螺旋断层放射治疗在胸部肿瘤中的应用

Clinical application of helical tomotherapy in thoracic tumor

目的螺旋断层放射治疗是近十年发展起来的一种新的调强适形放疗技术,其独创性的设计以螺旋CT旋转扫描方式,结合计算机断层影像导航调校,突破了传统加速器的诸多限制,对肿瘤患者进行高效、精确、安全的治疗。本文总结螺旋断层放射治疗在胸部肿瘤的临床应用,探讨其治疗发展方向及最新动态。方法以"螺旋断层放疗,胸部肿瘤,肺癌,肺转移瘤,胸膜间皮瘤,食管癌"为关键词,检索PubMed及CNKI期刊全文数据库2007-04-2016-04的相关文献,共检索到中文文献286条,英文文献297条。纳入标准:(1)肺癌、肺转移瘤的螺旋断层放疗;(2)胸膜间皮瘤的螺旋断层放疗;(3)食管癌的螺旋断层放疗。根据纳入标准,符合分析的文献26篇。结果螺旋断层放疗在胸部肿瘤有较好的疗效,其实现了高适形和均匀度的剂量分布,从而提高了靶区剂量和降低了周围正常组织剂量,在放疗靶区的剂量覆盖及危及器官的保护等方面具有一定优势,在胸部复杂不规则靶区,范围较大的靶区及多个靶点的放疗方面具有明显的优势,并且未明显增加放疗相关的毒副作用。结论螺旋断层放疗凭借对靶区的剂量覆盖及正常器官的保护等方面的独特优势,提高了肺癌、胸膜间皮瘤、食管癌等放疗疗效。但因目前相关临床试验较少,其治疗地位仍需大型多中心随机临床试验来确立。

OBJECTIVE Helical tomotherapy（HT） is a new intensity modulated conformal radiotherapy （IMRT） technique developed in the last decade. It originality design with spiral CT scanning system, combined with the computer image navigation and adjustment, breaking through the limitations of traditional accelerators and providing the tumor patients for efficient, accurate and safe treatment. This review summarized the clinical application of HT in thoracic tumor, and discuss the treatment progress and the latest variation. METHODS In full text database exploration system like PubMed and CNKI, we used ＂helical tomotherapy, thoracic tumor, lung cancer, pulmonary metastasis, pleural mesothelioma, esophageal cancer＂ as keywords to index pertinent literature between April 2007 and April 2016. Totally 286 Chinese literatures and 297 English literatures were found. Inclusion criteria： The HT of lung cancer and pulmonary metastasis;The HT of pleural mesothelioma; The HT of esophageal cancer. Finally 26 literature fit were collected. RESULTS According to the study and summary of literature, HT has a potent effect on thoracic tumor. It improved the dose distribution of conformal index and homogeneity Index, which can increase the target tumor dose and reduce the dose of the normal tissue. At the same time, HT has obvious superiority in the complex, large target area and multiple target radiotherapy. In addition, TH showed certain advantages in dose coverage of targets, sparing of organs at risk and does not increase the side effect of radiotherapy. CONCLUSIONS With HT highly target volume rate and homogeneous dose distribution, it has certain advantages in dose coverage of targets, sparing of normal organs and so on. The curative effect of lung cancer, pleural mesothelioma, esophageal cancer are improving, but its status still need large multicenter randomized clinical trial.