Crellin R P, Macmillan C H, Berridge J K, Morgan D A
Department of Clinical Oncology, Nottingham General Hospital, UK.
Clin Oncol (R Coll Radiol). 1993;5(3):139-42. doi: 10.1016/s0936-6555(05)80309-7.
Reports of late spinal cord damage after multiple fractions daily radiotherapy regimens for head and neck cancer are infrequent, but increasing. We have reviewed our experience of head and neck cancers treated thrice daily to examine this problem. Between 1982 and 1990, 65 patients with advanced head and neck cancer were treated by primary radiotherapy using three small fractions delivered on 5 days per week, with an inter-fraction interval of 3-4 hours during normal working hours. In 25 patients, the cervical spinal cord received > 39 Gy. In 13 patients, 39.6 Gy was given in 1.1 Gy fractions, and five received 41.8 Gy in 1.1 Gy fractions, two received 45.1 Gy in 1.1 Gy fractions and five received 45 Gy in 1.5 Gy fractions. Eleven of these patients have survived over 2 years, and can be assessed for late spinal cord damage. Ten of these received 1.1 Gy fractions with no cord damage. The only 2-year survivor whose cord received 45 Gy in 1.5 Gy fractions has developed mild, non-progressive long tract signs. Other late side effects were equivalent to those after conventionally fractionated radiotherapy. Tumour control was good, especially for the larynx. We feel that, for radiotherapy given with three small fractions daily and an inter-fraction interval of 3-4 hours, the spinal dose should not exceed 40 Gy.
头颈部癌每日多次分割放疗方案后迟发性脊髓损伤的报告并不常见，但有增多趋势。我们回顾了每日三次治疗头颈部癌的经验以研究这一问题。1982年至1990年间，65例晚期头颈部癌患者接受了原发性放疗，每周5天给予三次小分割照射，正常工作时间内分割间隔为3 - 4小时。25例患者的颈段脊髓接受了超过39 Gy的照射。13例患者接受了39.6 Gy，每次1.1 Gy；5例接受了41.8 Gy，每次1.1 Gy；2例接受了45.1 Gy，每次1.1 Gy；5例接受了45 Gy，每次1.5 Gy。其中11例患者存活超过2年，可评估迟发性脊髓损伤情况。其中10例接受每次1.1 Gy照射，脊髓未出现损伤。唯一1例接受每次1.5 Gy、脊髓剂量达45 Gy的2年存活者出现了轻度、非进行性的长束征。其他晚期副作用与常规分割放疗后的副作用相当。肿瘤控制良好，尤其是对喉癌。我们认为，对于每日三次小分割照射且分割间隔为3 - 4小时的放疗，脊髓剂量不应超过40 Gy。
