缩小非小细胞肺癌术后放疗临床靶区的对比研究  

Reduced irradiation target volume of mediastinal lymph node drainage in conformal radiotherapy for patients with non-mall cell lung cancer after thoracic surgery

作　　者：石玉生[1] 邓晓刚[1] 闫卫平[1] 陈龙华[1] 

机构地区：[1]南方医科大学南方医院放疗科,广东广州510515

出　　处：《南方医科大学学报》2007年第8期1224-1226,共3页Journal of Southern Medical University

摘　　要：目的缩小非小细胞肺癌术后放疗的靶区照射体积,减少食管和肺的放射损伤。方法53例非小细胞肺癌患者术后放疗,随机分成A、B两组。A组按照传统原则给予淋巴引流区预防性照射;B组患者根据术后的淋巴结分期,病理未发现有淋巴结转移的区域不作预防性照射,临床靶体积明显小于A组患者。两组患者采用常规分割放疗,2Gy/次,5次/周,放射剂量相同。随访超过2年,分析两组患者的2年生存率、淋巴引流区局部控制率、肺和食管的放射性损伤。结果全部患者的2年生存率为58.5%,A、B两组患者的生存曲线统计学差异不显著。A、B两组患者的淋巴引流区失败率和靶区外淋巴结复发率分别为13.8%、16.7%和3.4%、8.3%(P=1和P=0.571)。急性放射性肺炎和晚期局限性放射性肺纤维化的发生率A、B两组患者分别为6.9%、0%和62.1%、58.3%(P=0.459和P=0.782);急性放射性食管炎和远期食管狭窄的发生率A、B两组患者分别为27.6%、12.5%和6.9%、4.2%(P=0.039和P=1)。结论缩小临床靶区后并未引起纵隔淋巴引流区的控制率下降,而急性放射食炎的发生率明显降低。Objective To decrease lung and esophageal radiation injuries by reducing irradiation target volume ofmediastinal lymph mode drainage in conformal radiotherapy （CRT） for patients with non-small cell lung cancer （NSCLC） after thoracic surgery. Methods Fifty-three patients with NSCLC were randomized into groups A and B to receive 3D-CRT after thoracic surgery. Patients in group A, according to conventional therapy, received preventive nodal irradiation （PNI） of the mediastinal lymph node drainage, and those in group B, according to pathological nodal staging after operation, did not have PNI of the metastasis-flee area to reduce the clinical target volume （CTV）. Patients in both groups were treated with conventional fractionated radiotherapy （CFRT） at 2 Gy in each fraction, and 5 fractions each week. All patients were followed up for two years to record their 2-year survival rate, local relapse of lymph node drainage and lung and esophageal radiation injuries. Results The total 2-year survival rate was 58.5% in these patients and comparable between the two groups. The rates of local regional relapse and recurrence out of the CTV were 13.8% and 3.4% in group A and 16.7% and 8.3% in group B, respectively （P=1 and P=0.571）. The incidence of radiation pneumonia and lung fibrosis were 6.9% and 62.1% in group A and 0% and 58.3% in group B （P=0.459 and P=0.782）, and that of radiation esogphagitis and esophagus stricture rates were 27.6% and 6.9% in group A and 12.5% and 4.2% in group B, respectively （P=0.039 and P=1）. Conclusion Reduced CTV does not warrant decrease in the local control but may lower the incidence of acute esophageal radiation injury in postoperative patients with NSCLC.

关 键 词：癌 非小细胞肺/放射疗法 临床靶体积 辐射损伤 

分 类 号：R734.2[医药卫生—肿瘤]