Ramuz O, Bourhis J, Mornex F
Département de radiothérapie-oncologie, EA 643, centre hospitalier Lyon-Sud, Pierre-Bénite, France.
Cancer Radiother. 1997;1(6):801-9. doi: 10.1016/s1278-3218(97)82961-7.
The physiopathology of radiation-induced bone damage is no completely elucidated. Ionizing radiation may induce an inhibition or an impairment of growing bone. This fact is of particular importance in children, and represents one of the most important dose-limiting factors in the radiotherapeutic management of children with malignant diseases. Scoliosis, epiphyseal slippage, avascular necrosis, abnormalities of craniofacial growth may be observed after radiation. Child's age at the time of treatment, location of irradiated bone and irradiation characteristics may influence the radiation-related observed effects. In adults, pathological analysis of mature bone after ionizing radiation exposure are rare, suggesting that it is difficult to draw a clear feature of the action of radiation on the bone. Osteoporosis, medullary fibrosis and cytotoxicity on bone cells lead to fracture or necrosis. Various factors can influence bone tolerance to radiation such as bone involvement by tumor cells or infection, which is frequent is mandibulary osteoradionecrosis. Technical improvements in radiation techniques have also decreased radio-induced bone complications: the volume, fractionation and total dose are essential to consider. The absence of a consistent radiation-induced late effects evaluation scale has hampered efforts to analyze the influence of various therapeutic maneuvers and the comparison of results from different reported series. The currently proposed evaluation scale may help harmonizing the classification of radiation-induced bone late effects.
辐射诱导骨损伤的生理病理学尚未完全阐明。电离辐射可能会抑制或损害正在生长的骨骼。这一事实在儿童中尤为重要，并且是患有恶性疾病儿童放射治疗管理中最重要的剂量限制因素之一。辐射后可能会观察到脊柱侧弯、骨骺滑脱、缺血性坏死、颅面生长异常。治疗时儿童的年龄、受照射骨骼的位置和照射特征可能会影响与辐射相关的观察到的效应。在成年人中，电离辐射暴露后成熟骨的病理分析很少见，这表明很难明确辐射对骨骼作用的特征。骨质疏松症、骨髓纤维化和对骨细胞的细胞毒性会导致骨折或坏死。各种因素会影响骨骼对辐射的耐受性，如肿瘤细胞或感染对骨骼的累及，这在放射性下颌骨坏死中很常见。放射技术的技术改进也减少了放射性骨并发症：体积、分次照射和总剂量是需要考虑的关键因素。缺乏一致的辐射诱导晚期效应评估量表阻碍了分析各种治疗策略的影响以及比较不同报道系列结果的努力。目前提出的评估量表可能有助于统一辐射诱导骨晚期效应的分类。
