全胸膜腔混合射线照射结合局部治疗恶性胸水的疗效观察

The effect of whole pleural cavity irradiation with combined^(60)Co and electron beam plus local biological agents on malignant pleural effusion

目的 用60 Coγ线和电子线混合照射治疗恶性肿瘤胸膜转移伴恶性胸水 ,观察患者对治疗的耐受性、急性毒副作用和疗效。方法 自 1996年 1月到 1998年 12月共治疗恶性胸水 5 5例。其中肺癌伴胸水49例 ,乳癌术后伴胸水 4例 ,恶性胸腺瘤术后伴胸水 2例。患者胸水被完全引流。60 Co野包括全胸膜腔 ,中央铅块屏蔽 ,屏蔽处照射电子束。用美国Multidata公司软件EXT 2 .4计算中平面胸膜受量 ,10 0 %等剂量线为2Gy ,常规照射 15次。可见肿瘤局部加量 2 0Gy/ 10次。患者同时接受 3～ 6个疗程化疗。用Kaplan Meier法计算胸水控制率和患者生存率。结果 治疗结束后胸水即时疗效表现为完全缓解 9例 ,部分缓解 46例。 6、12、18个月的胸水控制率和患者生存率分别为 76 %、5 3 %、44%和 6 4%、34%、2 6 %。中位胸水控制期为 14个月(范围为 2～ 32个月 )。中位生存期为 9个月 (范围为 4～ 32个月 )。治疗前后心、肝、肾功能未见异常。骨髓抑制是联合放、化疗的主要并发症。另有急性放射性食道炎 19例 (Ⅰ Ⅱ级 ) ,后期胸膜明显增厚伴纤维化 3例。未发生急性放射性肺炎。结论 60 Coγ线和电子线混合照射全胸膜腔 [30Gy/ (15次·3周 )

Objective To study the effect and complications of combined 60 Co γ ray and electron beam irradiation to malignant pleural effusion. Methods From January, 1996 to December, 1998, 55 patients with malignant pleural effusion (unilateral; 49 cases of primary lung cancer, 4 breast cancer and 2 thymic tumor) received whole pleural cavity irradiation of 60 Co γ ray with centrally placed lead blocks to protect the vital organs and normal lung tissue, and the electron beam irradiation at the area which was covered by lead blocks in 60 Co γ ray irradiation. The pleural effusion was completely drained before radiotherapy, and dose distribution of middle level was calculated by TPS using EXT 2.4 version software (Multidata Co.USA). The 100% isodose curve was 2?Gy, 15 fractions were given and another 20?Gy/10Fx irradiation was added to the visible tumor. All patients received sequential chemotherapy for 36 cycles (cisplatinbased regimens for lung cancer and thymic tumor, cyclophosphamide and adriamycin and fluoracil for breast cancer). KaplanMeier curve was used to evaluate the pleural effusion control rate and survival rate of patients. Results Complete remission of the malignant pleural effusion was seen in 9 patients and partial in 46 when treatment completed. The 6, 12, 18month pleural effusion control rate and survival rate of the patients were 76%, 53%, 44% and 64%, 34%, 26%, respectively. The median control time of effusion and survival time were 14 months (232 months) and 9 months (432 months) respectively. We did not find any abnormality in liver function as well as in kidney function before and after treatment. Myelosuppression was the main side effect after combined chemotherapy and radiotherapy. Nineteen patients suffered from acute oesophagitis in grade 12, and 3 serious pleural fibrosis. There was no acute irradiation pneumonitis. Conclusion The treatment for malignant pleural effusion with combined ^(60) Co γ ray and electron beam irradiation is tolerable and effective in clinical use.