姑息放射治疗纵隔淋巴结转移癌的疗效分析

The Effect Analysis of Patients with Mediastinal Metastasis Carcinoma Treated with Three Dimension Conformal Radiotherapy

目的:探讨三维适形放射治疗(3DCRT)复发性纵隔淋巴结转移癌的疗效及其不良反应。方法:用3DCRT方法治疗复发性纵隔淋巴结转移癌65例,其中34例此前接受过不同程度放射治疗(再程放疗组),31例为首次放疗(首程放疗组)。3DCRT肿瘤剂量再程放疗组为40～50GY/20～25次/4～5周(中位剂量46.71GY);首程放疗组为60～70GY/30～35次/6～7周(中位剂量63.95GY)。结果:再程放疗组和首程放疗组症状缓解情况分别为:呼吸困难(75.0%比77.8%),声音嘶哑(36.3%比41.6%),神经痛(66.7%比71.4%),上腔静脉综合征(66.7%比83.3%),呛咳(81.8%比80.0%)。1～2个月后复查,再程放疗组和首程放疗组有效率(完全缓解加部分缓解)分别为67.6%和80.6%,无变化(NC)为32.4%和19.4%;组间比较均无显著性差异。1、2、3年生存率分别为67.8%、34.1%、20.1%和74.5%、49.2%、35.48%,差异有统计学意义。再程放疗患者出现急性放射损伤多于首程放疗组,但组间比较无显著差异。结论:3DCRT对复发性纵隔淋巴结转移癌的姑息治疗作用显著,在放疗后复发的患者3DCRT仍然是较好的选择,近期疗效显著。

Objective：To evaluated the clinical results of three dimension conformal radiotherapy for 65 patients with mediastinal metastasis carcinomaradiotherapy for patients with mediastinal metastasis carcinoma after surgery. Methods：We retrospectively studied 65 patients with mediastinal metastasis carcinoma after surgery. Among patients ,34 have been received external beam radiotherapy（EBRT group）,and the rest have no external beam radiotherapy history（NEBRT group）.The clinical information is comparable. The prescribe dose to the center of tumor was 50-60GY/25-30F/5-6W in NEBRT group,and 40-50GY/20-25F/4-5W in EBRT group. Results：Two group have gotten the similar symptom relieve rate. In EBRT group symptom relieve rate of breathing difficulties,voice hoarseness,neuralgia,SVCS and cough was 75.0%,36.3%,66.7%,66.7%,and 81.8% respectively,while with similar result of 77.8%,41.6%,71.4%,83.3% and 80.0% in NEBRT group. The total effective rate（CR＋PR） of two group 1-2 month after radiation was 67.6% and 80.6%,and 32.4% and 19.4% case were no changed （NR）. There was no significant difference between two groups. One-year,two-year and three-year survival rate in in EBRT and NEBRT group was 67.8%,34.1%,20.1% and 74.5%,49.2%,35.48% respectively. In NEBRT group there was more patients occur acute reaction than in EBRT,but has no statistically difference apparently. More patients died of local recurrence in NEBRT than in EBRT. Conclusions：3DCRT can offer palliative role in the treatment of mediastinal metastasis carcinoma. For patients who have received radiotherapy 3DCRT also was a good choice.