图像引导大分割调强放疗联合对侧食管保护治疗不可切除Ⅲ期非小细胞肺癌的效果及安全性  

Efficacy and safety of image-guided hypofractionated intensity-modulated radiotherapy combined with contralateral esophageal protection in treatment of unresectable stageⅢnon-small cell lung cancer

作　　者：张涛[1] 许晶 丁曼华 徐海亭[1] 张朦 惠华[1] 王强[1] Zhang Tao;Xu Jing;Ding Manhua;Xu Haiting;Zhang Meng;Hui Hua;Wang Qiang(Department of Radiation Therapy,Xuzhou Cancer Hospital,Xuzhou 221000,China)

机构地区：[1]徐州市肿瘤医院放疗科,徐州221000

出　　处：《肿瘤研究与临床》2023年第6期419-423,共5页Cancer Research and Clinic

基　　金：江苏省六大人才高峰项目(YY-156)。

摘　　要：目的:探讨图像引导大分割调强放疗(Ig-HypoRT)联合对侧食管保护治疗不可切除Ⅲ期非小细胞肺癌(NSCLC)患者的效果及不良反应。方法:回顾性分析2016年1月至2019年1月徐州市肿瘤医院收治的45例不可切除Ⅲ期NSCLC患者的临床资料。患者接受以铂类为基础的两药联合化疗方案诱导化疗,然后行Ig-HypoRT,共给予肿瘤剂量60~63 Gy/12~18次,每次3.5~5.0 Gy。放疗过程中将对侧食管作为危及器官进行勾画,限制V 45 Gy≤1.8 cc、V 55 Gy≤0.4 cc。观察患者疗效、生存情况及不良反应发生情况。 结果:45例患者中完全缓解9例,部分缓解31例,疾病稳定4例,疾病进展1例,有效率为88.8%(40/45)。中位随访34个月,45例患者中位总生存(OS)时间25.0个月(95% CI 21.7~28.8个月),1、2、3年OS率分别为78.9%、56.8%、47.7%;中位无进展生存(PFS)时间18.5个月(95% CI 15.0~22.0个月),1、2、3年PFS率分别为59.8%、32.6%、18.6%。3年局部复发率为9%(4/45)。1~2级放射性食管炎发生率为80%(36/45),1~2级胸痛发生率为20%(9/45)。3~4级不良反应发生率为13%(6/45),其中3级肺不张发生率为7%(3/45),3级放射性肺炎发生率为4%(2/45),4级咯血发生率为2%(1/45)。 结论:Ig-HypoRT联合对侧食管保护治疗不可切除Ⅲ期NSCLC,能够提高患者生存率并减轻食管不良反应。ObjectiveTo explore the efficacy and adverse reactions of image-guided hypofractionated intensity-modulated radiotherapy(Ig-HypoRT)conbined with contralateral esophageal protection in treatment of patients with unresectable stageⅢnon-small cell lung cancer(NSCLC).MethodsThe clinical data of 45 patients with unresectable stageⅢNSCLC who were admitted to Xuzhou Cancer Hospital from January 2016 to January 2019 were retrospectively analyzed.Patients received induction chemotherapy with a platinum-based dual-drug combination regimen,followed by Ig-HypoRT with a total dose of tumor of 60-63 Gy/12-18 times at 3.5-5.0 Gy/time.Contralateral esophagus was delineated as an organ at risk during radiotherapy,limiting V45 Gy≤1.8 cc and V55 Gy≤0.4 cc.Patients'efficacy,survival and the occurrence of adverse reactions were observed.ResultsAmong 45 patients,there were 9 cases of complete remission,31 cases of partial remission,4 cases of stable disease and 1 case of disease progression,and the effective rate was 88.8%(40/45).The median follow-up time was 34 months,45 patients had a median overall survival(OS)time of 25.0 months(95%CI 21.7-28.8 months),with 1-,2-,and 3-year OS rates of 78.9%,56.8%and 47.7%,respectively;the median progression-free survival(PFS)time was 18.5 months(95%CI 15.0-22.0 months),with 1-,2-and 3-year PFS rates of 59.8%,32.6%and 18.6%,respectively.The 3-year local recurrence rate was 9%(4/45).The incidence of grade 1-2 radioactive esophagitis was 80%(36/45);the incidence of grade 1-2 chest pain was 20%(9/45).The incidence of grade 3-4 adverse reactions were 13%(6/45),including 7%(3/45)of grade 3 pulmonary atelectasis,4%(2/45)of grade 3 radioactive pneumonia,and 2%(1/45)of grade 4 hemoptysis.ConclusionsIg-HypoRT combined with contralateral esophageal protection for unresectable stageⅢNSCLC can improve survival rate and reduce esophageal adverse reactions of patients.

关 键 词：肺肿瘤 放射疗法 图像引导大分割调强放疗 食管保护 

分 类 号：R734.2[医药卫生—肿瘤]