肺鳞癌后程加速超分割放疗前瞻性研究

THE PRELIMINARY STUDY ON THE LATE COURSE ACCELERATED FRACTIONATION RADIOTHERAPY FOR SQUAMOUS CELL CARCINMA OF THE LUNG

目的 :探讨后程加速超分割放射治疗肺鳞癌的临床效果。方法 :12 0例肺鳞癌随机均分为两组。常规分割放射治疗组 (CF组 ) :2 .0 Gy/次 ,1次 / d,5次 /周 ,大野照射至 DT4 0 Gy(分 2 0次 ,4周完成 )后缩野照射临床肿瘤区 ,总量达 6 5 Gy～ 70 Gy,总疗程 6 .5周～ 7.0周 ;后程加速超分割放射治疗 (L CAF)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 ,1.2 Gy/次 ,2次 / d,间隔 6 h;照射 10个治疗日 ,总剂量达 6 4 Gy,总疗程 6周 ,照射野设计及放射线类型两组均相同。结果 :(1)疗程 :总有效率 (CR+PR)率 L CAF组为 86 .7% ,CF组为 6 1.7% ,两组总有效率差异有显著性意义 (P<0 .0 5 )。 1年、2年生存率和局部控制率 L CAF组分别为 73.3%、6 3.3%和 6 8.3%、4 5 % ,CF组分别为 5 6 .6 %、2 6 .7%和 5 0 %、18.3%两组差异有显著性意义 (P<0 .0 5 )。 (2 )放射性气管炎 ,肺炎均无差异。 (3)放射性食管炎 :L CAF组为 78.3% ,CF组为 5 5 %。结论 :后程加速超分割放射治疗肺鳞癌 ,患者均能耐受 ,近期疗效和 1年、2年生存率及局部控制率明显优于常规放疗 。

Objective:To investigate the clinical value of late course accelerated fractionation radiotherapy for advanced squamous cell carcinoma of the lung.Methods:One hundred and twenty patients with squamous cell carcinoma of the lung were randomized into radiotherapy by conventional fractionation group or late course accelerated fractionation group.The conventional fractionation (CF) consisted of 2.0 Gy per day,5 times a week to a total dose of 65 Gy～70 Gy.The late course accelerated fractionation (LCAF) was given with the same schedule as of during the first two thirds of radiotherapy to a total dose of 40 Gy in 4 weeks,then followed by acceltrated fractionation.Accelerated fractionation was 1.2 Gy twice a day,with an interval of 6 hours to a total dose of 64 Gy in 6.0 weeks.Results:The overall respouse rate was 86.7 % in LCAF and 61.7 % in CF,respectively ( P <0.05).LCAF improved the 1 and 2 year survival and local control rate as compared to CF.There was no significant difference in the acute radiation induced tracheitis pneumonitis or lung fibrosis between the two groups.Acute radiation induced esophagitis was observed in 47 (78.3 %) patients with LCAF and 33(55 %) patients with CF.Conclusion:The preliminary results from our study showed that LCAF radiotherapy for squamous cell carcinoma of the lung were with better early response rate,survival and local control rate than that of CF.LCAF radiotherapy is a good method and worthy of being recommended.