三维适形后程逐步递量加速放疗局部晚期NSCLC的近期疗效观察

Analysis of short-term effects using accelerated-hypofractiovated three dimensional conformal radiotherapy for late-course NSCLC

目的:观察三维适形后程逐步递量加速放射治疗局部晚期非小细胞肺癌的近期疗效和早期放射反应。方法:对31例局部晚期NSCLC放疗患者均采用6MVX线照射,全程常规三维适形放疗,2.0Gy/次,5次/周,于40Gy后行CT扫描重新设计计划,后程改为2.3Gy/次,2.6Gy/次,3.0Gy/次分别照射3次,5次/周,总剂量至63.7Gy。照射野包括胸部CT可见的原发灶以及纵隔≥1.0cm单个或成束淋巴结。结果:放疗结束后1个月和3个月CT评价疗效,完全缓解(CR)4例,部分缓解(PR)14例,稳定(SD)3例,进展(PD)4例,总有效率为72%。急性放射性食管炎发生率Ⅰ、Ⅱ级68.0%(17/25),Ⅲ级4.0%(1/25),急性放射性肺炎发生率Ⅰ、Ⅱ级64.0%(16/25),Ⅲ级4.0%(1/25)。结论:后程逐步递量加速放射治疗非小细胞肺癌是对放射治疗非小细胞肺癌的有益尝试,近期疗效满意且早期放射反应可以接受。

OBJECTIVE：Hypofinctionation was used to treat non-small cell lung cancer （NSCLC） using three-dimensional（3D） conformal radiation therapy,and assess the early response and side effects of hypofractionation. METHODS： 31 late-course NSCLC patients with chemotherapy were treated with 6 MV radiation. Treated with conventional fractionatedir radiation of 40 Gy followed 3DCRT to primary lesion, 2.0 Gy per fraction, 5 fractions per week.After 40 Gy, all patient were performed with CT scanning for new plans. Changed for 2.3 Gy per fraction,2.6 Gy per fraction, 3.0 Gy per fraction, tolal 3 fraction, 5 fractions per week, total dose 63.7 Gy for late treatment. Large fields compassing the primary tumor,positive lymph nodes and elective lymph node region larger than 1.0 cm. RESULTS：Was evaluated by enhanced CT scanning 1 month after completion of radiotherapy. treatments.CR（4）,PR（14）,SD（3） and PD（4） The CR rate was 72%.The most common acute complication was esophagitis occurring （68.0%,17/25）,with Grade Ⅰ、Ⅱ.（4.0%,1/25） were Grade Ⅲ.The patients had acute pulmonary toxicity with were Grade 0,（64.0%,16/25） were GradeⅠ、Ⅱ.（4.0%,1/25） were Grade Ⅲ. CONCLUSIONS： The doses used in late-course hyper-fractionation accelerated radiotherapy for locally advanced non-small cell lung cancer can be increased noticeably.Late-course hyperfractionation accelerated radiotherapy had excellent short-term effect;Its toxicity was acceptable.