CTV同步减量根治性IMRT对Ⅲ期NSCLC回顾观察  

Retrospective clinical study of simultaneous reduced dose in clinical target volume of radical intensity-modulated radiotherapy for treatment of stage Ill non-small.cell lung cancer

作　　者：陈秀丽[1] 刘宁波[1] 赵路军[1] 姬凯[1] 石翔宇 王大权[1] 陈曦[1] 王平[1] 

机构地区：[1]天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心 天津市“肿瘤防治”重点实验室 天津市恶性肿瘤临床医学研究中心,天津300060

出　　处：《中华放射肿瘤学杂志》2016年第7期686-689,共4页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金项目（81372518）

摘　　要：目的 观察CTV同步减量根治性IMRT对不能手术的Ⅲ期NSCLC患者的疗效及不良反应。方法 回顾分析2010—2014年本院收治的Ⅲ期NSCLC患者共70例,均为IMRT同步减量照射,PGTV （GTV外放0.5 cm）剂量为60 Gy分30次或60.2 Gy分28次,PTV剂量为54 Gy分30次或50.4 Gy分28次。40例患者放疗前新辅助化疗,50例同步放化疗,25例放疗后辅助化疗。观察近期疗效及不良反应。Kaplan-Meier法进行生存分析。结果 中位随访时间42.8（16.9~68.3）个月,近期有效率（CR＋PR）81%,CR率7%（5/70）,PR率74%（52/70）,SD率13%（9/70）,PD率6%（4/70）。全组中位生存时间为26.6（5.2~68.3）个月,2年OS、LRFS、PFS率分别为55%、68%、45%。全组发生≥3级RP 9%（6/70）,食管炎4%（3/70）,骨髓抑制7%（5/70）。结论 应用肿瘤临床靶区同步减量的IMRT治疗Ⅲ期NSCLC是可行的,值得进一步大样本前瞻性研究。Objective To evaluate the efficacy and adverse effects of radical intensity-modulated radiotherapy （IMRT） with simultaneous reduced dose in clinical target volume （CTV） for inoperable stage Ⅲ non-small cell lung cancer （NSCLC）. Methods A retrospective analysis was performed on a total of 70 patients with stage Ⅲ NSCLC who were admitted to our hospital from 2010 to 2014. All patients received simultaneous reduced-dose IMRT with a prescribed dose of 60 Gy in 30 fractions or 60.2 Gy in 28 fractions for primary gross tumor volume （PGTV, expansion of gross tumor volume by 0.5 cm） and a prescribed dose of 54 Gy in 30 fractions or 50.4 Gy in 28 fractions for planning target volume （PTV）. In the 70 patients, 40 received neoadjuvant chemotherapy prior to radiotherapy, 50 concurrent chemoradiotherapy, and 25 adjuvant chemotherapy after radiotherapy. Short-term treatment outcomes and adverse reactions were evaluated. The Kaplan-Meier method was used for survival analysis. Results The median follow-up time was 42.8 months （16.9-68.3 months）. The short-term response rate （complete response （CR） plus partial response （PR）） was 81.4%. The CR, PR, stable disease, and progressive disease rates were 7%（5/70）, 74%（52/70）, 13%（9/70）, and 6%（4/70）, respectively. In all patients, the median survival time was 26.6 months （5.2-68.3 months）. The 2-year overall survival, local recurrence-free survival, and progression-free survival rates were 55%, 68%, and 45%, respectively. In all patients, 9%（6/70） had grade ≥3 radiation pneumonitis, 4%（3/70） grade ≥3 oesophagitis, and 7%（5/70） grade ≥3 myelosuppression. Conclusions IMRT with simultaneous reduced dose in CTV is effective for stage Ⅲ NSCLC. It deserves further prospective studies with large sample sizes.

关 键 词：癌 非小细胞肺/放射疗法 放射疗法 调强 临床靶区减量 

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