适形调强放疗同期整合瘤床推量治疗肺癌脑转移瘤的可行性研究  

Feasibility study on the treatment for brain metastases of lung cancer via intensity-modulated radiotherapy combined with simultaneous integrated boost

作　　者：程学斌[1] 肖林[1] 

机构地区：[1]江门市中心医院肿瘤科,广东江门529070

出　　处：《中国癌症杂志》2016年第8期687-692,共6页China Oncology

摘　　要：背景与目的：肺癌脑转移的发生率呈上升趋势，适形调强放射治疗（intensitymodulatedradiotherapy，IMRT）＋瘤床同期整合推量（Simultaneousintegratedboost，SIB）技术对于脑转移患者是一种新的治疗选择。本研究旨在探讨全脑IMRT＋瘤床SIB治疗合并1-4个肺癌脑转移灶患者的近期临床疗效及治疗相关不良反应，明确该方案的可行性。方法：前瞻性收集2014年6月-2015年6月在江门市中心医院确诊为肺癌脑转移（转移病灶数1-4个）的32例患者，所有患者均行全脑5野IMRT（40Gy／20f）＋瘤床SIB（50Gy／20f），分别评价其靶区剂量分布、放疗总有效率、肿瘤局部控制率、1年生存率、各种急性及晚期不良反应。结果：所有患者均完成放疗。全组2级呕吐、恶心和癫痫发生率分别为9．4％、15．6％和12．5％，2例出现2级认知功能障碍，4例出现2级记忆力损伤，2例出现3级记忆力损伤，无4级急性及晚期不良反应。放疗总有效率为71．9％，肿瘤局部控制率为96．9％，1年生存率为44％。结论：全脑5野IMRT（40Gy／20f）＋瘤床SIB（共10Gy，即总量50Gy／20f）治疗1～4个肺癌脑转移灶是可行的。Background and purpose： The incidence of lung cancer with brain metastasis tends to go up. The technique of intensity-modulated radiotherapy （IMRT） with simultaneous integrated boost （SIB） for tumor bed is a new treatment choice for patients with brain metastasis. This study aimed to investigate the feasibility of 1MRT combined with SIB for tumor bed in the treatment of brain metastases of lung cancer by exploring its short-term clinical effect and treatment-related toxicities. Methods： Thirty-two patients who were diagnosed as having lung cancer with 1-4 brain metastases were prospectively collected. All the brain metastases were treated with whole brain 5 fields IMRT （40 Gy/20 f） combined with SIB （50 Gy/20 f）. The dosage distribution within the target volume and dose-volume histogram were evaluated. Meanwhile, the overall response rate of radiotherapy, the local tumor control rate, 1-year survival rate, treatment-related acute and late toxicities were also calculated. Results： All patients were treated with IMRT successfully. The rate of Grade 2 vomitting, nausea, epilepsy was 9.4%, 15.6%, and 12.5%, respectively. Two cases had Grade 2 cognitive impairment, 4 cases had Grade 2 memory injury, and 2 cases had Grade 3 memory injury. There were no any Grade 4 events of acute and late toxicities. The overall response rate of radiotherapy was 71.9%. The local tumor control rate was 96.9%, and 1-year survival rate was 44%. Conclusion： It is feasible to use 5 fields IMRT （40 Gy/20 f） combined with S1B （boosting 10 Gy, i.e. total dose 50 Gy/20 f） for the treatment of brain metastases of lung cancer.

关 键 词：适形调强放射治疗 肺癌 脑转移 同期整合推量 

分 类 号：R734.2[医药卫生—肿瘤]