stereotactic radiosurgery or fractionated stereotactic radiotherapy for the treatment of vestibular schwannoma is presented. Because of the small volume of the cochlea a dose–volume analysis is not
feasible.Instead, the current literature on the effect of the mean dose received by the cochlea and other treatment- and patient-related factors on outcome are evaluated. Based on the data, a specific threshold dose to cochlea for sensorineural hearing loss cannot be determined; therefore, dose–prescription limits are suggested. A standard for
evaluating radiation therapy–associated ototoxicity as well as a detailed approach for scoring toxicity is presented.
本文对头颈肿瘤高剂量放疗、立体放射外科或前庭神经鞘瘤立体定向分割放疗后的感音神经性听觉丧失进行综述。由于耳蜗的体积很小，剂量体积分析是不可能的。而当前的文献评价了耳蜗平均剂量及治疗和病人相关因素对结果的影响。
RADIATION-ASSOCIATED KIDNEY INJURY 肾的放射剂量体积效应
The kidneys are the dose-limiting organs for radiotherapy to upper abdominal cancers and during total body irradiation. The incidence of radiotherapy-associated kidney injury is likely underreported owing to its long latency and because the toxicity is often attributed to more common causes of kidney injury. The pathophysiology of radiation injury is poorly understood. Its presentation can be acute and
irreversible or subtle, with a gradual progressive dysfunction over years. A variety of dose and volume parameters have been associated with renal toxicity and are reviewed to provide treatment guidelines. The available predictive models are suboptimal and require validation. Mitigation of radiation nephropathy with angiotensin-converting enzyme inhibitors and other compounds has been shown in animal models and, more recently, in patients.
肾脏是上腹部癌或全身照射放疗的剂量限制器官。由于肾损伤的潜伏期很长而且常常归因于更常见的肾损伤，所以放射相关的肾损伤通常没报导。对放射性肾损伤的病理生理学理解非常贫乏。肾损伤可以是急性的和不可逆的或敏感的，伴随着多年的功能损伤逐渐进展。剂量体积变化参数与肾毒性相关，经过回顾上述数据提出了相应的指南。已知的预测模型差强人意，需要进一步确认。使用血管紧张素转换酶抑剂和其他复合物已经在动物模型中显示出减轻放
射性肾病的作用，而最近也在病人中显示出该结果。 RADIATION-ASSOCIATED LIVER INJURY 放射相关的肝损伤
The liver is a critically important organ that has numerous functions including the production of bile, metabolism of ingested nutrients, elimination of many waste products, glycogen storage, and plasma protein synthesis. The liver is often incidentally irradiated during radiation therapy (RT) for tumors in the upper- abdomen, right lower lung, distal esophagus, or during whole abdomen or whole body RT. This article describes the endpoints, timecourse,and dose-volume effect of radiation on the liver.
肝脏是一个重要的器官，它执行着多个功能，包括产生胆汁，对摄入营养的代谢，消除多种废物，贮存糖原，并制造血浆蛋白。在上腹部肿瘤，下段食管，右下肺或全腹或全身放疗时肝脏常被照射。本文主要讲述肝脏照射的终点，时间过程和剂量体积效应。 RADIOTHERAPY DOSE–VOLUME EFFECTS ON SALIVARY GLAND FUNCTION
唾液腺的放射剂量体积效应
Publications relating parotid dose–volume characteristics to
radiotherapy-induced salivary toxicity were reviewed.Late salivary dysfunction has been correlated to the mean parotid gland dose, with recovery occurring with time. Severe xerostomia (defined as long-term salivary function of <25% of baseline) is usually avoided if at least one parotid gland is spared to a mean dose of less than z20 Gy or if both glands are spared to less than z25 Gy (mean dose). For complex, partial-volume RT patterns (e.g., intensity-modulated radiotherapy), each parotid mean dose should be kept as low as possible, consistent with the desired clinical target volume coverage. A lower parotid mean dose usually results in better function. Submandibular gland sparing also significantly decreases the risk of xerostomia. The currently available predictive models are imprecise, and additional study is required to identify more accurate models of xerostomia risk.
本文对已报导的腮腺剂量体积特征与放射计致的唾液分泌功能毒性的关系作了综述，晚期分泌功能障碍与腮腺平均剂量相关，并随着时间而恢复。严重的干燥综合症（定义为长期的分泌功能小于基
线的25%）通常是可以避免的，如果至少一侧腮腺在平均剂量小于20Gy时，或双侧腮腺小于25Gy(平均剂量)。在复杂的，部分容积放疗的模式中（如调强放疗）双侧腮腺的平均剂量应该尽可能地低，同时必须保证靶区被处方剂量覆盖。腮腺剂量降低意味着良好的功能保护。下颌下腺剂量控制同样能显著下降干燥综合征的危险。当前的预测模型显得不精确，需要更多的研究以确定出干燥综合征危险性的准确模型。
THE LESSONS OF QUANTEC RECOMMENDATIONS FOR REPORTING AND GATHERING DATA ON DOSE–VOLUME DEPENDENCIES OF TREATMENTOUTCOME
QUANTEC推荐报告和收集剂量体积依赖治疗结果的教训 The 16 clinical articles in this issue review the dose–volume dependence of toxicities of external beam radiotherapy.They are limited by the difficulty of synthesizing results from different
publications. The major problems stem from incomplete reporting of results and use of incompatible or ambiguous endpoints. Here we
specify these problems; give recommendations to authors, editors, and reviewers on standards of reporting; and provide methods of defining endpoints suitable for the dose–volume analysis of toxicity. Adopting these recommendations will facilitate meta-analysis and increase the utility of individual studies of the dependence of complications on dose distributions.
这个系列的16篇临床文章回顾了外照射放疗剂量体积依赖的毒性。它们的局限性在于不能通过不同的文章得出综合结果。主要的问题在于不完整的结果报告以及应用了不可比较和模糊的终点指标。我们在这里列出了这些问题；并对作者、编辑和报告标准的综述者提出建议；而且提出了适合确定剂量体积毒性分析终点指标的方法。采纳这些建议将会使Meta分析变得更容易，并提高并发症与剂量分布研究的实用性。
USE OF NORMAL TISSUE COMPLICATION PROBABILITY MODELS IN THE CLINIC
临床中应用正常组织并发症概率模型
The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review summarizes the currently available
three-dimensional dose/volume/outcome data to update and refine the
normal tissue dose/volume tolerance guidelines provided by the classic Emami et al. paper published in 1991. A ‘‘clinician’s view’’ on using the QUANTEC information in a responsible manner is presented along with a description of the most commonly used normal tissue
complication probability (NTCP) models. A summary of organ-specific dose/volume/outcome data, based on the QUANTEC reviews, is included.
临床中对正常组织效应定量分析（QUANTEC）回顾性总结了当前所有的三维适形的剂量/体积/结果数据以更新和改进1991年由
Emami等发表的经典的正常组织剂量/体积耐受指南。以一个“临床学家的视角”用负责任的态度来使用QUANTEC信息，就要按照广泛应用的NTCP模型来描述。包括了以QUANTEC综述为基础的器官特异性的剂量/体积/结果数据。
QUANTEC目录
