恶性肿瘤多发转移病灶螺旋断层放疗的初步探讨  

Preliminary experience of helical tomotherapy for multiple metastatic lesions of malignant tumor

作　　者：李志强[1] 黎静[1] 文婷[1] 张晋建[1] 李重[2] 杨美玲[2] 项红霞[2] 贾峻嵩[1] 陈静[1] 徐艳红[1] 侯友贤[1] 

机构地区：[1]广州军区广州总医院螺旋断层放疗中心,广州510010 [2]广州中医药大学研究生院,广州510405

出　　处：《广东医学》2013年第7期1040-1043,共4页Guangdong Medical Journal

摘　　要：目的分析恶性肿瘤多发转移病灶螺旋断层放疗的可行性。方法回顾22例行螺旋断层放疗的恶性肿瘤多发转移患者的临床资料,分析其螺旋断层放疗计划模式,患者的姑息疗效及早期不反应。结果患者中位年龄52.7岁,治疗床进床距离为11.5～64.9 cm,中位距离为32.4cm,治疗时间为410.4～1944.6s,中位时间为781.0s。大体肿瘤体积(GTV)23.4～1978.3 mL,中位体积为136.9mL。计划靶体积为113.8～3520.9mL,中位体积817.2mL。GTV的剂量为30～66Gy,中位分次剂量为3Gy。8例骨转移患者疼痛缓解,1例患者放疗后肿瘤热缓解。22例患者中18例伴有血液学毒性,其中1例因出现Ⅳ度白细胞减少及血小板减少而终止放疗,6例患者出现Ⅲ度骨髓抑制,对症处理后完成放疗。1例患者出现Ⅰ度腹泻,3例患者出现Ⅱ度腹泻,2例患者出现咽痛。结论用螺旋断层放疗同时治疗恶性肿瘤多发转移病灶可行,能有效地缓解患者的症状,如何减少全身多发转移放疗时的骨髓抑制需要进一步研究。Objective To investigate the feasibility of helical tomotherapy （HT） for muhiple metastatic lesions of malignant tumor. Methods Retrospective study of 22 patients with muhiple metastatic lesions treated by HT was performed for analysis of schema, palliation effect and acute toxicities of HT for malignant tumor patients with multiple metastasis. Results The median age was 52. 7 years. The couch travel distance ranged from 11.5 to 64. 9 era, with the median treatment time of 781.0 s. Radiation dose to the gross tumor volume was 30 ～ 66 Gy, with the median fractional dose of 3 Gy. Eight patients with multiple hone metastasis experienced pain reduction, and 1 patient was relieved from tumor fever. Hematologic toxicity was revealed in 18 patients; among which 1 patient withdrew due to grade IV leukocytopenia and thrombocytopenia, and 6 patients had grade Ⅲbone marrow depression, who completed radiotherapy with appropriate procession. 1 patient experienced grade I diarrhea, grade Ⅱ diarrhea and pharyngodynia were recorded in 1, 3 and 2 cases, respectively. Conclusion HT is feasible for patients with multiple metastatic lesions, providing effective symptom palliation, though how to reduce bone marrow depression needs further study.

关 键 词：螺旋断层放疗 放射治疗 多发转移病灶 骨髓抑制 

分 类 号：R814[医药卫生—影像医学与核医学]