非小细胞肺癌低分割放疗研究进展

Advance in Hypofractionated Radiotherapy of Non-small Cell Lung Cancer

肺癌是全球发病率和死亡率第一的恶性肿瘤,虽然放疗在NSCLC的治疗中具有可观的局部疗效,但临床上仍有部分患者出现治疗失败。放疗失败的主要原因是局部未控、复发或远处转移。与常规分割相比,大分割放疗可在不增加放疗次数的情况下提高总的放疗剂量;对于接受相同BED照射的NSCLC患者,大分割放疗除了能带来局部控制率上的增加外,还可减少治疗次数,节省治疗时间和费用,增加病人的便捷,提高医用加速器的使用效率。L-Q模型的数据在预测大分割放疗疗效时存在许多局限。除经典L-Q模型所模拟的机制外,还可能有其他机制的参与。分子影像是无创性评价放疗疗效的可靠手段,利用不同分子显像剂结合胞内特定靶分子,能够对恶性肿瘤的代谢水平、乏氧状态、增殖能力等情况进行较为准确的评估,为大分割放疗提供良好的疗效评估手段并成为研究其特殊放射生物效应的有力工具。

Lung cancer is the first global incidence and mortality of malignant tumor. Although radiotherapy in the treatment of NSCLC has considerable local curative effect, there are still some patients clinical treatment failure. The main cause of the failure of the radiation are local control, recurrence or distant metastasis. Compared with the conventional segmentation, the segmentation radiotherapy can improve the total radiation dose without any increase in number of radiotherapy cases; For NSCLC patients with exposure of the same BED, hypofractionated radiation therapy can control the increase of local and reduce the number of treatment. In addition, it can save time and cost of treatment, which can increase patients convenient and the efficiency of the use of the medical accelerator. Data of L-Q model in the prediction of large divided radiotherapy curative effect have a lot of limitations. In addition to the classic L-Q model by simulation mechanism, there could be other mechanisms involved in. Molecular imaging is a noninvasive evaluation of curative effect of radiotherapy and reliable means, which use different molecular imaging agent combined with the specific target molecules in a cell. It assessed relatively accurate malignant tumor metabolism, proliferation capacity status, lack of oxygen, and so on. It provides good curative effect for large divided radiotherapy evaluation means and becomes a powerful tool for research has its special radiation biological effect.