腔内高剂量与低剂量近距离放射治疗中晚期肺癌疗效比较

Clinical Analysis of High Dose Rate Intraluminal After-loading Irradiation for Treatment of Mid-advanced Lung Cancer

目的探讨高剂量率后装腔内放疗结合体外放疗治疗中晚期肺癌合适剂量分割与临床疗效。方法61例中晚期肺癌随机分为A组和B组。A组腔内放疗施源器中轴外5～10mm处参考剂量10Gy/次/周×2～3次/2～3周;B组腔内放疗施源器中轴外5～10mm处参考剂量5Gy次/周×4～6次/4～6周。体外放疗两组相同。结果A组1、3、5年局控率分别为74.2%、26.7%和16.7%。B组1、3、5年生存率分别为64.5%、45.2%和20.9%。两组比较,统计学无显著意义(P>0.05)。A组1、3、5年局控率分别为60.0%、33.3%和20.0%。B组1、3、5年局控率分别为74.2%、61.3%和41.9%,两组3、5年局控率有显著意义(P<0.05)。并发症:大咯血、放射性食管炎、气管支气管炎、肺炎、气管及肺纤维化等A组明显高于B组(P<0.01)。结论192铱高剂量率后装腔内放疗低剂量放疗优于高剂量放疗,疗效高,并发症少。结合体外放射腔内放疗合适剂量应以5Gy/次周,总剂量20～30Gy为宜。

Objective To analyze the therapeuticeffect of high dose rate intrluminal after-loading irradiation （ALI） plus external irradiation （EI） on patients with mid-advanced lung cancer （MLC）, and evaluate optimal total dose of and dosing schedule for ALI. Methods From June, 1993 to December 1997,we total treated of 61 MLC cases,in which 30 patients with high-dose fractionation ALI（A group） and 31 cases by low-dose fractionation ALI（B group）. The survival rate between two group was compared. Results The 1-3-5 year survival rate in A group was 56. 7% ,26. 7% and 16.7% respectively. While in B group, it was 64. 5%,45.2% and 29. 0% respectively. Which was no significantly different （P〈0. 05）. The complications had accrued rates in A group were much better than those in B group （P〉0.01）. Conclusion The therapeutic efect of B group is better than that of A group for MLC. It is safe and less side-effect. We conclude that 60-70Gy of EI plus 20-30Gy/4-6 times of ALI might be the optimal dose.