当代妇科癌症患者骨盆放射损伤的预后和处理方法。

V S Ivankova, E A Domina, T V Khrulenko, L M Baranovska, O A Glavin
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引用次数: 0

摘要

背景:考虑到放射生物学原理,放射治疗技术的快速发展和放射治疗(RT)纳米技术在实践中的实施,确保了计划剂量将以最小的健康组织照射递送到目标体积,同时保持所保证的RT质量。因此,放射治疗的进一步发展不仅涉及新技术在放射实践中的应用,还涉及放射医学和临床放射生物学领域的深入发展。目的:探讨192Irsource高能(HDR -高剂量率)近距离放射治疗(BT)的最佳模型,并与60Co参考γ辐射的效果进行比较,从而提高妇科癌症患者(GCPs)的放化疗(CRT)的有效性,同时对肿瘤环境中关键器官和组织的辐射负荷最小。放射生物学研究的目的是确定使用外周血淋巴细胞(PBL)的跨膜电位(TMP)和活性氧(ROS)产生强度作为肿瘤环境或其床的非恶性细胞放射敏感性的预测指标的可行性,以尽量减少gcp的RT并发症。材料与方法:对II-III期、T2-3N0-1M0期肿瘤患者115例进行综合保守治疗。根据使用的HDR BT方法和使用的化学增敏剂的背景,选择三组患者。取放疗前GCPs (n = 24)和表面健康个体(AHIs,即对照组,n = 18)的血液样本进行放射生物学研究。结果:回顾在HDR BT中使用60Co或192Ir源的直接结果和随访数据显示,与60Со HDR BT给药相比,主要研究组在CRT疗程后分别增加了16.6%和20.1%的肿瘤阳性反应。关于局部反应,注意到在主要组中几乎没有II级辐射反应。根据放射生物学研究结果,确定gcp PBL中TMP水平比AHIs高1.36倍。结论:晚期放射损伤的发生取决于个体计算机规划的准确性和计划放射治疗过程的正确复制,及时纠正治疗方案,采用合理的综合医疗预防措施,肿瘤进程和伴随疾病的严重程度,以及使用的hdr放射源类型(192Ir和60Co)。与AHIs相比,gcp的PBL中TMP值和ROS产生强度的变化,以及个体患者PBL中这些参数的高值,是在放疗计划之前将它们作为表征放射并发症可能性的附加指标的理由。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CONTEMPORARY APPROACHES TO PROGNOSTICATION AND MANAGEMENT OF PELVIC RADIATION INJURIES IN GYNECOLOGICAL CANCER PATIENTS.

Background: Rapid development of radiotherapeutic techniques and implementation of radiation therapy (RT) nanotechnologies in practice, taking into account principles of radiobiology, ensures that the planned dose will bedelivered to the target volume with minimal irradiation of healthy tissues while maintaining the guaranteed RTquality. Therefore, further advance of RT involves not only implementation of the new technologies in radiationpractice, but also the intensive developments in fields of radiation medicine and clinical radiobiology.

Objective: search for optimal models of the high-energy (HDR - high dose rate) brachytherapy (BT) using the 192Irsource in comparison with effects of the reference gamma radiation from 60Co, thereby, to increase the effectivenessof chemoradiation therapy (CRT) of gynecological cancer patients (GCPs) with minimal radiation loads on criticalorgans and tissues in the tumor environment. The radiobiological study was aimed to determine the feasibility ofusing the transmembrane potential (TMP) and intensity of reactive oxygen species (ROS) production in peripheralblood lymphocytes (PBL) as predictors of radiosensitivity of non-malignant cells from the tumor environment or itsbed in order to minimize the RT complications in GCPs.

Materials and methods: Patients (n = 115) with cancer stages II-III, T2-3N0-1M0 were managed with comprehensiveconservative treatment. Three groups of patients were selected depending on the applied HDR BT method against abackground of the administered chemosensitizing agents. Blood samples of GCPs (n = 24) before the RT initiationand of apparently healthy individuals (AHIs, i.e. the control group, n = 18) were taken for the radiobiologicalresearch.

Results: Review of the direct results of 60Co or 192Ir sources use in HDR BT and of the follow-up data showed theincreased tumor positive response in the main study groups after CRT course by respectively 16.6 % and 20.1 % incomparison with 60Со HDR BT administration. Concerning local reactions it was noted that grade II radiation reactions were almost absent in the main groups. According to the results of radiobiological studies, it was establishedthat TMP level in PBL of GCPs was 1.36 times higher than in AHIs.

Conclusions: Thus, the emerging of late radiation injuries depended on the accuracy of of individual computer planning and correct reproduction of the planned RT course, timely correction of treatment programs, use of a complexof rational medical prophylaxis, severity of tumor process and concomitant disorders, as well as on the used type ofHDR radiation sources (192Ir and 60Co). Changes in TMP values and intensity of ROS production in PBL of GCPs in comparison with AHIs, and the high values of these parameters in PBL of individual patients are a rationale to specifythem as additional indicators characterizing the possibility of radiation complications before the RT planning.

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Problemy radiatsiinoi medytsyny ta radiobiolohii
Problemy radiatsiinoi medytsyny ta radiobiolohii Medicine-Radiology, Nuclear Medicine and Imaging
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