加速超分割放疗结合化疗治疗非小细胞肺癌所致上腔静脉压迫综合征  

Accelerated hyperfractionation radiation therapy combined with chemotherapy for non-small cell lung cancer complicated with superior vena cava syndrome

作　　者：叶明[1] 王丽娟[1] 付小龙[1] 钱浩[1] 蒋国梁[1] 赵森[1] 

机构地区：[1]上海医科大学附属肿瘤医院放疗科

出　　处：《中华肿瘤杂志》2001年第5期426-427,共2页Chinese Journal of Oncology

摘　　要：目的　评价加速超分割放疗结合化疗治疗非小细胞肺癌所致上腔静脉压迫综合征的耐受性及其疗效。方法　 34例经组织学或细胞学证实为原发性支气管肺癌合并上腔静脉压迫综合征的患者 ,男性 30例 ,女性 4例 ,中位年龄 5 7岁 (36～ 78岁 )。病理诊断 :鳞癌 17例 (5 0 0 % ) ,腺癌 14例(4 1 2 % ) ,鳞腺癌 2例 (5 9% ) ,低分化癌 1例 (2 9% )。胸部CT显示 ,病变主要位于上纵隔和右肺上叶。放疗前先给予全身化疗 1周期 ,化疗结束后 2 4～ 72h实施放疗。放疗计划为对原发灶和纵隔转移淋巴结区域给予加速超分割放疗 ,肿瘤量 30Gy·2 0次 -1·2周 -1,然后避开脊髓加量 36～ 40 8Gy·(30～ 34 )次 -1·(3～ 3 5 )周 -1。放疗结束后 ,继续行全身化疗。结果　全组完全缓解 2 0 6 % (7/ 34 ) ,部分缓解 5 0 0 % (17/ 34 ) ,轻度缓解 2 9 4% (10 / 34 )。 1,2年生存率分别为 5 8 1%和 18 2 %。平均生存期12个月。结论　本研究中放疗所采用的分割剂量和总剂量是可以耐受的 ,治疗效果与Ⅲ期非小细胞肺癌非手术治疗效果相似。本组病例的生存率与病理类型无关。Objective This retrospective study was done to evaluate the patient′s tolerance and effect of accelerated hyperfractionation radiation therapy in the treatment of superior vena cava syndrome (SVCS) caused by non small cell lung cancer (NSCLC).Methods Thirty four NSCLC patients complicated with SVCS were treated between January 1992 and September 1996. Their ages ranged from 36～78 years (median 57). There were 30 (88.2%) male and 4(11.8%) female patients. Dyspnea (67.6%) and facial swelling (52.9%) were the two most common symptoms. Engorgement of neck veins (38.2%) and dilated chest wall veins (28.5%) were the most common physical findings. According to their pathological diagnosis, there were 17(50%) squamous cell carcinomas, 14(41.2%) adenocarcinomas, 2(5.9%) mixed squamous and adenocarcinomas and 1(2.96%) pooly differentiated carcinomas. By thoracic CT scans, a mass was most commonly found in the right upper lobe and the upper mediastinum. For these patients, chemotherapy IEP or IAP (IFO 2.0 g d1～4, DDP 40 mg d1～3, Vp 16 0.1 g d1～3 or ADM 50 mg d1) was given first. Twenty four to 72 hours after chemotherapy, accelerated hyperfractionation radiation therapy was started to deliver to the primary tumor and the metastatic mediastinal lymph nodes, a tumor dose of 30 Gy/20fx/2wk followed by a boost to 36～40.8 Gy/30～34fx/3～3.5 wk. Diuretics, steroids and dehydrating agents were concomittantly prescribed during the radiation therapy.Results Relief of SVCS to various degrees was noted in all patients. CR, PR and MR rates were 20.6% (7/34), 50%(17/34) and 29.4%(10/34), respectively. The median survival was 12 months (4～26 months). The 1～2 year actuarial survival rates were 58.1% and 18.2% Except radio esophagitis in different degrees, no other severe complications were observed.Conclusion The fraction and total dose of radiotherapy are tolerable in this accelerated hyperfractionation trial. Radiation therapy combined with chemotherapy gives similar results as non surgery for stage Ⅲ NSCLC

关 键 词：非小细胞肺癌 放射治疗 加速分割放射治疗 上腔静脉压迫综合征 

分 类 号：R734.2[医药卫生—肿瘤] R654.4[医药卫生—临床医学]