复发支气管肺癌CT引导后装放疗小样本临床研究  

CT guided intraluminal brachytherapy in recurrent bronchogenic carcinoma:a clinical trial in small group

作　　者：马辰莺[1] 徐晓婷[1] 张汝婷[1] 秦颂兵[1] 周菊英[1] MA Chen-ying XU Xiao-ting ZHANG Ru-ting QIN Song-bing ZHOU Ju-ying(Department of Radiotherapy, First Affiliated Hospital of Soochow University, Suzhou 215006, P. R. China)

机构地区：[1]苏州大学附属第一医院放疗科,江苏苏州215006

出　　处：《中华肿瘤防治杂志》2016年第18期1244-1249,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81302384)

摘　　要：目的 随着有效化疗药物及靶向药物的使用,肺癌患者的生存期显著延长,随之而来的是局部复发的患者日益多见。腔内近距离放疗（intraluminal brachytherapy,ILBT）被公认为是一种可应用于无临床手术机会的支气管恶性肿瘤患者的二线治疗方式。本试验通过随访研究以评价CT引导的高剂量率ILBT治疗复发支气管肺癌患者的近期及远期疗效及安全性。方法 收集苏州大学附属第一医院2009-06-01-2015-09-30收治的15例复发支气管肺癌患者的临床特征、治疗方法、疗效及不良反应,并利用Kaplan-Meierer法进行生存分析。结果 15例复发支气管肺癌的患者均接受ILBT,均可评价疗效和不良反应。全组完全缓解（complete response,CR）2例,部分缓解（partial response,PR）11例,稳定（stable disease,SD）1例,进展（progression disease,PD）1例,总有效率（response rate,RR）86.7%（13/15）,疾病控制率（CR＋PR＋SD）93.3%（14/15）。患者在ILBT后第1、2、4和8周末时的气促评级均显著减少,P〈0.001。ILBT后的平均局部缓解期为（5.27±3.35）个月,中位局部缓解期为3.24个月,联合支气管介入治疗（P=0.013）及ILBT累积剂量〉20Gy（P=0.013）可提高局部有效率。患者中位无进展生存期（progress-free survival,PFS）为9.5个月（95%CI：12.2~16.5个月）,平均PFS为（15.8±14.4）个月,中位生存期（overall surrival,OS）23.0个月（95%CI：25.0~30.0个月）,平均OS（28.0±17.0）个月,1、2年生存率分别为93.3%（14/15）和40.0%（6/15）。主要不良反应为支气管痉挛和咯血,其次为咳嗽、气促、乏力、恶心呕吐和骨髓抑制。结论 CT引导的ILBT治疗复发支气管肺癌是一种安全、有效的肿瘤姑息治疗方式,值得扩大样本量进一步研究。OBJECTIVE Overall survival （OS） of lung cancer patients were significantly extended as consequences of chemotherapy and targeted drugs utilization, which resulted in increase of local recurrences. The study followed up pa- tients to evaluate the short-term,long-term efficacies and safety of high dose rate （HDR） intraluminal brachytherapy （IL- BT） on recurrent bronchogenic carcinoma （RBC） patients, and investigate the factors that influence prognosis. METHORDS Clinical records, treatment, curable effects and adverse events of 15 patients treated in the First Affiliated Hospital of Soochow University, diagnosed as recurrent hronchogenic cancer between 1st June 2009 and 30th September 2015 were reviewed,survival analysis was done by Kaplan-Meierer method. RESULTS Fifteen RBC patients all received ILBT, and both curable effects and safety were available. The group consisted of 2 CR （2/15）, 11 PR （11/15）, 1 SD （1/15） and 1 PD （1/15）. The response rate （RR） was 86.7%（13/15） and disease control （CR＋PRA-SD） was 93.3%（14/15）. The Dyspnca indexes of the patients decreased significantly in week 1,2,4 and 8 after ILBT treatment （P〈0. 001）. The average post-ILBT partial remission period was （5.27±3.35） months, median partial remission period 3.24 months. The combination therapy of ILBT and bronehofiberseope （P=0. 013） and ILBT total dose ≥20 Gy could rise partial effective rate. The progres-free survival （PFS） of patients was 9.5 months （95%CI： 12.2-16.5 months）, average FPS was （15.8± 14.4） months, median OS was 32. 0 months （95% CI： 25.0 - 30.0 months）, and one-year OS was 93.3% （14/15）, three-year OS was 40.0% （6/15）. The main adverse events were bronchospasm and hemoptysis（grade Ⅲ）, others were grade Ⅰ- Ⅱ. CONCLUSION CT guided ILBT is a safe, effective palliative treatment for RBC, and it needs further study in large groups.

关 键 词：肺肿瘤 腔内近距离放疗 高剂量率 外照射放疗 局部缓解 

分 类 号：R734.2[医药卫生—肿瘤]