Turesson I, Nyman J, Holmberg E, Odén A
Department of Oncology, University of Gothenburg, Sahlgrenska Hospital, Sweden.
Int J Radiat Oncol Biol Phys. 1996 Dec 1;36(5):1065-75. doi: 10.1016/s0360-3016(96)00426-9.
Patients treated with identical radiotherapy schedules show a substantial variation in the degree of acute and late normal tissue reactions. To identify any possible contributing factors to this phenomenon, we have analyzed the treatments of 402 breast cancer patients.
The patients received adjuvant postoperative radiotherapy between 1972 and 1985 and have been followed up since then. Multivariate analyses were performed with peak reflectance erythema and peak acute reaction score as endpoints for the acute reactions, and with progression rate of telangiectasia as well as telangiectasia score as endpoints for the late reactions. Twenty patient- and treatment-related factors were tested such as age, menopausal status, hemoglobin level, serum calcium, smoking habits, hypothyroidism, diabetes, hypertension, blood pressure, cardiovascular and autoimmune disease, the influence of hormone therapy and chemotherapy, pretreatment reflectance value, acute skin reactions, radiation quality, individual dose, bilateral fields, and the total effect (TE) for the dose schedule applied.
The TE was a strong prognostic factor for all endpoints. In addition to TE, blood pressure was prognostic for the peak erythema measured by reflectance spectrophotometry, and the pretreatment reflectance value was prognostic for the acute score. The only independent prognostic factors found for the progression of skin telangiectasia and telangiectasia score except for TE were the individual dose and the acute skin reactions.
These factors explained at most about 30% of the variance describing the total patient-to-patient variability for each endpoint. The remaining variability is still unexplained but may be related to individual differences in cellular radiosensitivity, partly determined by genetic variations and partly by unknown epigenetic factors.
接受相同放疗方案治疗的患者，其急性和晚期正常组织反应程度存在显著差异。为了确定导致这一现象的可能因素，我们分析了402例乳腺癌患者的治疗情况。
这些患者于1972年至1985年间接受了术后辅助放疗，此后一直处于随访中。多因素分析以峰值反射红斑和峰值急性反应评分作为急性反应的终点，以毛细血管扩张的进展率以及毛细血管扩张评分作为晚期反应的终点。对20个与患者和治疗相关的因素进行了测试，如年龄、绝经状态、血红蛋白水平、血清钙、吸烟习惯、甲状腺功能减退、糖尿病、高血压、血压、心血管和自身免疫性疾病、激素治疗和化疗的影响、治疗前反射值、急性皮肤反应、放射质量、个体剂量、双侧照射野以及所应用剂量方案的总效应（TE）。
总效应（TE）是所有终点的一个强有力的预后因素。除TE外，血压对通过反射分光光度法测量的峰值红斑具有预后意义，治疗前反射值对急性评分具有预后意义。除TE外，发现的皮肤毛细血管扩张进展和毛细血管扩张评分的唯一独立预后因素是个体剂量和急性皮肤反应。
这些因素最多解释了每个终点描述患者间总体变异性的约30%的方差。其余的变异性仍无法解释，但可能与细胞放射敏感性的个体差异有关，部分由基因变异决定，部分由未知的表观遗传因素决定。
