多靶区三维适形放疗在胸部肿瘤的临床应用

Efficacy of multi-target three-dimensional conformal radionthrapy on the chest tumaor.

目的研究胸部多病灶肿瘤行多靶区三维适形放射治疗的可行性及应用价值.方法对36例胸部原发肿瘤肺内纵隔转移或双肺多发转移瘤等晚期肿瘤,采用多靶区三维适形放射治疗,优化指标:照射靶区尽可能采用PET/CT定位,靶区以2～4个为宜,采用共面或非共面多野照射,每次剂量2Gy,5次/周,或5～8Gy/次,3次/周,均为90%剂量曲线包绕PTV,总照射剂量或生物等效剂量70～80Gy,在放疗结束后2月行胸部CT或PET/CT进行评价.结果 36例患者中,2例病灶完全消失(CR),23例病灶明显缩小(PR),有效率(CR+PR)69.4%,放疗中未出现明显放射性肺炎、放射性食管炎.结论晚期胸部肿瘤或转移瘤应用三维适形放射治疗采用多靶区治疗,局部控制率高,有较好的近期疗效,早期并发症低,患者可耐受.

Objective To evaluate the feasibility and application of the multi - target three - dimensional conforreal radiotherapy on the chest tumor. Methods Thirty six cases of the chest tumor of the lung and/or mediastinum metastases or lung metastases cancer were treated by the multi - target of three - dimensional conformal radiotherapy. The optimized index ：we tried to orient the irradiating target by PET/CT. There were 2 to 4 targets ,and we radiated by coplanarity or uncoplanarity planning target volume received a minimum of 90% of the prescribed dose was given in 2Gy / fraction , 5 fractions per week or 5 - 8Gy / fraction, 3 fractions per week, with the total dose ranging from 70 to 80Gy, all patients were evaluated by CT or PET/CT after 2 - month radiotherapy. Results Among the 36 cases, the tumor of 2 cases were disappeared, 23 cases were reduced obviously . The effective rate （ CR ＋ PR ） was 69. 4% , and no acute radiation - induced penumonitis and radiation - induced esophagitis . Conclusion The local control rate of the patients with the chest tumor treated by the multi - target of three - dimensional conformal radiotherapy are obvious, the recent effect is good , there is no early severe complications , the patients are well tolerated.