高剂量率腔内放射治疗原发性支气管肺癌合并肺不张

HIGH DOSE RATE ENDOBRONCHIAL IRRADIATRION PRIMARY LUNG CANCER COMPLICATED WITH ATELECTASIS

目的研究高剂量率（ＨＤＲ）腔内放疗加外照射治疗原发性支气管肺癌合并肺不张的肺复张和近期疗效。方法原发性支气管肺癌９５例，Ｋａｒｎｏｆｓｋｙ评分２０～５０分。治疗分两组：Ａ组５７例，先用ＨＤＲＩｒ－１９２腔内照射，７～１０Ｇｙ，每周１次，共２～３次，总剂量为２０～３０Ｇｙ，而后常规外照射，剂量与Ｂ组相同。Ｂ组３８例，单纯外照射，先大野每次２Ｇｙ，总剂量为４０Ｇｙ／４Ｗ，后缩野每次２Ｇｙ，总剂量为２０～３０Ｇｙ／２～３Ｗ。结果Ａ组肺复张率较Ｂ组为高（Ｐ＜０．０５）。肺不张时间超过６个月者复张困难。一年生存率分别为４２％（２４／５７）和３９．５％（１５／３８），无明显差异。结论高剂量率腔内放射结合外照射可改善原发性支气管肺癌合并肺不张的症状。

PURPOSE To detemine the efficacy of high dose rate endobronchial irradiation combined with external radiotherapy in the treatment of primary bronchial lung cancer with atelectasis with regard to the clearing up of the atelectasis and the immediate results.METHODS A retrospective study was done on 95 primary bronchial cancer patients complicated by atelectasis involving more than one lobe. The initial perfomance status of the patients was only 20￣50 by Karnofsky scale. According to the method of treatment, the patients were divided into two groups: Group A (57 cases) in which the treatment was carried out by endobronchial HDR Ir-192 irradiation followed by external beam irradiation only; Group B (38 cases) single external beam irradiation. The total endobronchial irradiation doses ranged from 20 to 30 Gy,while the total external beam irradiation dose ranged from 60￣70Gy.RESULTS It was shown that atelectasis relief rate,the functional status improvements and irradiation tolerance were much better in Group A than in Group B,with differences statisically significant. When the time of atelectasis was over 6 months,relief was difficult to achieve. The one year survival rate of the two groups was of no statistical significance.CONCLUSIONS The use of HDR endobronchial irradiation combined with external beam irradiation for atelectic lung cancer can achieve better symptomatic relief.