IMRT联合后程立体定向放射治疗局部中晚期非小细胞肺癌的近期疗效分析  

Clinical efficacy of IMRT combined with late course stereotactic body radiotherapy for local middle-late stage non-small cell lung cancer

作　　者：罗茜[1] 王颖[1] 吴永忠[1] 周伟[1] 柳先锋[1] 

机构地区：[1]重庆市肿瘤研究所/医院/癌症中心放疗科,重庆400030

出　　处：《重庆医科大学学报》2017年第1期32-36,共5页Journal of Chongqing Medical University

摘　　要：目的:比较适形调强放射治疗(intensity modified radiotherapy,IMRT)联合后程立体定向放射治疗(stereotactic body radiotherapy,SBRT)与单纯IMRT治疗局部中晚期非小细胞肺癌的疗效。方法:将90例局部中晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者随机分成试验组和对照组,各45例。试验组采用IMRT联合后程SBRT,先行IMRT,常规分割剂量至50 Gy/5周,再采用SBRT推量17.5 Gy/1周;对照组采用IMRT,常规分割剂量至70 Gy/7周。在放疗结束3~6个月后行肺部增强CT检查,采用实体瘤治疗疗效评价标准(response evaluation criteria in solid tumors,RECIST)评价完全缓解率(complete remission,CR)和部分缓解率(partial remission,PR)。按照放射治疗肿瘤学组(radiation therapy oncology group,RTOG)标准评价正常组织急性反应。结果:试验组治疗的有效率(CR+PR)明显高于对照组,分别为84.44%和66.67%,2组之间有统计学差异(P=0.05)。试验组的放射性肺炎发生率要低于对照组,分别为4.44%和13.33%,但2组之间无统计学差异(P=0.138)。2组放射性食管炎发生率分别为44.44%和48.89%,2组之间亦无统计学差异(P=0.822)。放射性脊髓炎均未发生。结论:IMRT联合后程立体定向放射治疗局部中晚期非小细胞肺癌安全有效,疗效优于单纯IMRT放疗,且引起的急性组织反应少,故临床上值得推广应用。Objective：To compare the clinical efficiency of intensity modified radiotherapy（IMRT）/stereotactic body radiotherapy（SBRT）with that of IMRT in the treatment of local middle-late stage non-small cell lung cancer. Methods：Totally 90 patients with local middle-late stage non-small cell lung cancer（NSCLC）were randomly divided into two groups：experimental group（45 patients）and control group（45 patients）. The experimental group was firstly treated by IMRT plan（conventional fractionation to a total dose of DT 50 Gy/5 weeks）and then followed by SBRT plan（hypo-fractionation to a total dose of DT 17.5 Gy/1 weeks）.The control group was treated by mere IMRT plan（conventional fractionation to a total dose of DT 70 Gy/7 weeks）. Lung enhanced CT scanning were performed 3 to 6 months after radiotherapy. Complete remission（CR） and partial remission（PR） rates were assessed according to the RECIST criterion. Acute inflammatory reaction of normal tissue were assessed according to the RTOG criterion. Results：The CR and PR rates of experimental group were remarkably higher than those of control group,84.44% and 66.67%,respectively. There were statistically significant differences between the two groups（P=0.05）. The incidence rate of radioactive pneumonia in experimental group was inferior to that of control group,4.44% and 13.33%,respectively. The incidence rates of radioactive esophagitis were 44.44%and 48.89%,respectively. No significant difference was found between two groups regarding incidence rate of radioactive pneumonia（P=0.138）and radioactive esophagitis（P=0.822）. No radioactive myelitis were found in either groups. Conclusions：Compared with IMRT,IMRT/SBRT is safer and more effective. And the acute tissue side reactions rarely occurred. Therefore,it could be extended and widely used in clinical work in the future.

关 键 词：后程立体定向放射治疗 适形调强放射治疗 非小细胞肺癌 放射治疗 

分 类 号：R734.2[医药卫生—肿瘤]