非小细胞肺癌脑转移调强放射治疗可行性研究  

Feasibity study for brain metastases of non-small cell lung cancer treated with IMRT

作　　者：王靖 卢冰[2] 胡银祥[2] 欧阳伟炜[2] 苏胜发[2] 王刚[2] 龙金华[2] 栗蕙芹[2] 

机构地区：[1]兴义市人民医院肿瘤科,贵州兴义562400 [2]贵阳医学院附属医院胸部肿瘤科,贵州贵阳550004

出　　处：《中华肿瘤防治杂志》2013年第16期1253-1256,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：贵州省科技攻关项目〔黔科合SY(2010)3078〕;贵州省科学技术自然基金〔黔科合J字(2010)2186号〕

摘　　要：目的:探讨调强放射治疗(intensity modulated radiation therapy,IMRT)非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移的可行性。方法:选择NSCLC脑转移初治患者30例,分析近期疗效、治疗前后生活质量和毒副作用,与重新设计全脑加后程三维适形(WBRT+3DCRT)和立体定向(WBRT+SRT)放疗计划相比,通过癌旁正常脑组织剂量体积特点分析IMRT的优势。结果:30例患者完全缓解和部分缓解分别为16.7%(5/30)和33.3%(10/30)。治疗后全组IMRT后简短精神状态量表评分为25.67±2.73,较治疗前的22.90±4.94提高,P<0.001;治疗后3～5个转移灶者为24.77±3.24,较治疗前的19.23±4.64提高,P=0.001。全组治疗后日常生活能力量表评分为79.00±14.82,较治疗前的68.67±19.60提高,P<0.001;治疗后3～5个转移灶者为72.31±15.63,较治疗前的55.77±19.13提高,P=0.001。急性Ⅱ级损伤发生率为10%(3/30),晚期Ⅱ级毒副作用1例,Ⅳ级毒副作用1例。IMRT使瘤旁V35(147.56±80.77)、V40(50.86±32.33)和V45(22.32±15.40)明显较3DCRT和SRT减少,尤以3～5个病灶者显著,V35为214.56±58.09,V40为79.29±22.76,V45为34.17±12.64,P值均<0.05。结论:IMRT治疗NSCLC脑转移有效,毒副作用可耐受,转移病灶3～5个的患者选择IMRT可能更优。OBJECTIVE： To investigate the feasibility of clinical prospective study for brain metastases from non-small cell lung cancer （NSCLC） treated with intensity modulated radiotherapy （IMRT）. METHODS： Thirty NSCLC untreated patients with brain metastases treated with IMRT. Through evaluating the response,quality of life before and after treatment,toxicity and normal brain tissue adjacent to the tumor dose-volume parameters,the advantages of IMRT was analyzed and compared to redesigned three-dimesional conformal radiation therapy （3D-CRT） or stereotactic radio- therapy （SRT） plans. RESULTS： Complete remission was 16.70//00 （5/30）, partial remission was 33.3% （10/30）. Mini- mental state examination score （all patients 25.67 _± 2.73, three to five metastases patients 24.77--4-3.24） and activities of daily living score （all patients 79.00±_ 14.82, three to five metastases patients 72.31-4-15.63） after treatment were higher than that before treatment（the former all patients 22.9 ± 4.94, three to five metastases patients 19.23± 4.64; the later all patients 68.67±19.60, three to five metastases patients 55.77 ± 19.13）, especially with three to five brain metastases le- sions （P〈0.05）. Acute injury of grade lI was 10%（3/30） and late injury of grade lI ,IV was in one patient. Dose vol- ume V3 （147.56±80.77） ,V40 （50.86±32.33） and V45 （22.32±15.40） in normal tissue adjacent to the brain tumor was obviously decreased in IMRT, especially within three to five metastases lesions （V35 214.56± 58.09, V40 79.29±22.76, V45 34.17 ±12.64,P〈0.05）. CONCLUSIONS： IMRT treatment of NSCLC brain metastases is effective and the toxicity can he tolerated. For the patients with 3--5 brain metastases lesions selecting IMRT may be a better choice.

关 键 词：癌 非小细胞肺 放射疗法 肿瘤转移 放射治疗剂量 治疗结果 

分 类 号：R734.2[医药卫生—肿瘤]