低分割3DCRT治疗早期非小细胞肺癌的临床观察

Clinical Observation of Hypo-fractionated 3DCRT for Patients with Initial Non-small Cell Lung Cancer

目的评价拒绝手术或有手术禁忌症的早期非小细胞肺癌患者接受低分割三维适形放射治疗（3DCRT）的疗效、不良反应和并发症。方法39例经病理组织学和（或）细胞学确诊拒绝手术或有手术禁忌症的早期非小细胞肺癌患者接受3DCRT，分割剂量为4～6Gy／次，5次／周，总量DT为60～76Gy．相对生物剂量为80．6～100．4Gy，靶区仅包括肿瘤原发灶和转移淋巴结，其中18例配合化疗2～4周期。结果CR率为66．7％（26／39），其中相对生物剂量〈90Gy的CR率50％（9／18），≥90GyCR率80．9％（17／21），两者比较差异有统计学意义（P〈0．05）。1、3、5年生存率分别为100％、84．2%、33．3％，中位生存期42月，较传统手术疗效略低。未出现3级以上的放射性食管炎，只有1例发生4级放射性肺炎，其余均为3级以下。结论3DCRT能否代替手术治疗早期非小细胞肺癌尚须进一步开展随机研究。

Objective To evaluate the therapeutic effect, adverse effect and complications of hypo frac tionated three-dimensional conformal radiotherapy（3DCRT） for patients with initial non-small cell lung cancer （NSCLC）. Methods Thirty-nine patients were finally diagnosed by pathohistology and （or） cytology,all the patients who refused to be treated by surgery or couldn＇t be treated by surgery received hy po fractionated 3DCRT, the fractionated doses were from 4 Gy to 6 Gy, five times a week, the total doses were from 60 Gy to 76 Gy , the biologically effective doses（BED） were from 80. 6 Gy to 100. 4 Gy. The plan targeted volume（PTV） included the primary tumor and metastatic nodes. 18 cases of them were combined with 2-4 cycles chemotherapy after radiotherapy. Results The complete response （CR） rate was 66.7 % （26/39）, in which the CR rate of whose BED〈90 Gy was 50%（9/18）, the CR rate of whose BED~ 90 Gy was 80. 9%（17/21）, there was significant difference between the patients whose BED〈90 Gy and whose BED≥ 90 Gy （P〈0.05）. The overall 1 year, 3 year, 5 year survival rate was 100%. 84. 2% and 33.3%, respectively. The therapeutic effects were a little less than the radical resections. The radiation esophagitis higher than grade 3 was not found and only one patient was accompanied with grade 4 radiation pneumonitis. Conclusion Could hypo-fractionated 3DCRT replace operation in the treatment of initial non-small cell lung cancer ？ It deserves doing research further.