低剂量放疗增敏化疗治疗复发难治恶性肿瘤(附28例)

A retrospective study of low-dose radiotherapy sensitizing chemotherapy in 28 patients of relapsed and obstinate malignant solid tumors

目的：探索低剂量超分割放疗（low dose hyper-fractionated radiotherapy,LDHFR）作为化疗增敏因子在复发难治性恶性肿瘤治疗中的安全性及有效性。方法：回顾性分析陕西省人民医院2013年5月至2015年4月收治的28例复发、转移的恶性实体肿瘤患者,进行LDHFR增敏化疗的不良反应和疗效评价。急性反应依据照射部位分类,参照不良事件通用术语标准（CTCAE 3.0标准）分级,治疗反应按实体肿瘤疗效评价标准（RECIST 1.1标准）分级。结果：既往化疗20例,中位化疗6个周期（2~20个周期）。LDHFR增敏次数：13例1次、10例2次、5例3次以上（3~5次）。急性毒性反应主要表现在血液系统、消化系统、和心血管系统。9例原发灶和转移部位为PR（9/28）,转移淋巴结9例PR（9/16）,二者间差异无统计学意义（P=0.213）。肺癌4例（33.33%）、消化道肿瘤3例（30%）、乳腺或卵巢肿瘤（女性相关肿瘤）1例（25%）、头颈肿瘤1例（50%）间PR差异无统计学意义（P〉0.05）。病理类型特异PR分析,鳞癌（4/5）显著高于腺癌（4/16,P=0.047）和小细胞癌（1/6,P=0.002）,差异均具有统计学意义。结论：LDHFR增敏化疗在复发难治性恶性肿瘤治疗中具有较好的耐受性。鳞癌局部反应率显示出一定的优势,然而尚需后期纳入更多患者、采用随机对照前瞻性研究排除偏倚。

Objective：To evaluate the safety and efficacy of a palliative regimen with combining low - dose hyper- fractionated radiotherapy（LDHFR）,as a chemo - potentiator,in relapsed and obstinate malignant solid tumors. Methods：Retrospectively study the safety and efficacy of 28 relapsed and obstinate carcinoma patients,who were trea-ted by palliative regimen combining LDHFR,from May 2013 to April 2015. Acute adverse events were classified and graded by the radiotherapy sites and The National Cancer Institute（NCI）Common Terminology Criteria of Adverse E-vents（CTCAE 3. 0）. Treatment responses were graded by the Response Evaluation Criteria in Solid Tumors（RECIST 1. 1）. Results：Twenty patients were previously treated by chemotherapy with median 6 cycles（range 2 ~ 20）. LDHFR was implemented with 1 cycle in 13 patients,2 cycles in 10 patients and 3 cycles in 5 patients（range 3 ~ 5）. Acute adverse events were majorly in hematological,gastrointestinal（GI）system and cardiovascular system. Partial remissions （PR）were obtained in 9 with primary and metastatic lesion（total 28）and in 9 with lymphatic infiltrated lesion（total 16）,but no statistical significance（P = 0. 213）. PR were different between lung caner（4 cases,33. 33% ）,digestive system cancer（3 cases,30% ）,breast and ovary（1 case,25% ）and head and neck caner（1 case,50% ）with no sta-tistical significance（P ﹥ 0. 05）. PR analyzed by pathologic types showed that squamous cell carcinoma（4 / 5）was sta-tistical significantly higher than adenocarcinoma（4 / 16,P = 0. 047）or small cell carcinoma（1 / 6,P = 0. 002）. Con-clusion：LDHFR was well tolerated in relapsed and obstinate carcinoma as a chemo - potentiator. The dominance of PR in squamous cell carcinoma needed to be validated by advanced patients internalizing and prospectively random-ized controlled trail to eliminate the bias.