Trott K R
Department of Radiation Biology, St. Bartholomew's Medical College, London, Great Britain.
Strahlenther Onkol. 1994 Jan;170(1):1-12.
This editorial explores the scientific basis of radiotherapy with doses of < 1 Gy for various non-malignant conditions, in particular dose-effect relationships, risk-benefit considerations and biological mechanisms.
A review of the literature, particularly clinical and experimental reports published more than 50 years ago was conducted to clarify the following problems. 1. The dose-response relationships for the therapeutic effects on three groups of conditions: non-malignant skin disease, arthrosis and other painful degenerative joint disorders and anti-inflammatory radiotherapy; 2. risks after radiotherapy and after the best alternative treatments; 3. the biological mechanisms of the different therapeutic effects.
Radiotherapy is very effective in all three groups of disease. Few dose-finding studies have been performed, all demonstrating that the optimal doses are considerable lower than the generally recommended doses, yet few of these studies meet the required standard. In different conditions, risk-benefit analysis of radiotherapy versus the best alternative treatment yields very different results: whereas radiotherapy for acute postpartum mastitis may not be justified any more, the risk-benefit ratio of radiotherapy of other conditions and particularly so in dermatology and some anti-inflammatory radiotherapy appears to be more favourable than the risk-benefit ratio of the best alternative treatments.
Radiotherapy can be very effective treatment for various non-malignant conditions such as eczema, psoriasis, periarthritis humeroscapularis, epicondylitis, knee arthrosis, hydradenitis, parotitis and panaritium and probably be associated with less acute and long-term side effects than similarly effective other treatments. Randomized clinical studies are required to find the optimal dosage which, at present, may be unnecessarily high. Since no adequate experimental studies have been performed nothing is known about the mechanisms of these therapeutic radiation effects. Good experimental models are now available which should be used to investigate the cellular and molecular mechanisms involved.
本社论探讨了针对各种非恶性疾病采用低于1 Gy剂量进行放射治疗的科学依据，特别是剂量效应关系、风险效益考量及生物学机制。
对文献进行综述，尤其查阅了50多年前发表的临床和实验报告，以阐明以下问题。1. 对三组疾病的治疗效果的剂量反应关系：非恶性皮肤病、关节炎及其他疼痛性退行性关节疾病和抗炎性放射治疗；2. 放射治疗后及最佳替代治疗后的风险；3. 不同治疗效果的生物学机制。
放射治疗对所有三组疾病都非常有效。进行的剂量探索研究很少，所有研究都表明最佳剂量远低于一般推荐剂量，但这些研究中很少有符合要求标准的。在不同情况下，放射治疗与最佳替代治疗的风险效益分析产生非常不同的结果：产后急性乳腺炎的放射治疗可能不再合理，而其他疾病尤其是皮肤病和一些抗炎性放射治疗的风险效益比似乎比最佳替代治疗的风险效益比更有利。
放射治疗对于各种非恶性疾病，如湿疹、银屑病、肩周炎、肱骨外上髁炎、膝关节骨性关节炎、汗腺炎、腮腺炎和脓性指头炎等可能是非常有效的治疗方法，并且可能比同样有效的其他治疗方法产生更少的急性和长期副作用。需要进行随机临床研究以找到最佳剂量，目前该剂量可能过高。由于尚未进行充分的实验研究，对这些放射治疗效果的机制尚不清楚。现在有良好的实验模型，应利用这些模型来研究其中涉及的细胞和分子机制。
