Gallez-Marchal D, Fayolle M, Henry-Amar M, Le Bourgeois J P, Rougier P, Cosset J M
Radiother Oncol. 1984 Aug;2(2):93-9. doi: 10.1016/s0167-8140(84)80044-4.
Out of 134 patients irradiated below the diaphragm to a dose of 40 Gy for Hodgkin's disease at the Institut Gustave-Roussy, 19 (14%) were subsequently found to present with radiation injuries of the gastrointestinal tract. Since five patients presented with two different injuries, 24 radiolesions were observed. Most of them (17 out of 24) were gastric or duodenal. Twelve (out of 24) were ulcers. Nine patients required surgery. A complete cure of the radiation injuries was obtained in 15 out of 19 patients. Sex, age, stage, histology or initial chemotherapy were not found to play a role in the occurrence of radiation damage. On the contrary, the role of a previous exploratory laparotomy appeared important; for the patients who underwent laparotomy and irradiation, the complication rate was 23%. For the patients treated by irradiation alone, the complication rate was 7% (p less than 0.01). Fractionation was found to be another important parameter: for 52 patients treated using 3 weekly fractions of 3.3 Gy, the complication rate was 25%, compared to 8% (p less than 0.01) for 76 patients treated using 4 weekly fractions of 2.5 Gy. Combining these two factors, we found a 42% complication rate for the group of patients who underwent laparotomy and who were treated by means of 3 fractions of 3.3 Gy per week, whereas patients irradiated using 4 weekly fractions of 2.5 Gy, without any previous laparotomy, had only a 5% complication risk (p less than 0.001).
在古斯塔夫 - 鲁西研究所，134例因霍奇金病接受膈下40 Gy剂量照射的患者中，有19例（14%）随后出现了胃肠道放射性损伤。由于5例患者出现了两种不同的损伤，共观察到24处放射性损伤。其中大多数（24例中的17例）为胃部或十二指肠损伤。24例中有12例为溃疡。9例患者需要手术治疗。19例患者中有15例的放射性损伤得到了完全治愈。未发现性别、年龄、分期、组织学类型或初始化疗在放射性损伤的发生中起作用。相反，先前的 exploratory laparotomy（此处可能有误，推测为探查性剖腹术）似乎起重要作用；接受剖腹术和照射的患者，并发症发生率为23%。仅接受照射治疗的患者，并发症发生率为7%（p小于0.01）。分次照射被发现是另一个重要参数：52例采用每周3次、每次3.3 Gy进行治疗的患者，并发症发生率为25%，而76例采用每周4次、每次2.5 Gy进行治疗的患者，并发症发生率为8%（p小于0.01）。综合这两个因素，我们发现接受剖腹术且每周采用3次、每次3.3 Gy进行治疗的患者组并发症发生率为42%，而未进行过剖腹术、每周采用4次、每次2.5 Gy进行照射的患者，并发症风险仅为5%（p小于0.001）。
