大剂量常规分次与低分割三维适形放射治疗原发性非小细胞肺癌

High-dose conventional fractionted and hypofractionted of three-dimensional conformal radiotherapy for primary non-small cell cancer

目的 :观察大剂量常规分次与低分割三维适形放射治疗原发性非小细胞肺癌的疗效和放射反应 .方法 :87例适合三维适形放射治疗的原发性非小细胞肺癌患者随机分为常规分次和低分割组 .常规分次组 4 4例 ,采用每日 1次 ,每周 5次 ,每次 5～ 7Gy ,总剂量 36～ 6 0Gy ;低分割组 4 3例 ,隔日 1次 ,每周 3次 ,单次剂量和总剂量同常规分次组 .两组中心型肺癌 ,纵隔有淋巴结转移者合并常规纵隔野外照射 ,剂量 4 0～4 6Gy.结果 :1,2和 3a局部控制率 ,常规分次组分别为84 .1% ,6 5 .9%和 5 2 .3% ;低分割组分别为 79.1% ,5 1.2 %和2 7.9% .两组差异有显著性 (χ2 =4 .6 4 ,P =0 .0 35 ) .1,2和 3a生存率 ,常规分次组分别为 77.3% ,5 9.1%和 36 .4 % ;低分割组分别为 6 0 .5 % ,4 6 .5 %和 18.6 % .两组差异有显著性(χ2 =4 .30 ,P =0 .0 4 1) .1,2级放射性食管炎 ,常规分次组2 0例 ;低分割组 16例 .两组比较差异无显著性 (χ2 =0 .6 1,P=0 .4 5 ) .1,2级放射性肺炎 ,常规分次组 10例 ,低分割组 7例 .两组比较差异无显著性 (χ2 =0 .5 8,P =0 .4 6 ) .结论 :常规分次三维适形放射治疗原发性非小细胞肺癌更具有优势 .

AIM: To assess the responses and side effects of conventional fractionation (CF) regimen and hypo fractionation (HF) regimen in three-dimensional conformal radiotherapy (3DCRT) for primary non-small cell lung cancer. METHODS: Eighty-seven patients with primary non-small cell lung cancer who were suitable for 3DCRT were randomly divided into two groups: 44 cases entered in the CF group and 43 cases in the HF group. The CF group received 5-7 Gy per day, 5 d per week, to a total dose of 36- 60 Gy, the HF group were treated with the dose as that of the CF group, but once in two days. Those patients of central lung cancer and mediastinal lumph nodes lung cancer received conventional external-beam radiotherapy at the same time, with a total dose of 40-46 Gy. RESULTS: The local control rates at 1, 2 and 3 years were respectively 84.1% , 65.9% and 52.3% in the CF group and those in the HF group were respectively 79.1%, 51.2% and 27.9%. There were significant differences between the two groups (χ 2=4.64, P= 0.035) . The surgical rates at 1, 2 and 3 years were respectively 77.3%, 59.1% and 36.4% in the CF group and those in the HF group were 60.5%, 46.5% and 18.6%. The difference was significant (χ 2=4.30, P=0.041). The incidences of grade 1 and 2 acute esophagitis in the CF group were 20 cases and 16 cases in the HF group (χ 2=0.61, P=0.45). The incidences of grade 1 and 2 Radiotion Pneum onitis in the CF group were 10 cases and 7 cases in the HF group (χ 2=0.58, P=0.46). CONCLUSION: The CF regimen of 3DCRT is superior to the HF regimen of 3DCRT for primary non-small cell lung cancer.