奇金病和精原细胞瘤患者接受膈下放疗时并发症，尤其是胃肠道损伤的一个重要因素，且既往胃肠道疾病与放疗相关肠道并发症风险增加有关。在这些疾病中，除少数例外，大体肿瘤可通过3500 cGy或更低剂量得到控制，放疗科医生应设法优化治疗比率。
