立体定向放射治疗常规外照射后复发非小细胞肺癌

Feasibility of reirradiation for postradiation recurrent non-small-cell lung cancer using stereotactic radiotherapy

目的研究三维适形放射治疗常规放射治疗后复发的非小细胞肺癌可行性,观察近期疗效及早期并发症的发生率.方法 2001年10月～2003年10月,27例非小细胞肺癌放疗后复发病例,OUR--TPS三维治疗计划系统设计放射治疗计划,剂量体积直方图(DVH)评价和优化放射治疗计划,体部固定装置立体定向放射治疗.计划靶区为临床所见肿瘤区外放1.0～1.5 cm,计划靶区体积(PTV)中位体积为302 cm3(78.9～514.2 cm3),计划照射剂量为42 Gy,6～7Gy/次,隔日照射.观察急性放射反应及近期疗效.结果 27例患者均顺利完成治疗;27例患者的中位随访期为8个月(6～14个月),随访率为100%.初次放射治疗至再放射治疗的中位间隔时间为17个月(12～29个月),再放射治疗肿瘤中位剂量46 Gy(42～48 Gy).近期疗效为完全缓解(CR)26%(7/27),部分缓解(PR)48%(13/27),无变化(NR)15.0%(4/27),进展(PD)11%(3/37),总有效率为74.0%(20/27).根据RTOG分级,急性放射性食管炎发生率1～2级11%(3/27),急性放射性肺炎发生率1～2级15%(4/27);骨髓抑制发生率1～2级8.3%(7.4/27);心脏损伤发生率1～2级7.4%(2/27).结论三维适形放射治疗放疗后复发的非小细胞肺癌有较好的近期疗效,早期放射反应较低,患者能耐受,晚期反应及远期疗效有待观察.

Objective To evaluate the Feasibility of reirradiation for postradiation recurrent non-small-cell lung cancer using stereotactic radiotherapy and to assess the immediate response and early/late radiation reactions. Methods From September 2001 to September 2003, 27 cases of postradiation recurrent non-small-cell lung cancer were treated by stereotactic radiotherapy. TPS were designed by OUR-7-TPS and dose volume histography was used to verify and optimize the radiation plan. Radiaton doses were delivered by immobilization device. Planning tumor volume were 15mm beyond clinical turnout volume. Irradiation dose were 42Gy by 6-7 fractions on the other days. Immediate response and early/late radiation reactions were assessed by RTOG/WHO standards. Results All 27 cases completed their reirradiation. The median period from last irradiaton was 19 months. The median delivery dose were 44Gy. The complete response rate was 74 %. Main early radiation factions included acute esophagitis and acute peumonitis. Conclusion Stereotactic irradiation is feasible For postirradiation recurrent non-small-cell lung cancer with good immediate response and tolerable acute reactions. Long-term reaction and effect need further study.