三维适形放射治疗(3DCRT)非小细胞肺癌临床研究

The Effect of Three-dimensional Conformal Radiation Therapy on Non-small Cell Lung Cancer

目的:研究三维适形放射治疗(3DCRT)非小细胞肺癌(NSCLC)的临床疗效和不良反应。方法:对52例Ⅰ～Ⅳ期NSCLC患者采用3DCRT技术治疗,并与采用常规放疗的50例患者临床资料进行对比分析。3DCRT组治疗靶区包括原发肿瘤加阳性淋巴结引流区,采用4～6个共面、非共面野照射,处方剂量DT2～3Gy/次,1次/天,5次/周,总剂量DT66～72Gy。常规RT组放疗靶区包括原发灶加同侧肺门、上纵隔或全纵隔,前后野对穿照射,DT36～40Gy后避开脊髓改斜野照射,1.8～2.0Gy/次,1次/天,5次/周,总剂量DT60～70Gy。结果:3DCRT组有效率(CR+PR)为90.4%,常规RT组为72.0%,两组差异有统计学意义(P<0.01);临床症状改善率分别为96.5%和86.4%。两组差异有统计学意义(P<0.01)。3DCRT组0.5年、1年、2年生存率分别为92.3%、75.0%、42.3%,均高于常规RT组的76.0%、60.0%、30.0%;0.5年生存率两组比较有差异(P<0.05),1年、2年生存率两组间无明显差异(P>0.05)。3DCRT组与常规RT组不良反应发生率分别为12.5%和23.7%,其中急性放射性食管炎、白细胞减少两组间差异有统计学意义(P<0.05),且3DCRT组无Ⅲ级以上不良反应发生。结论:3DCRT治疗NSCLC有较好的近期疗效和临床症状改善率,不良反应轻,患者易耐受,可提高肿瘤控制率,提高生存质量。

Objective： To investigate the effect of three-dimensional confonnal radiation therapy （3DCRT） on nunsmall cell lung eanc.er（NSCLC）. Methods： We retrospectively analyzed 52 eases of Ⅰ-Ⅳ stage NSCLC trcated with 3DCRT and 50 NSCLC cases treated with conventional radiotherapy. In the 3DCRT group, only tumor anti lymph nodes with metastasis were included in the clinical target, with 4-6 co-plane or non-eo-plane shoot areas, at 2-3 Gy/fraction, once per day, 5 times per week, with a total dose of 66-72 Gy. In the conventional RT group, the shoot area contained obvious tumor and homonymy hilum of the lung, the mediastinum superior or hol-interpleural spaee, and eirea para-prick. When the total close reached 36-40 Gy, we ahered the oblique portally administered radiation in order to avoid affecting the spinal cord. The regimen was DT 1.8-2.0 Gy/fraction, once per day. 5 limes per week, with a total dose of 60-70 Gy. Restilts： The response rate （CR＋PR） was 90.4% in the 3DCRT group and 72% in the conventional RT group, with a statistically significant difference（P〈0.01）. The rate of improvement of clinical status was 96.5% in the 3DCRT group and 86.4% in the conventional RT group （P〈0.01）. In the 3DCRT group, the 0.5-, 1- and 2-year overall survival rates were 92.3%, 75.0% and 42.3%, respectively. In the conventional RT group, the 0.5-, 1- and 2-year overall survival rates were 76%. 60% and 30%, respectively. A statistically significant difference was found in lhe 0.5-year overall survival rate between the two groups. No significant difference was found in the 1-year and 2-year overall survival rates between the two groups. The adverse reaction rates in the 3DCRT and the conventional RT group were 12.5% and 23.7%, respectively, with a statistically significant difference between the two （P〈0.05）. No cases with stage Ⅲ or higher in the 3DCRT group experienced severe adverse effects. Conclusion： 3DCRT is feasible for the treatment of NSCLC. 3DCRT has good therapeutic effects with slight adverse effects, improves clinical symptoms, and is well-tolerated.