QUANTEC目录

RADIATION DOSE–VOLUME EFFECTS AND THE PENILE BULB 放射剂量体积效应与阴茎

The dose, volume, and clinical outcome data for penile bulb are

reviewed for patients treated with external-beam radiotherapy. Most, but not all, studies find an association between impotence and

dosimetric parameters (e.g., threshold doses) and clinical factors (e.g., age, comorbid diseases). According to the data available, it is prudent to keep the mean dose to 95% of the penile bulb volume to <50 Gy. It may also be prudent to limit the D70 and D90 to 70 Gy and 50 Gy, respectively, but coverage of the planning target volume should not be compromised. It is acknowledged that the penile bulb may not be the critical component of the erectile apparatus, but it seems to be a surrogate for yet to be determined structure(s) critical for erectile function for at least some techniques.

本文回顾了外照射病人的阴茎剂量体积和临床结果数据。大部分研究发现阳萎和剂量参数(阈值)和临床因子(如年龄，合并症)。根据可获得的数据，应该尽量控制阴茎的95%阴茎体积的平均剂量小于50Gy,也可以尽量限制D70和D90在70Gy和50Gy，但包含在PTV内时不应妥协。目前已经明确阴茎不是勃起的关键组成，但它可能是某些至少技术上对勃起功能重要的待决定结构的替代。 RADIATION DOSE–VOLUME EFFECTS IN RADIATION-INDUCED RECTAL INJURY 放射所致的直肠损伤的剂量体积效应

The available dose/volume/outcome data for rectal injury were reviewed. The volume of rectum receiving $60Gy is consistently associated with the risk of Grade $2 rectal toxicity or rectal bleeding. Parameters for the Lyman-Kutcher-Burman normal tissue complication probability model from four clinical series are remarkably

consistent,suggesting that high doses are predominant in determining the risk of toxicity. The best overall estimates(95% confidence interval) of the Lyman-Kutcher-Burman model parameters are n = 0.09

(0.04–0.14); m = 0.13(0.10–0.17); and TD50 = 76.9 (73.7–80.1) Gy. Most of the models of late radiation toxicity come from

three-dimensional conformal radiotherapy dose-escalation studies of early-stage prostate cancer. It is possible that intensitymodulated

radiotherapy or proton beam dose distributions require modification of

these models because of the inherent differences in low and intermediate dose distributions.

本文回顾直肠损伤的剂量/体积/结果。直肠接受≥60Gy体积持续与≥2级的直肠毒性反应或直肠出血有关。来自4个临床系列的Lyman-Kutcher-Burman正常组织并发症概率模型的参数非常一致，提示高剂量在决定毒性风险起主导作用。最好的Lyman-Kutcher-Burman模型参数的总体估计(95%可信区间)，n=0.09(0.04-0.14);m=0.13(0.10-0.17);和TD50=76.9(73.7-80.1)Gy。大部分模型的晚反应放疗毒性反应来自早期前列腺癌三维适形放疗的剂量评价研究。因为固有的低或中等剂量分布差异，在调强或质子治疗中需要对这个模型进行调整。

RADIATION DOSE–VOLUME EFFECTS IN THE BRAIN 脑的放射剂量体积效应

We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1–2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors.For fractionated RTwith a fraction size of <2.5Gy, an incidence of radiation necrosis of 5%and 10%is predicted to occur at a biologically effective dose of 120 Gy (range, 100–140) and 150 Gy (range, 140–170), respectively. For twice-daily fractionation, a steep increase in toxicity appears to occur when the biologically effective dose is >80Gy. For large fraction sizes ($2.5 Gy), the incidence and severity of toxicity is unpredictable. For single fraction radiosurgery, a clear correlation has been demonstrated between the target size and the risk of adverse events. Substantial variation among different centers’ reported outcomes have prevented us from making toxicity–risk predictions.Cognitive dysfunction in children is largely seen forwhole brain doses of$18Gy. No substantial evidence has shown that RT induces irreversible cognitive decline in adults within 4 years of RT.

我们回顾了已发表的关于放疗引起的脑损伤的数据。放射性坏死出现的中位时间是放疗后1-2年。然而认知损伤在很多年以后才出现。其严重程度及发生率是剂量和体积依赖性的，并会因为化疗、年龄、糖尿病和空间因素而加剧。在每次分割小于2.5Gy的放疗中， 5%和10%的放射事件预计分别发生于BED在120Gy(范围100-140)和150Gy（范围140-170）时。在超分割放疗中，当BED大于80Gy后毒性反应的发生率会突然升高。在大分割放疗中（≥2.5Gy），毒性反应的发生率及严重性是不可预测的。在单次分割的放射外科中，在靶区体积与反应事件发生率之间有明确的相关。不同中心报告结果的明显差别使我们无法做出毒性风险预测。儿童认知功能障碍大部份出现在全脑照射剂量≥18Gy。成年人放疗后4年内没有明确证据表明放射可引起不可逆认知功能障碍。

RADIATION DOSE-VOLUME EFFECTS IN THE ESOPHAGUS 食管的放射剂量体积效应

Publications relating esophageal radiation toxicity to clinical variables and to quantitative dose and dose–volume measures derived from

three-dimensional conformal radiotherapy for non–small-cell lung cancer are reviewed. A variety of clinical and dosimetric parameters have been associated with acute and late toxicity. Suggestions for future studies are presented.

