OBSERVATIONS ON THE COMPARATIVE ANATOMY OF BLOOD
OBSERVATIONS ON THE COMPARATIVE ANATOMY OF BLOOD
复制标题
血液比较解剖学观察
DOI：
10.5694/j.1326-5377.1937.tb53514.x
复制
发表时间：
1937
影响因子：
11.4
通讯作者：
B. Bradley
中科院分区：
文献类型：
--
作者：
B. Bradley
在恶性组织细胞上的X射线和y射线等形式中，有同样重要的间接或生物作用总是要考虑的。因此，部分由于肿瘤组织的实际破坏（然而，不一定是全部），部分由于高血和可能从肿瘤床的非常小的血管中渗出的血液，引起了一系列奇妙的生物变化，这些变化构成成纤维反应或愈合反应，最终以病变组织的完美愈合而理想地结束。这就是克拉默所说的“巨噬细胞反应”，即单核细胞-成纤维细胞-成纤维细胞-纤维组织的序列，在任何恶性肿瘤的愈合过程中都非常重要。对于一个好的结果来说，没有叠加也很重要；这是一种常用的放射治疗方法，因为感染或脓毒性病变比干净的、未感染的病变愈合（如果能愈合的话）要长得多。最后，在放射治疗中，良好、充分的冲洗和引流是非常重要的。它们在某种程度上与肿瘤床的状态有关，因为如果要使照射的生物作用和效应发挥最大的作用，就必须有良好的血液供应和淋巴排水。在癌症治疗中，放射治疗师（有时外科医生，但不太自觉地）已经一次又一次地证明了这一点。现在，如果考虑到常见的表皮样型食管癌，我们浏览这些基本标准，我们发现其中一半，或至少三分之一，仍然不满意。普通食道鳞状细胞癌对放射相对敏感（多为III级或iv级），血液供应良好，淋巴引流丰富（从早期淋巴结延伸的角度来看，后者确实太好了）；因此，仅从这些方面来看，这类肿瘤应该对辐射有反应。但是，另一方面，几乎所有病例在首次发现时都进展良好（无论是明确淋巴结累及的ii期，还是远处转移的III期）；我们很少见到早期或晚期食管癌的病例。此外，由于他们的晚期，他们必须经常表现出超感染的迹象，最后，也许是最重要的，他们有一个可怜的、薄的、悲惨的肿瘤床来支持他们。他们没有好的、结实的、舒适的肿瘤床，比如说，嘴唇上的肿瘤；因此，就像咽喉癌和直肠癌（都在一个相对较薄的中空管的壁上）一样，它们对放射性没有反应。我们只需比较一下唇部、舌部和子宫颈的鳞状细胞癌的放射反应性，它们的类型和实际放射敏感性都很相似，但它们的肿瘤床是如此不同和优良。这就是食道生长通常不能满足的三个必要条件。当我们加上已经提到的三个解剖或结构上的原因，即，它们相对难以接近，它们早期通过丰富的淋巴排水系统延伸到区域淋巴结，它们靠近重要器官，如肺，我想我们可以说我们有一个合理的解释，为什么食道癌很难用放射治疗，为什么在如此多的情况下，无论以何种形式施加给它们的辐射能，它们都不能表现出仅仅是一种权宜之计的反应。
forms, such as X and y rays, on the cells of a malignant tissue, there is the equally important indirect or biologicalactionalwaysto be considered. By this, as a result partly of the actualdestruction of the neoplastic tissue (not necessarilyof all of it, however) and partly of the hyperremia and probableextravasationof blood from the very small vessels in the tumour bed, there is induced that wonderful series of biological changeswhich constitute the fibroblastic or healing reaction and which end ideally in perfecthealing of the diseased tissues. This is what Cramercalls the "macrophage reaction", that monocyte-fibroblast-fibrocyte-fibrous tissue sequencewhich is of such great importance in the healing processof any malignant neoplasm. The absenceof superaddedinfection is important also for a good result; it is a radiotherapeutic commonplacenow that an infected or septic lesion takesmuch longer to heal (if it heals at all) than a clean, non-infectedone. Good, adequate irrigation and drainage are, finally, of great importancein radiotherapy. They are bound up to someextent with the state of the tumour bed, for there must be good blood supply and lymphatic drainageif the biological action and effects of irradiation are to operateto the greatest advantage. This hasbeenproved time and againby radiotherapists (and sometimes, but less consciously, by surgeons)in carcinotherapy. Now if, consideringthe commonestor epidermoid type of eesophageal carcinoma,we run throughthese essentialcriteria, we find that half of them, or at least a third, remain unsatisfied. The ordinary squamous-celled carcinomata of the gullet are relatively radio-sensitive (mostly Grade III or GradeIV) and they havea fairly good blood supply and a rich lymphatic drainage (the last-mentioned is really too good from the viewpoint of early nodal extension); so, from these aspects alone, such tumours should respondwell to irradiation. But, on the otherhand,they arein almostevery casewell advancedwhen first seen (either in StageII with definite nodal involvement, or Stage III with distant metastases);seldom if ever do we seean early or StageI caseof oesophageal carcinoma.Also, they must often, becauseof their advancedstage, exhibit evidenceof superaddedinfection, and, lastly andperhapsmostimportantof all, they havea poor, thin and miserable tumour bed to support them. They havenot the good, substantialand comfortable tumour bed of, let us say, a carcinomaof the lip; and so, like the carcinomataof the pharyItx and rectum (all in the wall of a comparatively thin hollow tube), they are not radio-responsive. One need only mention by comparison the radioresponsivenessof the squamous-celledcarcinomata of the lip, of the tongue and of the cervix uteri, similar in type and so in actual radio-sensitivity, but with such different and excellent tumour beds. These, then, are the three necessary conditions which oesophageal growths fail as a rule to satisfy. And when we add to these the three anatomical or structural reasonsalready mentioned, namely, their relative inaccessibility, their early extension through a rich lymphatic drainage system to the regional lymph nodes,and their proximity to vital organs like the lungs, I think we might say that we have a reasonableexplanationof just why carcinomataof the gullet are difficult to treat by irradiation, and why they fail in so many casesto show anything more than a merely palliative responseto the application of radiant energy in whatever form it is administeredto them.