累及野调强放疗联合同步化疗治疗局部晚期非小细胞肺癌的疗效观察

Involved-field Irradiation Intensity Modulated Radiation Therapy with Concurrent Chemotherapy for Locally Advanced Non-small Cell Lung Cancer

目的比较累及野照射(IFI)和选择性淋巴结照射(ENI)调强放射治疗联合同步化疗治疗局部晚期非小细胞肺癌(LA-NSCLC)的不良反应和疗效。方法 49例LA-NSCLC患者前瞻性随机分为IFI组和ENI组,同步化疗两周期,行根治性调强放射治疗。结果 IFI组和ENI组≥2级放射性肺炎发生率分别为8.0%和37.5%(P=0.01);GTV平均剂量分别是(66.2±6.5)Gy和(61.3±6.3)Gy,(P=0.01);总有效率为92.0%和66.7%(P=0.03);预防照射区内淋巴结复发率为4.2%和4.0%,(P=0.49);1年局部失败率分别为8.0%和16.7%(P=0.62);1年生存率为72.0%和62.5%(P=0.48)。结论 IFI同步放化疗治疗LA-NSCLC可降低正常组织并发症的概率,提高靶区照射剂量和肿瘤控制率,预防照射区内淋巴结复发率无增加,有望延长患者生存期。

Objective To compare toxicities and clinical outcomes of involved field irradiation（IFI）and with elective nodal irradiation（ENI）intensity modulated radiation therapy（IMRT）with concurrent chemotherapy for locally advanced non-small cell lung cancer（LA-NSCLC）.Methods 49 patients with of LA-NSCLC were prospectively randomized into IFI group and ENI group,receiving 2 cycles of concurrent chemotherapy and radical IMRT.Results ≥grade 2 radiation pneumonitis developed in 8.0% of the patients in IFI group and 37.5% in ENI group（P=0.01）.The mean prescription doses to grass tumor volumes with IFI and ENI were（66.2±6.5）Gy and（61.3±6.3）Gy（P=0.01）.The responsive rates were 92.0% and 66.7%（P=0.03）,and the elective nodal failure（ENF）rates were 4.2%and 4.0%（P=0.49）,respectively.The 1-year local-failure rates were 8.0% and 16.7%（P=0.62）,while the 1-year survival rates were72.0% and 62.5%（P=0.48）,respectively.Conclusion IFI IMRT with concurrent chemotherapy for LA-NSCLC could reduce the probability of normal tissue complications and improve the target dose and tumor control rate without increasing incidence of elective nodal failure.It might further prolong patients＇ survival.