FRACTIONATION SENSITIVITY OF A FUNCTIONAL ENDPOINT - IMPAIRED SHOULDER MOVEMENT AFTER POST-MASTECTOMY RADIOTHERAPY
FRACTIONATION SENSITIVITY OF A FUNCTIONAL ENDPOINT - IMPAIRED SHOULDER MOVEMENT AFTER POST-MASTECTOMY RADIOTHERAPY
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DOI：
10.1016/0360-3016(89)90103-x
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发表时间：
1989-09-01
影响因子：
7
通讯作者：
THAMES, HD
中科院分区：
文献类型：
--
作者：
BENTZEN, SM;OVERGAARD, M;THAMES, HD
介绍了一项关于乳房切除术后放疗后肩部运动受损的分次敏感性的临床放射生物学研究。从1978年至1980年，163例乳腺癌患者接受了乳房切除术后照射，分12次，每周2次，为期37至46天。总剂量指定为最大吸收剂量51.36戈伊，或在腋窝中部水平指定的最小目标剂量36.6戈伊。从1981年至1982年，66例患者接受了最小目标剂量40.92戈伊，分22次，每周5次，为期29至35天。在1978年至1982年的整个期间，治疗技术基本上保持不变。在肩胛骨不固定的情况下测量手臂的最大屈曲度和外展度。通过与对侧手臂的活动度进行比较，建立了一个相对评分，表示肩关节运动受损的等级，评分范围为0-3。此外，还评估了工作能力和运动和休息时的疼痛。这些性能参数显着相关的肩关节运动受损的等级。中度或重度肩关节运动受损的发生率采用混合模型进行分析，该模型包括剂量分级、潜伏期和诱发临床因素。60岁以上的患者发生肩关节问题的风险明显更高。分析指出皮下纤维化是一个处理因素，并表明术后体育锻炼计划是有益的。手臂水肿对肩部性能没有统计学显著影响。α/。β的比值估计为3.5戈伊，95%置信限（c.l.）[0.7，6.2]戈伊。中度和重度肩关节损伤最终频率达到90%的时间长度估计为3.9年，95%置信限[3.1，4.6]年。名义标准剂量（NSD）形式主义未能产生等效总剂量方面受损的肩关节运动在两个分割时间表。尽管在许多临床系列中已经记录了大于常规剂量的剂量分次的有害影响，但本研究代表了功能性临床终点的分次灵敏度的首次定量。
A clinical radiobiological study of the fractionation sensitivity of impaired shoulder movement after postmastectomy radiotherapy is presented. From 1978 to 1980, 163 breast cancer patients received postmastectomy irradiation delivered in 12 fractions, 2 fractions per week, over a period of 37 to 46 days. The total dose was specified either as a maximum absorbed dose of 51.36 Gy, or a minimum target dose of 36.6 Gy specified at the level of midaxilla. From 1981 to 1982, 66 patients received a minimum target dose of 40.92 Gy in 22 fractions with 5 fractions per week over a period of 29 to 35 days. The treatment technique remained essentially unchanged during the whole period of 1978 to 1982. Maximal flexion and abduction of the arm were measured with unfixed scapula. A relative score, indicating the grade of impaired shoulder movement on a nominal scale from 0-3, was established by comparison with the mobility of the contralateral arm. In addition, working ability and pain at movement and at rest were evaluated. These performance parameters significantly correlated with the grade of impaired shoulder movement. The occurrence of moderately or severely impaired shoulder movement was analyzed using a mixture model incorporating dose-fractionation, latency, and predisposing clinical factors. The risk of shoulder problems was significantly higher among patients above 60 years of age. The analysis pointed to subcutaneous fibrosis as a disposing factor and indicates that postoperative physical exercise programs are beneficial. Arm edema had no statistically significant influence on shoulder performance. The .alpha./.beta. ratio was estimated at 3.5 Gy with 95% confidence limits (c.l.) [0.7, 6.2] Gy. The length of time to expression of 90% of the ultimate frequency of moderate and severe shoulder impairment was estimated at 3.9 years with 95% confidence limits [3.1, 4.6] years. The nominal standard dose (NSD) formalism failed to produce isoeffective total doses with respect to impaired shoulder movement in the two fractionation schedules. Although the deleterious effects of larger-than-conventional dose fractions have been documented in a number of clinical series, this study represents the first quantitation of the fractionation sensitivity of a functional clinical endpoint.