Böttcher H D
Strahlenther Onkol. 1986 Aug;162(8):503-13.
According to the case records found in literature of the last ten years, a combined therapy with ionizing radiation dose and systematic application of cytostatic drugs leaded much earlier to nephropathy, if the kidney was situated directly within the ray path, than radiotherapy alone. Hitherto no systematic experimentations on animals have been made in order to investigate the interaction of radiotherapy and cytostatic drugs in the sound kidney. The authors have submitted 240 white female Wistar rats to ablation of the right kidney and to extracorporal irradiation of the left kidney with increasing doses of 10 to 50 Gy. One half of these animals received additionally an intravenous injection of 6 mg adriamycin per kg of body weight. Another group of 24 animals was only treated with adriamycin, 24 animals were only operated, and 24 animals were not treated and served as control group. The laboratory examinations of blood and urine as well as the light-microscopic investigation of the treated kidneys showed already after 10 Gy modifications of the renal parenchyma which have to be imputed to irradiation. A threshold dose cannot be deducted from this assay. All morphologically demonstrable cell lesions were progressive. Adriamycin had a nephrotoxic influence on the parenchyma of the sound kidney which showed a compensatory hypertrophy. Combined treatment with ionizing radiation and adriamycin of the sound kidney of the rat showing a compensatory hypertrophy had a synergistic effect on the renal parenchyma and leaded to progressive nephropathy.
根据过去十年文献中发现的病例记录,如果肾脏直接位于射线路径内,与单独放疗相比,电离辐射剂量与细胞毒性药物的系统应用联合治疗会更早导致肾病。迄今为止,尚未对动物进行系统实验以研究放疗与细胞毒性药物在健康肾脏中的相互作用。作者对240只雌性Wistar白鼠进行了右肾切除,并对左肾进行体外照射,剂量从10 Gy增加到50 Gy。其中一半动物额外接受了每千克体重6毫克阿霉素的静脉注射。另一组24只动物仅接受阿霉素治疗,24只动物仅接受手术,24只动物未接受治疗作为对照组。血液和尿液的实验室检查以及对治疗后肾脏的光学显微镜检查显示,在10 Gy照射后,肾实质就已经出现了归因于辐射的改变。从该试验中无法得出阈值剂量。所有形态学上可证实的细胞损伤都是进行性的。阿霉素对表现出代偿性肥大的健康肾脏实质有肾毒性影响。对表现出代偿性肥大的大鼠健康肾脏进行电离辐射和阿霉素联合治疗,对肾实质有协同作用,并导致进行性肾病。