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[食管癌和贲门癌患者术前放疗中的交感-肾上腺和垂体-肾上腺系统]

[The sympathetic-adrenal and hypophyseal-adrenal systems in the preoperative irradiation of patients with cancer of the esophagus and cardia].

作者信息

Tarutinov V I, Starosel'skiĭ I V, Gol'dshmidt B Ia, Shmal'ko Iu P, Levchenko A M

出版信息

Med Radiol (Mosk). 1983 Nov;28(11):36-9.

PMID:6645828
Abstract

A study was made of 74 patients with esophageal and cardiac cancer, Stages II and IV. The excretion of catecholamines, corticosteroids and their precursors was studied, tests with adrenalin before and after preoperative irradiation at a summary dose of 30 Gy were done. It has been shown that before the start of radiation therapy the excretion of catecholamines and corticosteroids is lowered, the reaction to adrenalin administration is negative in most patients, the phase syndrome of cardiac hypodynamics associated with disturbed function of the sympathoadrenal system was revealed. After irradiation DOPA and dopamine excretion gets still lower whereas adrenalin excretion remains at the initial reduced level, the level of noradrenalin increases but does not achieve the normal level, i. e. a predominant decrease of catecholamine synthesis is observed. Adrenalin tests after irradiation revealed the depletion of the reaction of the cardiovascular system interrelated, to a great extent, with the activity of the sympathoadrenal system. Preoperative irradiation in patients with esophageal and cardiac cancer results in an increased excretion of 17-ketosteroids (17-KS) and 17-ketogenic steroids, however 17-KS excretion does not reach the normal level. For better tolerance of irradiation and for a radiosensitization effect testenate is administered to patients before and during radiation therapy. The administration of testenate 7-10 days before the start and during radiotherapy proved to be effective which was confirmed by noticeable necrobiotic and necrotic changes of cancer cells.

摘要

对74例处于II期和IV期的食管癌和贲门癌患者进行了研究。研究了儿茶酚胺、皮质类固醇及其前体的排泄情况,在术前总剂量为30 Gy的照射前后进行了肾上腺素测试。结果表明,在放射治疗开始前,儿茶酚胺和皮质类固醇的排泄降低,大多数患者对肾上腺素给药的反应为阴性,揭示了与交感肾上腺系统功能紊乱相关的心脏动力不足的阶段综合征。照射后,多巴和多巴胺的排泄进一步降低,而肾上腺素的排泄仍维持在最初降低的水平,去甲肾上腺素水平升高但未达到正常水平,即观察到儿茶酚胺合成主要减少。照射后的肾上腺素测试显示,心血管系统的反应耗竭,这在很大程度上与交感肾上腺系统的活动相关。食管癌和贲门癌患者术前照射会导致17-酮类固醇(17-KS)和17-生酮类固醇的排泄增加,然而17-KS的排泄未达到正常水平。为了提高对放疗的耐受性并产生放射增敏作用,在放疗前和放疗期间给患者使用睾酮酯。在放疗开始前7 - 10天及放疗期间给予睾酮酯被证明是有效的,癌细胞明显的坏死和坏死变化证实了这一点。

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