局部晚期非小细胞肺癌大分割适形放疗的临床研究  

Clinical research of hypofractionated conformal radiotherapy for locally advanced non-small cell lung cancer

作　　者：魏洁[1] 杜兴龙[1] 吕星旺 

机构地区：[1]安徽省滁州市第二人民医院放疗科,239000

出　　处：《中华全科医学》2014年第11期1742-1744,共3页Chinese Journal of General Practice

摘　　要：目的分析大分割放疗治疗局部晚期非小细胞肺癌的疗效和毒副反应。方法48例局部晚期非小细胞肺癌（Ⅲa期和Ⅲb期）行大分割三维适形放疗（DT：48—52．5Gy／12—15次），放疗后1月复查胸部CT分析客观有效率（CR＋PR）和局部控制率（CR＋PR＋SD）。中位随访20月后，观察1年、3年生存率和放射性食管炎，放射性肺炎等毒副反应。30例行常规分割剂量（DT：60Gy／30次）的对照分析。结果放疗后1个月观察大分割组和常规分割组的客观有效率（CR＋PR）分别为75．0％（36／48）和46．7％（14／30）（P〉0．05）。局部控制率（CR＋PR＋SO）分别为：89．6％（43／48）和83．3％（25／30）（P〉0．05）。2组1年生存率分别为：72．9％和46．7％，差异有统计学意义（P〈0．05）；3年生存率分别为27．1％，16．7％（P〉0．05）。1～2级放射性肺炎和1～3级食管炎的发生率为45．8％和47．9％，无3—4级晚期放射性肺炎和3级以上的放射性食管炎发生。结论大分割适形放疗可以提高近期疗效和1年生存率，毒副作用未明显增加，是否能提高远期疗效和合理的时间-剂量-分割模式尚需讲一步榛讨．Objective To explore the curative effect and adverse reaction of large divided radiotherapy for locally advanced non-small cell lung cancer. Methods 48 patients with locally advanced non-small cell lung cancer（ stage Ⅲ a and Ⅲ b） were treated with segmentation of three-dimensional conformal radiotherapy（ 3D-CRT, DT ：48.0 - 52.5 Gy/12 - 15 times）. After 1 month, patients were reexamined by chest CT to analyze Objective Response Rate （ORR, CR ＋ PR） and Local Control Rate（ CR ＋ PR, SD）. After a median follow-up of 20 months, 1-year survival rate, S-year survival rate and the toxic side effects, such as radiation esophagitis, radiation pneumonia, were observed. The control group, 30 patients, were treated with the routine dose（ DT：48.0 -52.5 Gy/12 -15 times） to be compared with the treatment group. Results 1 month after radiotherapy,in the treatment groups and the control groups, Objective Response Rate （ORR） was （ CR ＋ PR） 75.0% （36/48） and 46.7% （14/30） respectively（ P 〈 0. 05 ）. and Local Control Rate （ CR ＋ PR, SD） was 89.6% （43/48）and 83.3% （25/30） respectively（ P 〉 0.05 ）. 1-year survival rates of two groups were 72.9% and 46.7%, showing statistically difference between the two groups （X^2 = 5. 447, P = 5. 447 ）. 3-year survival rates were 27. 1% and 16.7% respectively,showing no statistical significance （X^2 = 1. 128, P = 1. 128 ）. The incidence rates of Level 1 - 2 of radioactive pneumonia and Level 1 - 3 of esophagitis were 45.8% and 47.9%, and there were no Level 3 - 4 radioactive pneumonia and Level 3 and more radioactive esophagitis. Conclusion Hypofractionated conformal three-dimensional conformal radiotherapy（3D-CRT） can improve the short-term curative effect and 1-year survival rate without obvious side effects, but whether it can improve the long-term curative effect And the reasonable amount of time, dose and segmentation model remained to be further discussed.

关 键 词：非小细胞肺癌 放射疗法 大分割放疗 

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