三维适形放疗联合化疗对恶性肿瘤致上腔静脉综合征的疗效分析

Clinical Analysis of the Treatment of Three-dimensional Conformal Radiotherapy Combined with Chemotherapy for Superior Vena Cava Syndrome with Malignant Causes

目的观察三维适形放疗联合化疗治疗恶性肿瘤性上腔静脉综合征的疗效和耐受性。方法将62例恶性肿瘤合并上腔静脉综合征患者,随机分为精放组(32例)和普放组(30例)。精放组采用三维适形放疗联合化疗,放疗采用6MV-X线,总剂量61.6 Gy;普放组采用普通放疗联合化疗,先采用大剂量冲击放疗,4 Gy/次,连续3次后改为常规放疗,总剂量44 Gy。化疗连续2个周期,21～28天为1个周期,第1个周期化疗与放疗同步。结果精放组CR 13例(40.6%),PR 17例(53.1%),目标病灶无PD病例;普放组CR 6例(20.0%),PR 21例(70.0%),目标病灶PD 1例(3.3%)。精放组CR率明显高于普放组(P<0.01)。KPS改善率两组分别为100.0%和83.3%(P<0.05)。不良反应两组比较无显著性差异。结论同步放化疗中,与普通放疗比较,三维适形放疗可提高恶性肿瘤所致上腔静脉综合征的疗效,改善患者生活质量,患者耐受性良好。

Objective To evaluate the efficacy and safety of three-dimensional conformal radiotherapy（3-DCRT） combined with chemotherapy for superior vena cava syndrome（SVCS） with malignant causes.Methods 62 patients by SVCS caused by malignant tumor were randomly divided into 3-DCRT group（32 cases） and conventional radiotherapy（CRT） group（30 cases）.Patients in 3-DCRT group were treated by 3-DCRT with a dose of 61.6 Gy,and patients in CRT group received CRT with a dose of 44 Gy by using 6MV-X linear accelerator.All the patients were concurrent managed with combination chemotherapy for two cycles.Results In 3-DCRT group,there were 13cases with CR（40.6%）,17cases with PR（53.1%）,none with PD.While in CRT group,there were 6cases with CR（20.0%）,21cases with PR（70.0%）,1case with PD.There was a significant difference in CR rate（P0.01）.The rate of improvement of KPS status respectively was 100.0% in 3-DCRT group and 83.3% in CRT group（P0.05）.Conclusion Simultaneous 3-DCRT and chemotherapy can improve efficacy and elevate the life quality of patientes with SVCS with good tolerance and safety.