MR引导大分割放疗在非小细胞肺癌中的临床应用研究  

Clinical application of MR-guided hypo-fractionated radiotherapy in non-small cell lung cancer

作　　者：乔强 戚浩然 刘晓 李晓琳 邢力刚 QIAO Qiang;QI Haoran;LIU Xiao;LI Xiaolin;XING Ligang(School of Clinical Medicine,Shandong Second Medical University,Weifang,Shandong 261053,China;Department of Radiation Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Science,Jinan,Shandong 250117,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261053 [2]山东省肿瘤防治研究院(山东省肿瘤医院)放疗科,山东第一医科大学(山东省医学科学院),山东济南250117

出　　处：《中华肿瘤防治杂志》2024年第23期1437-1443,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(82172866)。

摘　　要：目的探讨MR引导下大分割放射治疗非小细胞肺癌(NSCLC)的临床全流程可行性,包括治疗计划的制定、实施及疗效评估。方法采用描述性病例系列研究的方法,回顾性分析2021-07-01-2022-12-31山东省肿瘤医院收治的36例NSCLC患者临床资料。36例患者中,男28例,女8例;年龄45~83岁,中位年龄69岁;鳞状细胞癌9例,腺癌27例。根据TNM分期分为3组:早期(T1-3N0M0)14例,局部晚期(T1-4N1-3M0)9例,晚期(T1-4N0-3M1)13例。所有患者均在MR引导下行大分割放疗。以电话、短信或邮件的方式随访预后与不良反应状况。采用Kruskal-Wallis检验比较不同肺叶之间大体肿瘤靶区(GTV)中心位置在各方向的运动差异。结果所有患者均按时完成治疗,无任何因计划或MR加速器导致的治疗中断和暂停,无任何加速器相关安全性事件。通过Unity(MR引导放射治疗系统)实时在线监控,肿瘤主要向上下方向移动,且在所有肺叶间上下方向运动的差异有统计学意义,H=11.475,P=0.003。6例改变了基线计划,2例显示计划靶区(PTV)减少,4例显示PTV增加。早期、局部晚期及晚期患者中,中位PTV处方剂量覆盖率分别为96.0%、96.0%及95.9%,中位双侧肺放射剂量>20 Gy的肺体积(V20)分别为6.9%、6.3%和10.8%,中位脊髓最大剂量分别为1343.8、1614.6和1577.1 cGy。近期疗效结果显示,全组疾病控制率均达到100.0%(36/36),1年生存率为94.4%(34/36),1年局部控制率为100.0%(36/36)。早期、局部晚期及晚期患者的客观缓解率分别为50.0%(7/14)、55.6%(5/9)和23.1%(3/13)。随访结果显示,所有患者无4级及以上放疗相关不良事件。结论MR直线加速器(MR-Linac)可获得NSCLC患者大分割放疗临床需求的治疗计划,证明了MR-Linac用于肺部病灶大分割放疗的可行性。在线实时监控技术降低了分次内及分次间脱靶风险,保证了患者治疗的有效率,同时未明显增加严重不良反应。Objective To investigate the feasibility of the entire process for MR-guided hypo-fractionated radiotherapy in treating non-small cell lung cancer(NSCLC),including treatment planning,implementation,and efficacy assessment.Methods A descriptive case series study was conducted.The clinical data of 36 patients with NSCLC admitted to Shandong Cancer Hospital from July 1,2021,to December 31,2022 were retrospectively analyzed.Of the 36 patients,28were males and 8 were females;aged 45 to 83 years,with median age 69 years;9 cases of squamous cell carcinoma and 27cases of adenocarcinoma.According to TNM stage,they were divided into 3 groups:14 cases of early stage(T_(1-3)N_0 M_0),9 cases of locally advanced stage(T_(1-4)N_(1-3)M_0)and 13 cases of late stage(T_(1-4)N_(0-3)M_1).All patients underwent MR-guided hypo-fractionated radiotherapy.Patient prognosis and adverse reaction status were followed by telephone,short message service or email.The test of Kruskal-Wallis was used to compare the movement of gross tumor volume(GTV)center location in various directions between different lobes.Results All patients completed their treatments on time without any interruptions or pauses due to the treatment plan or MR accelerator,and there were no accelerator-related safety incidents.Through real-time online monitoring with Unity,tumors were observed to mainly move in the superior-inferior direction,with statistically significant differences in superior-inferior motion among all lung lobes(H=11.475,P=0.003).Six cases had modifications to the baseline plan,with two cases showing reductions in planned target volume(PTV)and four cases showing increased PTV.The median PTV prescription dose coverage rates for early-stage,locally advanced,and advanced patients were 96.0%,96.0%and 95.9%respectively,The median lung volume receiving more than 20 Gy(V_(20))were 6.9%,6.3%and 10.8%,respectively,and the median maximum spinal cord doses were1343.8,1614.6 and 1577.1 cGy,respectively.The short-term efficacy outcomes showed a disease control rate(DC

关 键 词：MR直线加速器 大分割放射治疗 非小细胞肺癌 自适应 

分 类 号：R734.2[医药卫生—肿瘤]