Acute radiation proctitis: A sequential clinicopathologic study during pelvic radiotherapy
Acute radiation proctitis: A sequential clinicopathologic study during pelvic radiotherapy
复制标题
DOI：
10.1016/s0360-3016(00)00744-6
复制
发表时间：
2000-11-01
影响因子：
7
通讯作者：
Hauer-Jensen, M
中科院分区：
文献类型：
--
作者：
Hovdenak, N;Fajardo, LF;Hauer-Jensen, M
目的：盆腔放射治疗中直肠毒性常受剂量限制。这项前瞻性研究检查了持续放射治疗期间临床、内镜和组织病理学直肠毒性的顺序发展和关联。方法与材料：33例非肠盆腔癌患者在放疗前、治疗2周后及治疗结束时（6周）行直肠镜活检，记录急性毒性症状，并对内镜下的变化进行分级，采用特设评分系统评估表面上皮、腺层和固有层的组织学变化。在抗cd68染色切片上观察巨噬细胞聚集情况。结果：治疗前内窥镜检查和活检无明显差异，临床症状逐渐加重。相比之下，内镜病理在2周时达到最大。治疗期间获得的活检显示表面上皮萎缩，急性隐窝炎，隐窝脓肿，隐窝扭曲和萎缩，以及间质炎症。组织学变化，特别是表面上皮的变化，在2周时比6周时更加明显。结论：与临床症状相比，内镜下变化稳定，组织学变化从治疗的第2周到第6周消退，这些结果可能对预防和治疗干预的设计和时机有影响，以减少放射性直肠炎，(C) 2000 Elsevier Science Inc。
Purpose: Rectal toxicity is often dose limiting during pelvic radiation therapy. This prospective study examined the sequential development and associations of clinical, endoscopic, and histopathologic rectal toxicity during ongoing radiation therapy.Methods and Materials: Thirty-three patients with nongastrointestinal pelvic carcinomas underwent proctoscopy with biopsy before radiation therapy, after 2 weeks treatment, and toward the end of the treatment course (6 weeks), Symptoms of acute toxicity were recorded, and endoscopic changes were graded, Histologic changes in the surface epithelium, glandular layer, and lamina propria were assessed using an an hoc scoring system. Macrophage accumulation was evaluated in anti-CD68 stained sections.Results: Pretreatment endoscopy and biopsies were unremarkable, Clinical symptoms progressed toward the end Of the treatment course. In contrast, endoscopic pathology was maximal at 2 weeks. Biopsies obtained during treatment exhibited atrophy of the surface epithelium, acute cryptitis, crypt abscesses, crypt distortion and atrophy, and stromal inflammation. Histologic changes, particularly those in the surface epithelium, were consistently more pronounced at 2 weeks than they were at 6 weeks,Conclusion: In contrast to clinical symptoms, endoscopic changes stabilize and histologic changes regress from the 2nd to the 6th week of treatment, These results may have implications for the design and timing of prophylactic and therapeutic interventions to reduce radiation proctitis, (C) 2000 Elsevier Science Inc.