三维适形放射治疗纵隔淋巴结转移性癌的不同剂量分割研究

A clinical study of different fractionated dose shemes in 3-dimensional conformal radiotherapy(3-DCRT) for mediastinal lymph node metastasis

目的：观察和比较低分割和高分割三维适形放射治疗纵隔淋巴结转移性癌的疗效及放射反应。方法：回顾性分析57例纵隔淋巴结转移性癌患者，其中低分割适形放疗25例：2．5～3Gy／次，1次／天，5次／周，共20～25次，4～5周完成；高分割适形放疗32例：4．5—5Gy／次，隔日照射（周六、周日不休息），共12—14次，3．3—4周完成。结果：低分割组和高分割组的1、3年局部控制率分别为72．0％、48．0％和93．6％、78．1％；1、3年生存率分别为68．0％、32．0％和90．6％、59．4％；急性放射性气管炎的发生率分别为36．0％和43．6％。结论：高分割适形放射治疗纵隔淋巴结转移性癌与低分割适形放疗相比在不明显增加急性放射反应发生的情况下，具有缩短总治疗时间、提高肿瘤局控率和患者生存率的优势。

Objective：To observe and compare the efficacy and radiation side effect of 3-dimensional conformal radiotherapy （3-DCRT） with low-fractionated conformal radiotherapy and hyperfractionation radiotherapy for mediastinal lymph node metastasis. Methods ： From March 2004 to January 2007, 57 patients with mediastinal lymph node metastasis who had been treated with 3-DCRT, were divided into group A（ 25 patients received low-fractionated conformal radiotherapy with 60-62. 5Gy/20-25 fractions, 4-5 weeks） and group B （32 patients received hyperfractionation radiotherapy with 60-63 Gy/12-14 fractions, 3.3-4 weeks ）. Results：The 1-, 3- year local control rate of group A and group B were 72% , 48% and 93.75% , 78. 125%. The 1-, 3-year survival rate of group A and group B were 68% , 32% and 90. 6%, 59.4%. Grade Ⅰ - Ⅱ acute bronchitis rate was 36%, 43.75%. Conclusion：The course of hyperfractionation is much shorter than low-fractionated conformal radiotherapy which can improve the local control rate and survival rate of patients with mediastinal lymph node metastasis, without increasing side-effect.