Gillette E L, Mahler P A, Powers B E, Gillette S M, Vujaskovic Z
Department of Radiological Health Sciences, Colorado State University, USA.
Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1309-18. doi: 10.1016/0360-3016(94)00422-H.
Late radiation injury to muscles and peripheral nerves is infrequently observed. However, the success of radiation oncology has led to longer patient survival, providing a greater opportunity for late effects to develop, increase in severity and, possibly, impact the quality of life of the patient. In addition, when radiation therapy is combined with surgery and/or chemotherapy, the risk of late complications is likely to increase. It is clear that the incidence of complications involving muscles and nerves increases with time following radiation. The influence of volume has yet to be determined; however, an increased volume is likely to increase the risk of injury to muscles and nerves. Experimental and clinical studies have indicated that the alpha/beta ratio for muscle is approximately 4 Gy and, possibly, 2 Gy for peripheral nerve, indicating the great influence of fractionation on response of these tissues. This is of concern for intraoperative radiation therapy, and for high dose rate brachytherapy. This review of clinical and experimental data discusses the response of muscle and nerves late after radiation therapy. A grading system has been proposed and endpoints suggested.
肌肉和周围神经的晚期放射性损伤并不常见。然而，放射肿瘤学的成功使得患者生存期延长，从而为晚期效应的发生、严重程度增加以及可能影响患者生活质量提供了更多机会。此外，当放射治疗与手术和/或化疗联合使用时，晚期并发症的风险可能会增加。显然，涉及肌肉和神经的并发症发生率会随着放疗后的时间而增加。体积的影响尚未确定；然而，体积增加可能会增加肌肉和神经损伤的风险。实验和临床研究表明，肌肉的α/β比值约为4 Gy，周围神经可能为2 Gy，这表明分次照射对这些组织的反应有很大影响。这对于术中放射治疗和高剂量率近距离放射治疗而言是一个值得关注的问题。本文对临床和实验数据进行综述，讨论放疗后晚期肌肉和神经的反应。已提出一种分级系统并建议了终点指标。
