非小细胞肺癌后程大剂量分割三维适形放射治疗

Late-course hypofractionated three dimensional conformal radiotherapy for non - small cell lung cancer

目的对非小细胞肺癌行大剂量分割三维适形放射治疗,探索此分割方法治疗非小细胞肺癌的近期疗效和急性放射反应。方法2001年6月-2003年12月,11例非小细胞肺癌患者进入本研究,可以评价病例共9例。常规放射治疗40Gy后对原发灶行大剂量分割三维适形放射治疗,3Gy/次,1次/日,5次/周,7-10次。治疗1个月后评价肿瘤消退情况和放射性副反应。结果9例患者顺利完成治疗。原发灶完全缓解率(CR)占33%(3/9),部分缓解率56%(5/9),无变化(1/9),总有效率为89%(8/9)。急性放射性食道炎发生率Ⅰ、Ⅱ级22%(2/9),Ⅲ级11%(1/9)。急性放射性肺炎发生率0级22%(2/9),I、Ⅱ级44%(4/9),Ⅲ、Ⅳ级33%(3/9)。急性骨髓抑制均在I级以下。2例分别于治疗结束2.5个月和5个月死于放射性肺炎。单次剂量超过2Gy的同侧受照肺体积≥400cc时,急性放射性肺炎明显加重。结论利用三维适形技术对非小细胞肺癌行后程大剂量分割照射,抑制肿瘤干细胞的加速再增殖是可行的,有较好的近期疗效。单次剂量大于200cCy的同侧受照肺体积是很好的预测放射性肺炎的指标。远期疗效和晚期并发症还有待进一步的观察。

Objective Hypofractionation was used to treat non-small cell lung cancer (NSCLC) using three-dimensional (3D) conformal radiation therapy,and assess the early response and side effects of hypofractionation.Methods Between June 2001 and December 2003,11 patients of NSCLC were enrolled in this study. 9 patients that could be evaluated were treated with the conventional fractionated irradiation of 40 Gy followed 3DCRT to primary lesion, 3 Gy per fraction, one fraction per day,5 fractions per week, 7-10 fraction. Tumor size and radical side effects were evaluated after one month of therapy.Results 9 patients had completed their treatments. CR. PR and NR of primary tumor were 33% (3/9), 56%(5/9) and 11% (1/9), respectively. The overall response rate (CR + PR) was 89%(8/9). Acute radiation pneumonitis(Grade 0) occurred in 22%, (Grade 1-2), in 44% and (Grade 3 - 4), in 33%. The hematopoietic toxicity of all patients was below Grade 1. Two patients died of radiation pneumonitis by 2.5 and 5 months after treatment, respectively. Acute radiation pneumonitis will increase obviously when the ipsilateral lung volume of dose exceeding 2 Gy is more than 400 cc. Conclusions It's viable that hypofractionation is delivered to treat NSCLC using 3DCRT, which can inhibit tumor stem cell accelerated reproliferation.The ipsilateral lung volume of dose exceeding 2 Gy is good index to forecast the development of radiation pneumonitis.Remote results and late complication await further follow - up.