Dale R G, Jones B
Department of Surgery and Cancer, Imperial College, London, UK.
Department of Oncology, Oxford University, UK.
Radiat Phys Chem Oxf Engl 1993. 2022 Nov;200:110214. doi: 10.1016/j.radphyschem.2022.110214. Epub 2022 May 6.
Unintended treatment interruptions during a course of radiotherapy can lead to extended overall treatment times which allow increased tumour cell repopulation to occur. Extra dose may therefore be required to offset any loss of tumour control. However, the manner in which the extra dose is delivered requires careful consideration in order to avoid the risk of increased normal tissue toxicity. Radiobiological modelling techniques can allow quantitative examination of such problems and may be used to derive revised pattens of radiation delivery which can help restore a degree of tumour control whilst limiting the likelihood of excess normal tissue morbidity. Unintended treatment interruptions can occur in any radiotherapy department but the rapid spread of the Covid-19 pandemic caused a major increase in the frequency of such interruptions due to staff and patient illness and the consequent self-isolation requirements. This article summarises the radiobiological considerations and caveats involved in assessing treatment interruptions and outlines the UK experience of dealing with the new challenges posed by Covid-19. The world-wide need for more education programmes in cancer radiobiology is highlighted.
放射治疗过程中意外的治疗中断可能导致总治疗时间延长，从而使肿瘤细胞再增殖增加。因此，可能需要额外的剂量来抵消肿瘤控制方面的任何损失。然而，额外剂量的给予方式需要仔细考虑，以避免增加正常组织毒性的风险。放射生物学建模技术可以对这类问题进行定量研究，并可用于推导修订后的放射治疗模式，这有助于恢复一定程度的肿瘤控制，同时限制正常组织出现过多并发症的可能性。任何放疗科室都可能发生意外的治疗中断，但由于新冠疫情的迅速蔓延，工作人员和患者患病以及随之而来的自我隔离要求导致此类中断的频率大幅增加。本文总结了评估治疗中断时涉及的放射生物学考量和注意事项，并概述了英国应对新冠疫情带来的新挑战的经验。文中强调了全球对更多癌症放射生物学教育项目的需求。
