后程加速超分割放射治疗中晚期肺鳞癌的临床研究

Late course accelerated fractionation radiotherapy for advanced squamous cell carcinoma of the lung

目的 评价后程加速超分割放射治疗肺鳞癌的放射反应、并发症、近期疗效和远期疗效。方法 6 6例中晚期肺鳞癌随机均分至 2个组。常规分割放射治疗 (CF)组 :2 .0Gy/次 ,1次 /d ,5d/周。大野照至 44Gy(分 2 2次 ,4.4周完成 )后缩野照射临床肿瘤区 ,总剂量达 6 6～ 70Gy ,总疗程为6 .6～ 7.0周 ;后程加速超分割放射治疗 (LCAF)组 :前 2 / 3疗程放射治疗方法同常规放射治疗组 ,缩野后加速超分割照射 ,1.5Gy/次 ,2次 /d ,间隔 6h ;照射 8～ 9个治疗日 ,总剂量达 6 8～ 71Gy ,总疗程 6 .0～ 6 .2周。照射野设计及放射线类型 2个组均相同。结果 (1)疗效 :完全缓解 (CR)率和总有效 (CR+PR)率LCAF组分别为 2 1.2 %和 87.8% ,CF组分别为 9.1%和 6 3 .6 % ,2个组总有效率差异有显著性意义 (χ2 =5 .2 80 ,P =0 .0 2 2 )。 1、2年生存率和局部控制率LCAF组分别为 75 .7%、6 1.5 %和 6 9.7%、46 .2 % ,CF组分别为 5 7.6 %、2 8.6 %和 5 1.5 %、2 1.4% ,2个组差异有显著性意义 (χ2 =4.476 ,P =0 .0 37和 χ2 =4.0 87,P =0 .0 43)。 (2 )放射性食管炎 :LCAF组为 81.8% ,CF组为 5 4.5 % (χ2 =5 .6 5 7,P =0 .0 18)。 (3) 2个组放射性气管炎、肺炎及肺纤维化均无差异。结论 后程加速超分割放射治疗肺鳞癌 ,患者均?

Objective To evaluate the efficacy and acute toxicity of late course accelerated fractionation radiotherapy for advanced squamous cell carcinoma of the lung. Methods Sixty six patients with squamous cell carcinoma of the lung were randomized into radiotherapy by conventional fractionation or late course accelerated fractionation. The conventional fractionation (CF) consisted of 2.0 ?Gy per day, 5 times a week to a total dose of 66～70?Gy. The late course accelerated fractionation (LCAF) was given with the same schedule as CF during the first two thirds of radiotherapy to a total dose of 44?Gy in 4.4 weeks, then followed by accelerated fractionation. Accelerated fractionation was 1.5 ?Gy twice a day, with an interval of 6 hours to a total dose of 68～71?Gy in 6.0～6.2 weeks. Results The complete response rate and overall response rate was 21.2% and 87.8% in LCAF, and 9.1% and 63.6% in CF, respectively (P=0.022). LCAF improved 1 and 2 year survival and local control rate as compared to CF. Acute radiation induced esophagitis was observed in 27 (81.8%) patients with LCAF, and 18 ( 54.5% ) patients with CF (P=0.018). There was no significant difference in the acute radiation induced tracheitis, pneumonitis or lung fibrosis between the two groups. Conclusions The preliminary results from our study has shown that LCAF radiotherapy for squamous cell carcinoma of the lung resulted in better early response rate, survival and local control than CF. The LCAF radiotherapy is tolerable.