Kirk J, Wingate G W, Watson E R
Clin Radiol. 1976 Apr;27(2):137-44. doi: 10.1016/s0009-9260(76)80134-1.
Twenty-seven patients with carcinoma of the bladder were treated at the Glasgow Institute of Radiotherapeutics as part of a national hyperbaric oxygen trial. These patients were treated on a 4 MeV linear accelerator either in air or in 3 atm, absolute, of oxygen, by random selection. Of these patients, one-third were found to have high-dose effects to an extent which necessitated surgery. No association was found between the incidence of high-dose effects and treatment in air or hyperbaric oxygen. The treatment protocol used in all cases was to give an intended modal tumour dose of 6000 rad in 24 fractions in approximately 5 weeks. As all patients had received the same modal dose, there was no apparent reason why some had developed high-dose effects. However, on the basis of a Cumulative Radiation Effect (CRE) analysis of the treatment regimes given, a close correlation was found between the maximum CRE achieved and the occurrence of high-dose effects. Above a threshold level of 1910 reu in the maximum CRE achieved, there was a high incidence and rapid onset of high-dose effects. The reasons for the occurrence of the exceptionally high CRE values found in some patients are discussed. From a review of clinical results of bladder treatments, it is apparent that at a CRE level of 1910 reu, the tumour control rate is still increasing with CRE. It is proposed that by choosing the dose given on any treatment schedule to keep the maximum value of the CRE achieved just below 1910 reu, the greatest probability of cure would be obtained with minimum complication rate.
作为一项全国性高压氧试验的一部分，27名膀胱癌患者在格拉斯哥放射治疗研究所接受了治疗。这些患者通过随机选择，在4兆电子伏直线加速器上分别于空气中或3个绝对大气压的氧气环境中接受治疗。在这些患者中，三分之一被发现出现了严重到需要进行手术的高剂量效应。未发现高剂量效应的发生率与在空气中或高压氧环境下治疗之间存在关联。所有病例所采用的治疗方案是在大约5周内分24次给予目标肿瘤剂量6000拉德。由于所有患者接受的目标剂量相同，因此对于一些患者出现高剂量效应，并无明显原因。然而，基于对所给予治疗方案的累积辐射效应（CRE）分析，发现所达到的最大CRE与高剂量效应的发生之间存在密切关联。在所达到的最大CRE超过1910雷姆单位的阈值水平时，高剂量效应的发生率很高且迅速出现。文中讨论了一些患者出现异常高CRE值的原因。从对膀胱癌治疗临床结果的回顾来看，显然在CRE水平为1910雷姆单位时，肿瘤控制率仍随CRE上升。建议通过选择任何治疗方案中的剂量，使所达到的CRE最大值刚好低于1910雷姆单位，从而以最低的并发症发生率获得最大的治愈可能性。
