适形调强与容积旋转调强技术对局部晚期非小细胞肺癌临床效果比较

Comparison of Clinical Effect of Step-and-shoot Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy for Locally Advanced Non-Small Cell Cancer

[目的]比较局部晚期非小细胞肺癌（NSCLC）常规静态调强（step-and-shoot intensity-modulated radiation therapy,s IMRT）和容积旋转调强（volumetric modulated arc therapy,VMAT）的临床效果。[方法]回顾性分析68例分别行IMRT和VMAT的NSCLC患者资料,IMRT组38例,VMAT组30例。比较两组患者的近期、远期疗效及急性不良反应。[结果]IMRT组和VMAT组的有效率分别为76.3%和80.0%。除放射性食管损伤外（P=0.045）,其他急性不良反应两组均无显著性差异（P〉0.05）。IMRT组和VMAT组中位OS分别为23.0个月（95%CI：20.4-25.5）和24.3个月（95%CI：21.6-26.9）;PFS分别为15.5个月（95%CI：13.5-17.6）和16.2个月（95%CI：13.5-18.9）;局部复发时间分别为17.1个月（95%CI：14.6-19.6）和18.4个月（95%CI：15.8-21.1）;远处转移时间分别为20.3个月（95%CI：17.5-23.1）和20.8个月（95%CI：17.5-24.1）,差异均无统计学意义（P〉0.05）。[结论 ]VMAT能够获得与IMRT相同的临床疗效,且可降低放射性食管损伤的发生率。

[Purpose] To compare the clinical effect of step-and-shoot intensity modulated radio- therapy（slMRT） and volumetric modulated arc therapy（VMAT） for locally advanced non-small cell lung cancer（NSCLC）. [Methods] The data of 68 cases with advanced NSCLC received IMRT（n=38） or VMAT （n=30） were included and analyzed retrospectively. The short-term and long-term clinical efficacy and acute toxicity between the two groups were evaluated. [Results] The total efficacy for IMRT and VMAT group was 76.3% and 80.0% respectively. Except fo radiation esophagitis （P= 0.045 ）, there was no significant difference for acute toxicity between the two groups （P〉0.05）. The median time to OS for IMRT and VMAT group were 23.0 months（95%CI：20.4-25.5） and 24.3 months （95%CI：21.6-26.9） respectively,the median time to PFS was 15.5 months（95%CI： 13.5-17.6） and 16.2 months （95%CI： 13.5-18.9）,the median time of local-regional recurrence （LRR） was 17.1 months（95%CI： 14.6-19.6） and 18.4 months（95%CI：15.8-21.1）,the median time of distant metas- tasis（DM） was 20.3 months（95%CI：17.5-23.1） and 20.8 months（95%CI： 17.5-24.1） respectively, there were no statistical differences between two groups for above 4 indexes（all P〉0.05）. [ Conclusion ] VMAT achieves the same clinical efficacy as IMRT and can reduce the incidence of radia- tion esophagitis in locally advanced NSCLC.