三维适形放射治疗非小细胞肺癌的等效生物剂量研究

Primary Exploration of Biological Effective Dose of Three Dimensional Conformal Radiation Therapy for Non-small Cell Lung Cancer

[目的]探讨三维适形放射治疗非小细胞肺癌(NSCLC)的适宜等效生物剂量.[方法]将100例行三维适形放疗的周围型NSCLC患者随机分为A、B、C三组:A组为等效生物剂量在65～75 Gy之间,平均72Gy;B组为等效生物剂量在76～85 Gy之间,平均80 Gy;C组为等效生物剂量在86～100 Gy之间,平均90Gy.所有患者于放疗结束后应用NP方案化疗4周期.按WHO制定的肿瘤客观疗效评价标准对三组患者疗效进行观察比较;按RTOG和EORTC制定的早晚期放射损伤分级标准对早晚期放射反应进行评价.放疗结束后每3个月随访复查1次至1年.[结果]100例患者均顺利完成治疗.3、6、9、12个月复查有效率(CR+PR)A组分别为86.67%、83.33%、63.33%、56.67%;B组分别为88.57%、88.57%、80.00%、71.43%;C组分别为94.30%、97.14%、97.14%、91.43%.三组患者3、6个月有效率比较差异无显著性.9个月有效率C组与A组比较差异有显著性.12个月有效率C组与A组、B组比较均差异有显著性.早晚期放射反应三组之间比较均无明显差异,严重放射反应罕见.[结论]三维适形放射治疗NSCLC的放射反应较轻,但是放疗剂量过低易导致局部复发率增高.提示三维适形放射治疗NSCLC的适宜等效生物剂量应在90Gy左右.

[Objective]To explore optimum biological effective dose（BED） of 3-dimensional conformal radiation therapy（3DCRT） for non small cell lung cancer（NSCLC）. [Methods]One hundred patients with peripheral NSCLC were divided randomly into three groups： the BED of group one was between 65-75Gy（median 72Gy）, group two was between 76-85Gy（median 80Gy） and group three was between 86-100Gy（median 90Gy）. All patients were treated with NP project chemotherapy after 3DCRT. The responses were observed and compared according to the evaluation standard of the tumor objective treatment effect of WHO. The acute and chronic side effects were evaluated according to the RTOG and EORTC criterion system. The follow up duration in which examination repeated once every three months was one year after 3DCRT. [Results]All patients with NSCLC completed 3DCRT and chemotherapy. The response rates （CR＋PR） for 3,6,9 and 12 months of group one were 86.67% ,83.33% ,63.33% ,56.67% ,of group two they were 88.57% ,88.57% ,80. 00%,71.43% ,of group three they were 94.30% ,97.14%,97.14% ,91.43%. The response rates had no significant differences for three and six months among three groups, but had significant differences for nine months between group one and group three, and also had significant differences for twelve months between group one and group three, group two and group three. The acute and chronic radiotherapy side-effects had no significant differences among three groups. Severe radiotherapy side-effects rarely appeared. [Conclusion]The radiotherapy side-effects of 3DCRT are mild for patients, but the recurrence rates increase if BED is lower . The results indicate optimum BED of 3DCRT for NSCLC should be about 90Gy.