Stadler P, Feldmann H J, Creighton C, Kau R, Molls M
Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität München, Germany.
Radiother Oncol. 1998 Aug;48(2):157-64. doi: 10.1016/s0167-8140(98)00032-2.
To evaluate the changes in tumor oxygenation during definitive split-course radiochemotherapy in locally advanced head and neck cancer (lymph nodes and primaries).
Twenty-four patients with locally advanced head and neck cancer were investigated pretherapeutically and during a defined course of radiochemotherapy (RCTh) with a total dose of 70 Gy given in 35 fractions over 9 weeks (2-week break after 30 Gy). In weeks 1 and 6, the patients received chemotherapy (5 FU and mitomycin C) concomitant with irradiation. The oxygen partial pressure measurements were carried out using polarographic needle probes in combination with a microprocessor-controlled device (pO2 histograph/KIMOC). Times of measurements were before therapy, at the end of week 3 (30 Gy), after a 2-week break (30 Gy) and at the end of therapy if measurable lesion was found (70 Gy).
There was a significant reduction in the median pO2 (P < 0.005, n = 18) and an increase in the hypoxic fraction (defined as the percentage of pO2 values of <5 mm Hg) after application of 30 Gy (P < 0.05, n = 18). This effect was partially reversed at the end of the 2-week break. During the break an increase in the median PO2 (P = 0.05, n = 12) and a decrease in the hypoxic fraction could be observed. Towards the end of therapy (70 Gy) a significant decrease (P = 0.02, n = 13) in the median pO2 occurred. Corresponding to this, the hypoxic fraction increased during the last 4 weeks of therapy (P = 0.06, n = 13).
Statistically significant changes in oxygenation in locally advanced head and neck cancer were found during a split-course radiochemotherapy. This information was obtained in a homogenous group of patients under well-defined therapeutic conditions. The decrease in the tumor oxygenation status at doses of 30 and 70 Gy are important findings because they are in contrast to the concept of continuous improvement of the oxygenation status during fractionated radiotherapy.
评估局部晚期头颈癌（淋巴结及原发灶）在根治性分段放射化疗期间肿瘤氧合情况的变化。
对24例局部晚期头颈癌患者在治疗前以及在一个确定疗程的放射化疗（RCTh）期间进行研究，总剂量70 Gy，分35次在9周内给予（30 Gy后有2周休息期）。在第1周和第6周，患者接受化疗（5-氟尿嘧啶和丝裂霉素C）并同步放疗。使用极谱针式探头结合微处理器控制装置（pO2组织分析仪/KIMOC）进行氧分压测量。测量时间为治疗前、第3周结束时（30 Gy）、2周休息期后（30 Gy）以及治疗结束时（若发现可测量病灶则为70 Gy）。
给予30 Gy后，中位pO2显著降低（P < 0.005，n = 18），低氧分数增加（定义为pO2值<5 mmHg的百分比）（P < 0.05，n = 18）。在2周休息期结束时，这种效应部分逆转。在休息期可观察到中位PO2增加（P = 0.05，n = 12），低氧分数降低。接近治疗结束时（70 Gy），中位pO2显著降低（P = 0.02，n = 13）。与此相应，在治疗的最后4周低氧分数增加（P = 0.06，n = 13）。
在分段放射化疗期间，局部晚期头颈癌的氧合情况发生了具有统计学意义的变化。这些信息是在明确治疗条件下的一组同质患者中获得的。30 Gy和70 Gy剂量时肿瘤氧合状态的降低是重要发现，因为它们与分次放疗期间氧合状态持续改善的概念相反。
