局部晚期非小细胞肺癌后装插植放疗  

Interstitial brachytherapy in locally advanced non⁃small cell lung cancer

作　　者：叶华 吴敬波 YE Hua;WU Jingbo(Department of Oncology,Affiliated Hospital of Southeast Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000

出　　处：《实用医学杂志》2023年第5期525-532,共8页The Journal of Practical Medicine

基　　金：四川省干部保健科研课题(编号:2020-1503)。

摘　　要：大多数Ⅲ期非小细胞肺癌(NSCLC)患者因肿瘤扩散或合并症而不适合手术。原发病灶内的局部区域控制的失败,仍然是不可切除的局部晚期NSCLC放疗后治疗失败的主要原因。对于NSCLC,肿瘤控制率随着原发灶放疗的生物效应剂量(BED)升高而增加。接受30 Gy单次放疗(BED=120 Gy)的患者有98%的局部控制率(LC)。另一项剂量反应分析显示,在120 Gy可能是比较合适和稳定的剂量。高剂量率(HDR)近距离放射疗法,又称后装插植放疗,其优势在于可以在单次分割照射中向靶区肿瘤给予高辐射剂量。随后剂量迅速下降,使照射到危及器官(OARs)的剂量保持较低的水平。此外,插植放疗抑制了肿瘤细胞的加速再增殖,导致其致死性损伤,并解决了由于器官运动或摆位确定性造成的目标偏离,避免了对OARs的不必要照射。在免疫治疗时代,胸部放疗对于保障NSCLC长期生存越发重要。HDR近距离放疗联合免疫治疗可能带来新的突破。前期临床试验也观察到良好的临床存活率和较低的急性和迟发毒性,为局部晚期NSCLC提供了一种新的治疗策略。Most patients with stageⅢNSCLC are not suitable for surgery because of tumor extension or comorbidities.The absence of loco⁃regional control,predominantly observed within the primary lesion,remains a major cause of treatment failure after radiotherapy for locally unresectable advanced NSCLC.For patients with NSCLC,the tumor control rate increases with the biological effect dose(BED)delivered to the primary tumor.Patients receiving 30 Gy in a single fraction(120 Gy BED)have a local control(LC)rate of 98%.Another dose⁃response analysis showed that favorable outcomes plateaued around 120 Gy BED.High⁃dose⁃rate(HDR)brachy⁃therapy can deliver high radiation doses in a single fraction to the target tumor.The dose falls rapidly,maintaining a virtually low dose irradiated to OARs.Moreover,HDR brachytherapy inhibits the accelerated re⁃proliferation of tumor cells,leads to lethal tumor cell damage,and eradicates target deviation attributed to organ movement or setup uncertainties,consequently avoiding unnecessary irradiation to OARs.In the current era of immunotherapy,thoracic radiation has become even more important for ensuring long⁃term survival in patients with NSCLC.Combination of HDR brachytherapy with immunotherapy may lead to better survival.We observed favorable clinical survival and low rates of acute and late toxicities,providing a new treatment strategy for locally advanced NSCLC.

关 键 词：高剂量率后装插植放疗 调强放射治疗 淋巴结 非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]