Mose S, Adamietz I A, Thilmann C, Saran F, Heyd R, Knecht R, Böttcher H D
Abteilung für Strahlentherapie und Onkologie, Universität Frankfurt/M.
HNO. 1995 Jul;43(7):421-6.
Among various therapies administered during radiation-induced mucositis, treatment with immunoglobulin has proven clinically successful. In this study the efficacy of prophylactic applications of immunoglobulin was investigated from January 1992 through August 1993. Forty-two patients with histologically-proven head and neck cancer were given postoperative radiation treatment. In cases with macroscopic tumor residues or inoperability, combined radio-chemotherapy was given. This included 51.3 Gy at 1.9 Gy 5x/week, boosted to 10-26 Gy at 2 Gy 5x/week and carboplatin 60 mg/m2 at days 1-5 and 29-33. Panthenol (4x10 ml/day) and nystatin (4 x 1 ml/day) were given to 20 patients as prophylactic treatment for mucositis. Twenty-two subsequent patients also received intramuscular 800 mg (5 ml) human immunoglobulin (1x/week). According to the Seegenschmiedt/Sauer classification the extent of mucositis was determined 3x/week. Comparison of the distribution of maximal mucositis revealed a slightly more severe mucosal reaction in the control group (n.s.). Analysis of the mean degree of mucositis in both groups demonstrated statistically significant differences (p = 0.031) related to the whole collective and patients receiving concomitant chemotherapy while no effect of immunoglobulin was found in patients treated by radiation alone. In the immunoglobulin-treated-group, the time from the beginning of therapy to the first interruption was prolonged 5 days (37.5 +/- 13.1 vs. 42.7 +/- 13.3 days), but this difference was not significant. Although prophylactic application of immunoglobulin seemed to lower the degree of radiation-induced mucositis, this effect was less significant when compared to the immunoglobulin given in a therapeutic manner.
在放射诱导性粘膜炎的各种治疗方法中，免疫球蛋白治疗已被证明在临床上是成功的。在本研究中，于1992年1月至1993年8月期间对免疫球蛋白预防性应用的疗效进行了调查。42例经组织学证实的头颈癌患者接受了术后放射治疗。对于有肉眼可见肿瘤残留或无法手术的病例，则给予联合放化疗。放疗方案为每周5次，每次1.9 Gy，总量51.3 Gy，之后每周5次，每次2 Gy，追加剂量10 - 26 Gy；化疗方案为在第1 - 5天和第29 - 33天给予卡铂60 mg/m²。20例患者给予泛醇（4×10 ml/天）和制霉菌素（4×1 ml/天）作为粘膜炎的预防性治疗。随后的22例患者还接受了肌肉注射800 mg（5 ml）人免疫球蛋白（每周1次）。根据Seegenschmiedt/Sauer分类法，每周3次确定粘膜炎的程度。最大程度粘膜炎分布的比较显示，对照组的粘膜反应稍严重一些（无统计学意义）。两组粘膜炎平均程度的分析表明，与整个队列以及接受同步化疗的患者相关，存在统计学显著差异（p = 0.031），而在单纯接受放疗的患者中未发现免疫球蛋白有效果。在免疫球蛋白治疗组中，从治疗开始到首次中断的时间延长了5天（37.5±13.1天 vs. 42.7±13.3天），但这种差异不显著。尽管免疫球蛋白的预防性应用似乎降低了放射诱导性粘膜炎的程度，但与以治疗方式给予免疫球蛋白相比，这种效果不太显著。
