Goffinet D R, Glatstein E, Fuks Z, Kaplan H S
Cancer. 1976 Jun;37(6):2797-805. doi: 10.1002/1097-0142(197606)37:6<2797::aid-cncr2820370635>3.0.co;2-h.
The incidence of subdiaphragmatic relapses in a group of 170 patients with non-Hodgkin's lymphomas treated with radiation to lymph-node bearing areas above and below the diaphragm is described. In patients treated with the standard inverted "Y" abdominal radiation portals, subdiaphragmatic relapses occurred in 29% of 132 patients. This high local failure rate may be attributed to the exclusion of many of the mesenteric lymph nodes and most of the liver and intestines from the irradiated fields. A safe and apparently effective radiation technique which treats the whole abdomen, used at Stanford in 38 patients since 1973, is described. Full thickness lead blocks protect the right hepatic lobe during the initial 1500-rad whole abdominal treatment (through anterior-posterior opposed fields). Horizontal decubitus (cross-table) lateral fields are then used to bring the para-aortic and mesenteric lymph node radiation doses to 3000 rads, followed by an additional 1400 rads through wide anterior-posterior ports, for a total central abdominal dose of 4400 rads. Dosimetric considerations, anatomic descriptions of subdiaphragmatic lymphatic drainage, complications of treatment, and the initial results of whole abdominal radiation therapy are also presented.
本文描述了一组170例非霍奇金淋巴瘤患者在接受膈上和膈下淋巴结区域放疗后的膈下复发率。在采用标准倒“Y”形腹部放疗野治疗的132例患者中，29%出现了膈下复发。这种较高的局部失败率可能归因于照射野未包括许多肠系膜淋巴结以及大部分肝脏和肠道。本文还介绍了一种自1973年以来在斯坦福大学用于38例患者的安全且明显有效的全腹放疗技术。在最初1500拉德的全腹治疗（通过前后相对野）期间，全厚度铅块保护右肝叶。然后使用水平卧位（跨床）侧野使腹主动脉旁和肠系膜淋巴结的放疗剂量达到3000拉德，接着通过宽前后野再追加1400拉德，使腹部中央总剂量达到4400拉德。文中还介绍了剂量学考量、膈下淋巴引流的解剖学描述、治疗并发症以及全腹放疗的初步结果。
