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20年前放化疗结合开始成为治疗性研究的最有希望的途径。但在大多实体瘤中这一方法没有得到有意义的进展,如头颈部癌虽有大量的临床对照试验,但没有得到任何增加存活率的证据。以下两个因素可能造成这一令人失望的结果:①与大多实体瘤可用的药物效力有关;②放疗与药物对正常组织毒性的蓄积限制了联合治疗时二者的剂量。相反在对放疗化疗均敏感的肿瘤中用这二种治疗得到了益处,如淋巴瘤、胚胎性肿瘤及小细胞肺癌,对于这些肿瘤巨大肿块的照射可改善局部控制率及随之而来的长期存活率。这一文章在实验及临床资料基础上讨论放疗及化疗的剂量、方案及其最佳结合方式,尤其是对化疗敏感肿瘤的治疗。
The combination of radiotherapy and chemotherapy 20 years ago began to become the most promising approach to therapeutic research. However, no significant progress has been made in this method in most solid tumors. For example, head and neck cancers have not received any evidence of increased survival despite numerous clinically controlled trials. The following two factors may cause this disappointing result: 1 It is related to the potency of drugs available in most solid tumors; 2 The accumulation of radiotherapy and drugs on normal tissue toxicity limits the dose of both drugs in combination therapy. Conversely, the use of these two treatments in tumors that are allergic to radiotherapy and chemotherapy benefits, such as lymphomas, embryonal tumors, and small cell lung cancer. The irradiation of these tumors with large masses can improve the local control rate and consequent long-term Survival rate. Based on experimental and clinical data, this article discusses the doses, protocols, and optimal combinations of radiotherapy and chemotherapy, especially for the treatment of chemotherapy-sensitive tumors.