Loeffler R K
Am J Roentgenol Radium Ther Nucl Med. 1974 Aug;121(4):748-53. doi: 10.2214/ajr.121.4.748.
Four schedules for the treatment of localized vocal cord carcinoma were compared, to establish a relationship between daily and total dose, and acute and late normal tissue reactions. All patients were treated 5 days per week. All of those who received 200 R daily (6,000 R in 30 treatments) developed a confluent mucositis and minimal to moderate subsequent aryepiglottic edema. Patients who received 180 R daily (6,480 R in 36 treatments) developed a patchy mucositis. Those who received 170 R daily (7,140 R or 6,400 rads in 42 treatments) developed only a brisk erythema, with decreasing incidence and severity of edema. At 160 R daily (6,880 R in 43 treatments) only a mild erythema developed, with no visible edema at any time. Local recurrence rates of about 10 percent for T1 lesions, and of about 25 per cent for T2 and T3 lesions, indicate that the decrease in reactions with longer fractionation has been achieved without loss of tumor control. Even minimal improvement in functional status following treatment for this highly curable malignancy well justifies the inconvenience of the increased number of treatments. The present formula of Ellis for normal tissue tolerance is not consistent with these findings, since the NSDs are essentially identical for all 4 schedules, while tolerance is notably improved by increasing fractionation.
比较了四种局部声带癌的治疗方案，以确定每日剂量和总剂量与急性和晚期正常组织反应之间的关系。所有患者每周接受5天治疗。所有每天接受200伦琴（30次治疗共6000伦琴）的患者都出现了融合性粘膜炎以及轻度至中度的后续会厌水肿。每天接受180伦琴（36次治疗共6480伦琴）的患者出现了斑片状粘膜炎。每天接受170伦琴（42次治疗共7140伦琴或6400拉德）的患者仅出现了轻度红斑，水肿的发生率和严重程度逐渐降低。每天接受160伦琴（43次治疗共6880伦琴）的患者仅出现了轻度红斑，任何时候都没有可见的水肿。T1病变的局部复发率约为10%，T2和T3病变的局部复发率约为25%，这表明在不丧失肿瘤控制的情况下，通过延长分割次数减少了反应。对于这种高度可治愈的恶性肿瘤，即使治疗后功能状态有最小程度的改善，也足以证明增加治疗次数带来的不便之处是合理的。埃利斯目前的正常组织耐受性公式与这些发现不一致，因为所有四种方案的NSD基本相同，而通过增加分割次数耐受性明显提高。
