Sindelar W F, Hoekstra H, Restrepo C, Kinsella T J
Am J Clin Oncol. 1986 Dec;9(6):504-9. doi: 10.1097/00000421-198612000-00008.
Ninety patients with a variety of advanced-stage malignancies were treated with surgical resection, when feasible, and with intraoperative radiotherapy. Certain patients received additional external beam radiotherapy. During clinical follow-up, 45 patients died. Twenty-two patients (49% of deaths) underwent detailed autopsies between 1 and 18 months after treatment, with special attention directed towards assessing radiation damage to various tissues. Histological changes related to radiation were generally manifested as fibrosis. Mild fibrotic changes in retroperitoneal soft tissues and mild hypocellularity in vertebral bone marrow were consistently present in patients treated for pancreatic carcinoma, gastric carcinoma, and retroperitoneal or pelvic sarcomas. Fibrosis of the soft tissues of the porta hepatis without narrowing of the bile duct was present in patients treated for pancreatic or gastric cancer. perineural fibrosis was present in retroperitoneal and pelvic nerve trunks in patients treated for abdominal or pelvic sarcomas and in patients treated for unresectable carcinoma of the pancreas. Significant radiation-related changes were generally not observed in major blood vessels, intestine, or ureter. Intact irradiated primary tumors consistently displayed necrosis.
九十例患有各种晚期恶性肿瘤的患者，在可行的情况下接受了手术切除及术中放疗。部分患者还接受了额外的外照射放疗。在临床随访期间，45例患者死亡。22例患者（占死亡患者的49%）在治疗后1至18个月之间接受了详细尸检，特别关注评估对各种组织的辐射损伤。与辐射相关的组织学变化通常表现为纤维化。接受胰腺癌、胃癌以及腹膜后或盆腔肉瘤治疗的患者，腹膜后软组织普遍存在轻度纤维化改变，椎骨骨髓存在轻度细胞减少。接受胰腺癌或胃癌治疗的患者，肝门软组织出现纤维化但胆管未狭窄。接受腹部或盆腔肉瘤治疗的患者以及无法切除的胰腺癌患者，腹膜后和盆腔神经干出现神经周纤维化。在主要血管、肠道或输尿管中，一般未观察到与辐射相关的显著变化。接受照射的原发肿瘤完整时始终显示坏死。
