芦荟多糖防治皮肤放射反应的临床研究

Clinical study using aloe polysaccharides to prevent and treat skin reaction induced by radiation

为了总结芦荟多糖(AP)对皮肤放射防护效果,回顾性分析2007-08-01-2008-08-01我院放疗的初治鼻咽癌(NPC)患者185例,用AP油膏2mg/mL作为皮肤放射保护剂,从放疗开始至结束予左颈照射野涂抹防护剂,右颈照射野不涂防护剂(空白)对照观察皮肤放射反应。全部患者鼻咽及颈部照射野采用直线加速器8MV X射线照射,辅以电子线照射颈后三角区。颈预防量DT50Gy/25次,根治量60～64Gy/30～32次。鼻咽68～72Gy/34～36次,5次/周。皮肤反应采用RTOG皮肤急性放射损伤分级标准评级。185例患者全部按计划完成放疗,用药组与对照组出现皮肤Ⅰ级放射反应分别为58.9%和71.4%,Ⅱ级分别为37.8%和25.9%,Ⅲ级分别为3.2%和2.7%,χ2=6.388,P=0.041;用药组与对照组出现皮肤Ⅰ级放射反应中位剂量分别为30和36Gy,Ⅱ级分别为50和54Gy,Ⅲ级分别为58和58Gy,χ2=0.350,P=0.839。初步研究结果提示,临床试用该药剂后Ⅱ级、Ⅲ级皮肤反应较高,提示该制剂对皮肤急性放射损伤无保护效果,须予以剂量或剂型改进。

The ojbective of this study was to determine the preventive and therapeutic efficacy of Aloe polysaccharides （AP） to radiation induced skin reaction （RISR）. From August 1st 2007 to August 1st 2008, a total of 185 newly diagnosed nasopharyngeal carcinoma （NPC） patients were included onto this study. A prospective self-control study method was used. AP was applied to the skin of one radiation fields of NPC patients from the beginning to the end of radiothera- py. On the other side, however, no skin repellent was used. Skin reaction was examined and documented after each fraction of radiotherapy. Eight MV X-ray was used to irradiate the nasopharyngeal and neck as main field while the triangle area of the neck was irradiated with electron beams. The preventive dose of 50 Gy/25 fractions （fx） and radical dose of 60--64 Gy/30--32 fx was administered to neck field and 68--72 Gy/34--36 fx, 5 fx/week. Skin reaction was evaluated by the RTOG skin acute toxicity standard. All 185 NPC patients complete radiotherapy as planned. The mcidence of grade I , II and III RISR was 58.9% vs 71.4%, 37.8% vs 25.9%, 3.2% vs 2.7%, respectively on the AP-applied side and the blank side （？（2 =6. 388, P=0. 041）. The median dose for the incidence of grade I , II and III RISR was 30 Gy vs 36 Gy, 50 Gy vs 54 Gy, 58 Gy vs 58 Gy, respectively on the AP-applied sicle and the blank side （χ2=0. 350, P=0. 839）. In conclusion, AP do not provide any protective effect against the radiation induced acute skin reaction in this study.