局部晚期非小细胞肺癌患者脾区低剂量放疗联合胸部三维适形放疗的效果研究  

EFFICACY OF LOW-DOSE RADIOTHERAPY IN THE SPLEEN REGION COMBINED WITH CHEST THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER

作　　者：刘睿[1] 尚庆军[1] 姜韬[1] 梁东海 姜鹏[1] 周非[1] 陈爱霞 厉彦子 于洪升[1] LIU Rui;SHANG Qingjun;JIANG Tao;LIANG Donghai;JIANG Peng;ZHOU Fei;CHEN Aixia;LI Yanzi;YU Hongsheng(Department of Radiation Oncology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肿瘤放疗科,山东青岛266003

出　　处：《精准医学杂志》2021年第3期258-261,266,共5页Journal of Precision Medicine

基　　金：山东省自然科学基金资助项目(ZR2015HM0-25);山东省科技发展计划项目(2011YD18003);北京市希思科临床肿瘤学研究基金资助项目(Y-HR2018-293、Y-HR2018-294);青岛大学附属医院“临床医学+X”科研项目。

摘　　要：目的探索脾区低剂量放疗联合胸部三维适形放疗对局部晚期非小细胞肺癌(NSCLC)患者的疗效及不良影响。方法未行手术治疗的ⅢA和ⅢB期NSCLC患者60例,根据治疗方案不同,分为对照组和联合治疗组(联合组)各30例,对照组患者只接受胸部三维适形放疗,联合组患者于每周一、四在胸部三维适形放疗前行脾区低剂量照射。胸部三维适形放疗处方剂量为60~66 Gy,每次1.8~2.0 Gy,共计放疗30~33次,每周放疗5次,6周左右完成,脾区低剂量放疗采用特殊低熔点铅挡块调整剂量率为1.5 cGy/min,总量为90~105 cGy,每次75 mGy,共计放疗12~13次,每周放疗2次,直至胸部三维适形放疗结束。结果与治疗前比较,仅对照组患者放疗后外周血中CD4^(+)T淋巴细胞百分数、CD4/CD8比值和NK细胞百分数显著降低,CD8^(+)T淋巴细胞百分数显著升高(t=-18.438~11.002,P<0.05);两组患者上述指标治疗前后的差值比较差异具有显著意义(t=-4.783~5.530,P<0.05)。联合组患者急性及慢性Ⅲ、Ⅳ级不良反应的患者较对照组少(Uc=2.300,χ^(2)=4.320,P<0.05),且联合组患者出现不良反应时放疗剂量高。两组患者治疗有效率、中位无进展生存期比较,差异有显著意义(Uc=1.870、3.967,P<0.05)。两组患者1、3、5年总生存率及中位生存期比较差异无显著性(P>0.05)。结论脾区低剂量放疗联合胸部三维适形放疗可以减轻放疗对机体免疫功能的损伤,降低放疗不良反应,提高放疗的近期效果及患者的生存率。Objective To investigate the efficacy and adverse effects of low-dose radiotherapy(LDR) in the spleen region combined with chest three-dimensional conformal radiotherapy(3 D-CRT) in patients with locally advanced non-small cell lung cancer(NSCLC). Methods A total of 60 patients with stage ⅢA/ⅢB NSCLC who did not undergo surgical treatment were enrolled, and according to the treatment regimen, they were divided into control group and combined treatment group, with 30 patients in each group. The patients in the control group received chest 3 D-CRT alone, and those in the combined treatment group received LDR in the spleen region before chest 3 D-CRT every Monday and Thursday. The prescribed dose of chest 3 D-CRT was 60-66 Gy in 30-33 fractions, with 1.8-2.0 Gy for each fraction, and chest 3 D-CRT was performed 5 times a week, for about 6 weeks in total;a special low-melting-point lead block was used for LDR in the spleen region to achieve an adjusted dose rate of 1.5 cGy/min, and the total dose was 90-105 cGy in 12-13 fractions, with 75 mGy for each fraction, twice a week until chest 3 D-CRT ended. Results After treatment, only the control group had significant reductions in the percentage of CD4+ T lymphocytes, CD4/CD8 ratio, and the percentage of NK cells in peripheral blood after radiotherapy, as well as a significant increase in the percentage of CD8+ T lymphocytes(t=-18.438-11.002,P<0.05), and there were significant differences in the changes of the above indices after treatment between the two groups(t=-4.783-5.530,P<0.05). Compared with the control group, the combined treatment group had a significantly lower number of the patients with acute and chronic grade Ⅲ/Ⅳ adverse reactions(Uc=2.300,χ2=4.320,P<0.05), with a high dose of radiotherapy when adverse reactions occurred. There were significant differences in response rate and median progression-free survival time between the two groups(Uc=1.870,3.967,P<0.05), while there were no significant differences in 1-, 3-, and 5-year overall survival rates

关 键 词：癌 非小细胞肺 放射治疗剂量 脾脏照射 胸部放疗 免疫 细胞 不良反应 预后 治疗结果 

分 类 号：R734.2[医药卫生—肿瘤] R730.26[医药卫生—临床医学]