Catterall M, Kingsley D, Lawrence G, Grainger J, Spencer J
Gut. 1975 Feb;16(2):150-6. doi: 10.1136/gut.16.2.150.
Thirty-nine unselected patients suffering from inoperable, recurrent, or residual adenocarcinoma of the stomach were referred for palliation with fast neutrons from the Medical Research Council's cyclotron at Hammersmith Hospital. A full course of 1440 rads given in 12 treatments over 26 days was administered to the patients. Because of the relatively low energy (7-5 MeV) of the beam from this particular machine, it was not possible to deliver the full dose uniformly throughout the tumour except in extremely thin patients. Pain, dysphagia, vomiting, and bleeding were relieved in the majority of cases. The side effects were minimal and easily controlled. Palpable masses disappeared. Five patients required surgery after neutron therapy. All the incisions were made through irradioated tissue and all except one healed normally. Tumour was present outside the treated area, but the absence of any palpable mass within the treated area was a consistent finding. Radiologically, the stomachs remained abnormal and later changes included gross mucosal abnormality and shrinkage. Fourteen patients came to necropsy and in 10 no tumour was present macroscopocally. Tumour cells were seen in all except two cases but these were few, surrounded by dense fibrous tissue, and may not have been viable. The remaining stomach was abnormal with a thickened wall and destruction of mucosa. Three of the four cases in which macroscopic tumour was present received less than the standard dose because of the inadequate penetration of the beam. Excellent regression of tumors was achieved by the neutrons, but the stomachs did not recover from this satisfactorily. Gastrectomy four to six months after treatment is therefore suggested. This operation and other surgical procedures in other patients were successfully carried out. There is a need for higher energy neutrons to improve treatment and extend it to patients of thick-set build.
39例未经挑选的患有无法手术切除、复发性或残留性胃腺癌的患者被转至哈默史密斯医院，接受医学研究委员会回旋加速器产生的快中子姑息治疗。患者接受了在26天内分12次给予的1440拉德的完整疗程治疗。由于这台特定机器产生的束流能量相对较低（7 - 5兆电子伏特），除了极瘦的患者外，无法在整个肿瘤中均匀地给予全剂量。大多数病例中，疼痛、吞咽困难、呕吐和出血症状得到缓解。副作用极小且易于控制。可触及的肿块消失。5例患者在中子治疗后需要进行手术。所有切口均通过受照射组织进行，除1例患者外，其余患者切口均正常愈合。治疗区域外存在肿瘤，但治疗区域内未触及任何肿块是一致的发现。放射学检查显示，胃部仍异常，后期变化包括明显的黏膜异常和萎缩。14例患者进行了尸检，其中10例在宏观上未见肿瘤。除2例患者外，所有病例均可见肿瘤细胞，但数量很少，被致密的纤维组织包围，可能已无活力。剩余的胃部异常，壁增厚，黏膜破坏。4例有宏观肿瘤的病例中有3例因束流穿透不足而未接受标准剂量治疗。中子治疗使肿瘤实现了显著消退，但胃部并未令人满意地恢复。因此建议在治疗后4至6个月进行胃切除术。该手术及其他患者的其他外科手术均成功实施。需要更高能量的中子来改善治疗效果，并将其应用于体型较胖的患者。
