基于PET／CT影像的大分割后程加速三维适形放疗与常规分割放疗治疗局部晚期非小细胞肺癌的前瞻性随机对照研究  

Accelerated hypofractionated 3-dimensional conformal radiotherapy vs conventional radiotherapy in locally advanced non-small cell lung cancer using PET/CT-derived plan: a prospectively randomized controlled trial

作　　者：于学娟[1] 韩大力[2] 刘增军[3] 柳善刚[1] 张品良[3] 李明[3] 任瑞美[3] 

机构地区：[1]山东省肿瘤医院,济南大学山东省医学科学院医学与生命科学学院,山东济南250117 [2]山东省肿瘤医院放三科室,山东济南250117 [3]山东省肿瘤医院内六科室,山东济南250117

出　　处：《肿瘤》2014年第3期253-259,共7页Tumor

摘　　要：目的 :比较基于正电子发射计算机断层摄影术(positron emission computed tomography,PET)/计算机断层摄影术(computed tomography,CT)的大分割后程加速三维适形放疗(3-dimensional conformal radiotherapy,3D-CRT)与常规分割放疗治疗局部晚期非小细胞肺癌的疗效和不良反应。方法 :2009年4月—2011年12月本院收治的60例局部晚期非小细胞肺癌被随机分为大分割后程加速3D-CRT组(A组,30例)和常规分割放疗组(B组,30例)。2组均在放疗前接受2个周期的诱导化疗(长春瑞滨联合顺铂)。A组患者按照基于PET/CT图像制定的放射治疗计划接受大分割后程加速3D-CRT(2.5 Gy/次至50 Gy,随后3 Gy/次,至放疗总剂量达65 Gy);B组患者按照基于CT图像制定的放射治疗计划接受常规分割放射治疗(60 Gy/30次)。2组患者于放疗结束后至少接受1个周期的辅助化疗(长春瑞滨+顺铂)。结果 :A组完全缓解8例(26.7%),部分缓解13例(43.3%),有效率为70.0%;B组完全缓解4例(13.3%),部分缓解9例(30.0%),有效率为43.3%;2组有效率差异有统计学意义(P=0.037)。A组的中位生存期和中位无进展生存期均优于B组(中位生存期分别为20.5和17.8个月,P=0.236;中位无进展生存期分别为10.2和8.2个月,P=0.001)。2组患者的化疗不良反应主要为骨髓抑制,经对症治疗后未明显影响化疗进程。急性放射反应主要表现为放射性肺炎和放射性食管炎,A组和B组患者中分别有1例和3例发生Ⅲ级放射性肺炎,此外分别有1例和2例发生Ⅲ级放射性食管炎。2组患者的放疗不良反应差异无统计学意义(P>0.05)。结论 :基于PET/CT图像制定的放射治疗计划进行大分割后程加速3D-CRT联合诱导化疗治疗局部晚期非小细胞肺癌显示出较好的疗效,绝大多数患者均能耐受治疗相关不良反应。Objective： To prospectively evaluate the efficacy and adverse reactions of accelerated hypofractionated 3-dimensional conformal radiotherapy （3D-CRT） vs conventional radiotherapy in locally advanced non-small cell lung cancer （NSCLC） using positron emission computed tomography （PET）/computed tomography （CT）-derived plan. Methods： Between April 2009 and December 2011, sixty patients with locally advanced NCSLC were enrolled and randomly divided into group A （accelerated hypofractionated 3D-CRT using PET/CT-derived plan, n = 30） and group B （conventional radiotherapy using CT-derived plan, n = 30）. All patients were treated with two cycles of induction chemotherapy （vinorelbine 25 mg/m2 dl, 8; cisplatin 40 mg/rn2, dl-3; repeat every 21 days）. The 30 patients in group A were treated with accelerated hypofractionated 3D-CRT （initially 2.5 Gy/fx, up to 50 Gy/20 fractions; then 3 Gy/fx, up to a total dose of 65 Gy）. The 30 patients in group B were treated with conventional radiotherapy （60 Gy/30 fx）. In addition, all patients were received at least one cycle of adjuvant chemotherapy of vinorelbine plus cisplatin. Results： In group A, 8 （26.7%） achieved complete response （CR）, 13 （43.3%） achieved partial response （PR）, and the objective response rate （CR＋PR） was 70.0%; in group B, 4 （13.3%） achieved CR, 9 （30.0%） achieved PR, and the objective response rate was 43.3%; the difference in objective response rate between the two groups was significant （P = 0.037）. The median survival time and the median progression-free survival time of group A were longer than those of the group B （20.5 vs 17.8 months, P = 0.236; 10.2 vs 8.2 months, P = 0.001）. The major side effect induced by chemotherapy was marrow suppression which could be relieved by symptomatic treatment. The major side effects induced by radiotherapy were radiation-induced esophagitis and pneumonitis. Grade II1 radiation-induced pneumonitis was observed in one and three patients in group

关 键 词：癌 非小细胞肺 放射疗法 化学疗法 正电子发射断层显像术 预后 

分 类 号：R734.2[医药卫生—肿瘤]