Letschert J G, Lebesque J V, Aleman B M, Bosset J F, Horiot J C, Bartelink H, Cionini L, Hamers J P, Leer J W, van Glabbeke M
University of Amsterdam, Department of Radiotherapy, The Netherlands.
Radiother Oncol. 1994 Aug;32(2):116-23. doi: 10.1016/0167-8140(94)90097-3.
The purpose of this study was to quantify the correlation between irradiated small bowel volume and late occurring small bowel complications.
Small bowel volumes in the high-dose region were measured using orthogonal barium films for 203 patients treated for rectal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EORTC multicentric study.
The 5-year estimate of late pelvic small bowel obstruction requiring surgery was 11%. No correlation between the irradiated small bowel volume and obstruction was detected. The actuarial 5-year estimate of chronic diarrhea varied from 31% in patients with irradiated small bowel volumes below 77 cm3 to 42% in patients with volumes over 328 cm3. This correlation was significant in the univariate and multivariate analysis (p = 0.025). The type of rectal surgery significantly influenced the incidence of chronic diarrhea and malabsorption, the actuarial 5-year estimate being 49% and 26% after low anterior resection and abdominoperineal resection, respectively (p = 0.04).
This study demonstrated that there is a volume-effect in radiation-induced diarrhea at a dose of 50 Gy in 25 fractions. No volume-effect for small bowel obstruction was detected at this dose-level in pelvic postoperative radiotherapy. A review of the literature data on small bowel obstruction indicates that the volume effect at this dose level can only be demonstrated in patients who were treated with extended field radiotherapy (estimated small bowel volume 800 cm3) after intra-abdominal surgery.
本研究旨在量化照射小肠体积与迟发性小肠并发症之间的相关性。
在一项欧洲癌症研究与治疗组织（EORTC）多中心研究中，对203例接受盆腔术后放疗至50 Gy的直肠癌患者，使用正交钡剂造影测量高剂量区域的小肠体积。
需要手术治疗的盆腔迟发性小肠梗阻的5年估计发生率为11%。未检测到照射小肠体积与梗阻之间的相关性。慢性腹泻的精算5年估计发生率在照射小肠体积低于77 cm³的患者中为31%，在体积超过328 cm³的患者中为42%。这种相关性在单因素和多因素分析中均具有显著性（p = 0.025）。直肠手术类型显著影响慢性腹泻和吸收不良的发生率，低位前切除术和腹会阴联合切除术后的精算5年估计发生率分别为49%和26%（p = 0.04）。
本研究表明，在25次分割给予50 Gy剂量时，放射性腹泻存在体积效应。在盆腔术后放疗的该剂量水平下，未检测到小肠梗阻的体积效应。对小肠梗阻的文献数据回顾表明，在该剂量水平下的体积效应仅在腹部手术后接受扩大野放疗（估计小肠体积800 cm³）的患者中得到证实。
