OPTIMIZATION OF UNCOMPLICATED CONTROL FOR HEAD AND NECK TUMORS
OPTIMIZATION OF UNCOMPLICATED CONTROL FOR HEAD AND NECK TUMORS
复制标题
DOI：
10.1016/0360-3016(90)90037-k
复制
发表时间：
1990-10-01
影响因子：
7
通讯作者：
TURESSON, I
中科院分区：
文献类型：
--
作者：
AGREN, A;BRAHME, A;TURESSON, I
近200名患者接受了两种不同剂量水平的头颈部肿瘤治疗。根据两个剂量水平下临床观察到的肿瘤控制和致死性正常组织并发症的概率，回顾性计算了最大无并发症控制的剂量，并与临床数据进行了比较。已经使用了用于控制和并发症的泊松统计模型，包括相关参数δ，描述控制和并发症在统计学上独立的患者比例。临床观察到的无并发症肿瘤控制的概率P+与仅一小部分治疗的患者是统计学独立的一致（δ）。= 0.2或20%）。通常，假设100%的患者在肿瘤控制和正常组织并发症方面具有统计学独立性。更确切地说，临床数据是一致的，几乎20%的患者对放射线更敏感，因为他们获得了局部肿瘤控制，但同时遭受致命的并发症。更大比例的患者（近30%）似乎对放射更具抵抗力，既没有显示严重的治疗并发症，也没有控制局部肿瘤生长。有人建议，如果这些患者组可以通过预测分析确定其正常组织的辐射敏感性，最好也为他们的肿瘤，简单的肿瘤控制可以增加约20%。这一数字是根据患者的精算生存率计算的，并已对剂量输送中不可避免的不确定性进行了校正。它还指出，约20%的患者永远不能保存的预测分析，因为相当大的统计方差相关的泊松过程和根除的最后一个克隆性肿瘤细胞。最后，请注意，可能存在的辐射敏感和耐药的患者群体是与已知的遗传缺陷，如共济失调毛细血管扩张症的敏感患者和修复有效的头部和颈部肿瘤的存在是非常有效的修复双链断裂。如果确实存在这种敏感和耐药的患者群体，则仅对正常组织进行预测性测定就应该足够了，避免了对最耐辐射的肿瘤细胞系进行取样的通常不可能的任务。
Almost 200 patients have been treated for head and neck tumors at two different dose levels. Based on the clinically observed probabilities for tumor control and fatal normal tissue complications at the two dose levels, the dose giving maximum uncomplicated control has retrospectively been calculated and compared with the clinical data. A Poisson statistical model for control and complications has been used including a correlation parameter, .delta., to describe the fraction of patients where control and complications are statistically independent. The clinically observed probability of uncomplicated tumor control, P+, is consistent with only a small fraction of the patients treated being statistically independent (.delta. = 0.2 or 20%). Customarily, 100% of the patients are assumed to be statistically independent with regard to tumor control and normal tissue complications. More precisely, the clinical data are consistent, with almost 20% of the patients being significantly more sensitive to radiation since they gain local tumor control but simultaneously suffer fatal complications. An even larger fraction of the patients (almost 30%) seemed to be more resistant to radiation, showing neither serious treatment complications nor control of the local tumor growth. It is suggested that if these patient groups could be identified by predictive assay for the radiation sensitivity of their normal tissues and preferably also for their tumors, the uncomplicated tumor control could be increased by about 20%. This figure is based on the actuarial survival of the patients and has been corrected for the inevitable uncertainty in dose delivery. It is also pointed out that about 20% of the patients can never be saved by a predictive assay because of the considerable statistical variance associated with the Poisson process and the eradication of the last clonogenic tumor cell. Finally, note that the possible existence of radiation sensitive and resistant patient groups is consistent with known genetic deficiencies such as ataxia telangiectasia for the sensitive patients and the existence of repair efficient head and neck tumors that are unusually efficient in repairing double strand breaks. If such sensitive and resistant patient groups do exist, it should be sufficient to perform a predictive assay on normal tissues alone avoiding the often impossible task of sampling the most radiation resistant tumor cell line.