Trott K R
Department of Radiation Biology, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary & Westfield College, University of London, UK.
Strahlenther Onkol. 1998 Aug;174(8):421-6. doi: 10.1007/BF03038564.
The radiobiological mechanisms which may be exploited in the design of new strategies of radiochemotherapy are discussed.
The identification of exploitable mechanisms of radiochemotherapy has to be based on the analysis of cellular and supracellular mechanisms of tumor cure, acute normal tissue injury and chronic normal tissue injury, respectively, as well as on experimentally documented mechanisms of cellular and supracellular interactions of chemotherapy and radiotherapy.
Only the addition of independent cytotoxic effects of radiotherapy and of chemotherapy are a sound basis for predicting the therapeutic effects on tumor cure probability. In the pathogenesis of normal tissue damage, however, complex interactions of supracellular mechanisms play a decisive role which may increase the rate of chronic side effects even in the absence of cellular interactions.
None of the presently used schedules of radiochemotherapy meets the scientific requirements outlined in the paper. For squamous cell carcinomas the most promising protocol would combine effective doses of chemotherapy and of radiotherapy without dose reduction and/or treatment prolongation simultaneously but without causing increased normal tissue injury.
讨论了在设计新的放化疗策略时可能利用的放射生物学机制。
确定可利用的放化疗机制必须分别基于对肿瘤治愈、急性正常组织损伤和慢性正常组织损伤的细胞及超细胞机制的分析，以及基于化疗和放疗的细胞及超细胞相互作用的实验记录机制。
只有放疗和化疗的独立细胞毒性作用相加才是预测对肿瘤治愈概率的治疗效果的可靠基础。然而，在正常组织损伤发病机制中，超细胞机制的复杂相互作用起决定性作用，即使在没有细胞相互作用的情况下也可能增加慢性副作用的发生率。
目前使用的任何放化疗方案均不符合本文所述的科学要求。对于鳞状细胞癌，最有前景的方案是将有效剂量的化疗和放疗联合应用，不降低剂量和/或延长治疗时间，同时又不增加正常组织损伤。
