非小细胞肺癌大分割三维适形放疗的剂量递增研究  

Escalated Dose Trial with Hypofractionated Three-dimensional Conformal Radiation Therapy for Non-small Cell Lung Cancer

作　　者：谢松喜[1] 李伟雄[1] 曾子君[1] 陈应瑞[1] 

机构地区：[1]广东省人民医院广东省医学科学院肿瘤中心放疗科,广州市510080

出　　处：《中国肿瘤临床》2009年第17期972-975,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨非小细胞肺癌大分割三维适形放疗的最大耐受剂量和毒性。方法:采用三维适形放疗,分割剂量3Gy/次,每周5次。据肺V20(照射剂量≥20Gy的肺的体积占双肺体积的百分比)进行剂量递增。V20≤20%组从66Gy开始剂量递增,20%<V20≤30%组从60Gy开始剂量递增。每个剂量级别至少入组3例患者。结果:2005年6月至2007年5月共有32例非小细胞肺癌患者进入临床试验。V20≤20%组,总剂量66Gy3例,69Gy3例,72Gy 3例,75Gy7例,在75Gy剂量水平有2例患者出现3级急性放射性肺炎和晚期放射性肺损伤。20%<V20≤30%组,总剂量60Gy 3例,63Gy 3例,66Gy 3例,69Gy 7例,在69Gy剂量水平有2例患者出现3度急性放射性肺炎和晚期放射性肺损伤。治疗结束后评价近期疗效完全缓解为19%(6/32),部分缓解为72%(23/32),稳定为9%(3/32),有效率为89%(29/32)。中位随访时间19个月(10～32个月),34.3%(11/32)患者出现病情进展,1年疾病无进展率为65.7%(21/32)。结论:非小细胞肺癌采用三维适形放疗技术3Gy/次大分割照射是可行的,肺V20≤20%的最大耐受剂量为75Gy,20%<V20≤30%为69Gy,今后还需要更多病例来验证其疗效和远期毒性。Objective： To assess the maximum tolerable dose （MTD） and toxicity of a hypofractionated three-dimensional conformal radiation therapy regimen in the treatment of non-small cell lung cancer （NSCLC）. Methods： Three-dimensional conformal radiation therapy was administered at 3Gy per fraction, 5 fractions per week. We escalated the dose according to the V20 of lung （the percent of the total lung volume exceeding 20Gy）. The total dose was escalated to 66Gy with 3Gy per fraction in a group of V20≤20% and to 60Gy in a group of 20%〈V20≤30%. At least 3 patients were enrolled at every total dose level. Results： Thirty-two patients were enrolled in this trial from June 2005 to May 2006. Three patients were enrolled at the dose level of 66Gy, 3 patients at the dose level of 69Gy, 3 patients at the dose level of 72Gy and 7 patients at the dose level of 75Gy in the group of V20≤20%. At the dose level of 75Gy, 2 of 7 patients experienced grade 3 acute radiation pneumonitis and long-term pulmonary toxicity. Three patients were enrolled at the dose level of 60Gy, 3 patients at the dose level of 63y, 3 patients at the dose level of 66Gy and 7 patients at the dose level of 69Gy in the group of 20%〈V20≤30%. At the dose level of 69Gy, 2 of 7 patients experienced grade 3 acute radiation pneumonitis and long-term pulmonary toxicity. All 32 patients were evaluated for tumor response： 6 patients had complete response, 23 had partial response and 3 exhibited stable disease, for a total of 29 of the 32 patients showing a response. Within a median follow-up time of 19 months （ranging from 10 to 32 months）, 11 of 32 patients had disease progression, and the 1-year progression-free survival rate was 65.7%. Conclusion： A radiation schedule of hypofractionated three-dimensional conformal radiation therapy （3Gy per fraction） is feasible but more data are needed to confirm its efficacy and long-term toxicity.

关 键 词：非小细胞肺癌 大分割 三维适形放疗 剂量递增 

分 类 号：R734.2[医药卫生—肿瘤] R730.55[医药卫生—临床医学]