回顾了非小细胞肺癌三维适形放疗食管毒性变量和等效剂量以及剂量体积。临床变量和剂量参数与早反应和晚反应毒性相关。并提出进一步的研究。

RADIATION DOSE–VOLUME EFFECTS IN THE HEART 心脏的放射剂量体积效应

The literature is reviewed to identify the main clinical and

dose–volume predictors for acute and late radiationinduced heart

disease. A clear quantitative dose and/or volume dependence for most cardiac toxicity has not yet been shown, primarily because of the

scarcity of the data. Several clinical factors, such as age, comorbidities and doxorubicin use, appear to increase the risk of injury. The existing dose-volume data is presented, as well as suggestions for future investigations to better define radiation-induced cardiac injury.

本文回顾了放射引起的心脏早反应和晚反应疾病以确定主要临床和剂量体积预测因子。心脏毒性剂量和/或体积依赖的定量关系还不明确，主要是因为数据分散。多个临床因素，如年龄、合并症和使用多柔比星，使心脏的损伤明显增加。剂量体积数据已存在，同时建议对放疗所致心肌损伤进行准确定义。

RADIATION DOSE–VOLUME EFFECTS IN THE LARYNX AND PHARYNX

咽和喉的放射剂量体积效应

The dose–volume outcome data for RT-associated laryngeal edema, laryngeal dysfunction, and dysphagia, have only recently been

addressed, and are summarized. For late dysphagia, a major issue is accurate definition and uncertainty of the relevant anatomical structures. These and other issues are discussed.

放疗相关的喉水肿，喉功能不全和吞咽困难的剂量体积结果数据最近已经完成摘要。晚期吞咽困难以及主要组织的准确界定和相关解剖结构的不确定性将在另外的文章中讨论。

RADIATION DOSE–VOLUME EFFECTS IN THE LUNG 肺的放射剂量体积效应

The three-dimensional dose, volume, and outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold ‘‘tolerance dose-volume’’ levels. There are strong volume and fractionation effects.

肺的三维剂量/体积和结果的数据经过仔细的回顾。有症状的肺炎的发生率与多个剂量测定参数有关，而没有“剂量体积耐受”阈值的证据。但存在着显著的体积和分次效应。

RADIATION DOSE–VOLUME EFFECTS IN THE SPINAL CORD

RADIATION DOSE–VOLUME EFFECTS IN THE STOMACH AND SMALL BOWEL

胃和小肠的放射剂量体积效应

Published data suggest that the risk of moderately severe ($Grade 3) radiation-induced acute small-bowel toxicity can be predicted with a threshold model whereby for a given dose level, D, if the volume receiving that dose or greater (VD) exceeds a threshold quantity, the risk of toxicity escalates. Estimates of VD depend on the means of structure segmenting (e.g., V15 = 120 cc if individual bowel loops are outlined or V45 = 195 cc if entire peritoneal potential space of bowel is outlined). A similar predictive model of acute toxicity is not available for stomach. Late small-bowel/stomach toxicity is likely related to maximum dose and/or volume threshold parameters qualitatively

similar to those related to acute toxicity risk. Concurrent chemotherapy has been associated with a higher risk of acute toxicity, and a history of abdominal surgery has been associated with a higher risk of late toxicity.

已报导的数据提出中重度（≥3级）放射诱发急性小肠毒性的危险可以用阈值模型预测，根据这个模型，有一个给定的剂量水平D，当接受大于这个剂量的体积（VD）超过某个阈值时发生毒性的危险升高。评价VD依赖结构节段的方式（如：在单个肠绊勾画出来时V15＝120ml或当整个腹膜腔内的小肠都勾画出来时V45＝

195ml）.对于胃却没有相似的预测急性反应的模型。晚期小肠/胃毒性反应可能和急性反应相似与最大剂量和/或体积阈值参数相关。同步化疗与急性毒性反应有联系，而腹部外科手术与晚反应高危有

关。

RADIATION DOSE–VOLUME EFFECTS OF OPTIC NERVES AND CHIASM

视神经和神交叉的放射剂量体积效应

Publications relating radiation toxicity of the optic nerves and chiasm to quantitative dose and dose–volume measures were reviewed. Few studies have adequate data for dose–volume outcome modeling. The risk of toxicity increased markedly at doses >60 Gy at z1.8 Gy/fraction and at >12 Gy for single-fraction radiosurgery. The evidence is strong that radiation tolerance is increased with a reduction in the dose per fraction. Models of threshold tolerance were examined.

本文回顾了已报导的视神经和神交叉剂量定量和剂量体积测量。少见有研究具备合适的剂量体积结果模型的数据。当剂量大小60Gy,1.8Gy/f或放射外科单次分割大于12Gy时发生毒性反应的危险显著升高。有明确的证据表明放射耐受性随着每次分割剂量的减少而升高。耐受阈值模型正在检验中。

RADIATION DOSE–VOLUME EFFECTS OF THE URINARY BLADDER

膀胱的放射剂量体积效应

An in-depth overview of the normal-tissue radiation tolerance of the urinary bladder is presented. The most informative studies consider whole-organ irradiation. The data on partial-organ/nonuniform

irradiation are suspect because the bladder motion is not accounted for, and many studies lack long enough follow-up data. Future studies are needed.

对现有的膀胱正常组织放射耐受性进行了深度的回顾分析。大部分研究信息认为是全器官照射，但是都被怀疑是部份器官/非均匀照射，因为没有考虑到膀胱的运动。而且很多研究缺管长期的随访数据。这些都需要进一步的研究。

RADIATION THERAPY AND HEARING LOSS 放射治疗与听力损伤

A review of literature on the development of sensorineural hearing loss after high-dose radiation therapy for headand-neck tumors and