立体定向放射治疗非小细胞肺癌疗效观察  

Stereotatic radiotherapy of non-small cell lung cancer

作　　者：王文高[1] 王琍[1] 魏子祥[1] 王多为[1] 江典模 

机构地区：[1]淮南第一矿工医院,安徽淮南232001

出　　处：《安徽理工大学学报（自然科学版）》2004年第1期79-82,共4页Journal of Anhui University of Science and Technology:Natural Science

摘　　要：研究立体定向放射治疗非小细胞肺癌的疗效及早期并发症的发生率。1999年12月至2003年10月,107例非小细胞肺癌。采用美国拓能公司立体定向治疗计划系统设计放射治疗计划,剂量体积直方图(DVH)评价和优化放射治疗计划,计划靶区为临床所见肿瘤区外放1.0～1.5cm,计划照射剂量为60～75Gy(中位剂量68Gy),2.2～3.0Gy/次,1次/d,5d/周,由美国瓦里安CL2100加速器照射,射野为固定野和非共面野或者大旋转弧。按照美国放射治疗协作组(RTOG)和世界卫生组织(WHO)标准观察急性放射反应和疗效。疗效(CR+PR)为88%(94/107),(NC+PD)即无效病例为12%(13/107)。1～3年生存率分别为85.78%、49.02%、23.88%。根据RTOG分级,急性放射性食道炎发生率,1～2级13.1%(14/107),3级0.93%(1/107),急性放射肺炎发生率1～2级26.2%(28/107),3级2.8%(3/107),WBC减少发生率1～2级19.6%(21/107),3级0.93%(1/107),PLT减少发生率1～2级14.9%(16/107),3级1.9%(2/107)。107例患者的随访日期为3～46月,(中位24月)随访100%。立体定向放射治疗采用大弧旋转+固定野照射,方法可行,有较好的疗效,早期并发症较低,能为患者耐受,更长期治疗效果及并发症有待进一步观察。Objective: To evaluate the feasibility of stereotatic radiation therapy of non -small cell lung cancer. Methods: During the period of time from Dec. of 1999 to Otc. of 2003, the radio-therapy for 107 NSCLC patients was designed and carried out by the stereotatic radiotherapy planning system of U.S Topslane Corporation. The dose volume histograhpy(DVH) was used to verify and optimize the radiation plan. The planning target volume (PTV) encompassed 1.0-1.5Cm safety margin beyond the clinical target volume (CTV). The total irradiation dose ranging from 60Gy to 75Gy was delivered at 2.2-3.0Gy once daily and 5 days per week. Fields of beam were large rotation angle and non-moving angle irradiated by Varian CL2100 accelerator. The immediate responses and acute side-effects were evaluated according to the WHO and RTOG criterion system. Results: All 107 patients completed their radiotherapy. The median radiation therapy dose to the gross tumor volume (GTV) was 68Gy(60-75Gy). The overall immediate responses rate (CR+PR) was 88%(94/107).The survival rates of 1,2 and 3-year were:85.78%,49.02%,23.88%. According to the RTOG criterion, grade 1-2 acute radiation esophagitis occurred in 13.1% (14/107),grade 3 in 0.93%(1/107), grade 1-2 acute radiation pneumonitis in 26.2%(28/107), grade 3 in 2.8%(3/107). Grade 1-2 of WBC was reduced in 19.6%(21/107, grade 3 0.93%(1/107. Grade 1-2 of PLT was reduced in 14.9%(16/107), grade 3 1.9%(2/107). The median follow-up duration was 24 months(3-46months). Conclusions: stereotatic radiotherapy can be considered as an effective and feasible approach to treat NSCLC with good responses but without any early serious complications. Long-termed survival and possible specific injury should await further study.

关 键 词：非小细胞肺癌 立体定向放射治疗 疗效 大弧旋转 固定野照射 

分 类 号：R734.2[医药卫生—肿瘤] R815[医药卫生—临床医学]