采用剂量递增模式的调强放射治疗对局部进展期胸腺瘤的临床效果观察

Observation on the clinical effect of intensity-modulated radiotherapy of adopting dose escalation mode for thymoma of locally progressive stage

目的:探索局部进展期胸腺瘤的放射治疗价值,为患者提供一种安全和有效的治疗手段。方法:回顾性分析11例局部进展期胸腺瘤Ⅲ期和(或)ⅣA期患者,其中胸腺瘤Masaoka分期Ⅲ期1例,ⅣA期10例,所有患者采用剂量递增模式的调强放射治疗,处方剂量分别为50 Gy、60 Gy和70 Gy,15~20次。评价治疗后1个月、3个月和6个月的治疗反应及疗效。结果:治疗后1个月原发灶完全缓解(CR)0例,部分缓解(PR)9例,占81.8%,总有效率(CR+PR)81.8%;治疗后3个月原发灶完全缓解(CR)0例,部分缓解(PR)10例,占90.9%,总有效率(CR+PR)90.9%;治疗后6个月原发灶完全缓解(CR)2例,占18.2%,部分缓解(PR)9例,占81.8%,总有效率(CR+PR)100%;1年、3年和5年生存率分别为100%、81.8%和81.8%。治疗期间出现Ⅰ~Ⅱ级消化系统反应6例,Ⅰ~Ⅱ级骨髓抑制4例,Ⅰ~Ⅱ级呼吸系统反应3例,Ⅰ级皮肤反应2例;治疗后1个月,Ⅰ级消化系统反应5例,Ⅰ级骨髓抑制3例,Ⅰ~Ⅱ级呼吸系统反应3例,Ⅰ级皮肤反应3例;治疗后3个月,Ⅰ级消化系统反应1例,Ⅰ级骨髓抑制1例,Ⅰ~Ⅱ级呼吸系统反应3例,Ⅰ级皮肤反应3例;治疗后6个月,Ⅰ~Ⅱ级呼吸系统反应6例,Ⅰ级皮肤反应1例,通过药物治疗症状可缓解。结论:采用剂量递增模式调强放射治疗局部进展期胸腺瘤安全有效,可提高局部控制率和生存率。

Objective： To explore the value of radiotherapy for thymoma of locally progressive stage so as to provide one kind of safe and effective treatment mean for patients. Methods： 11 patients with thymoma of locally progressive stage（III stage and IVA stage） were researched by using retrospective analysis, and there was 1 case was in III stage and there were 10 cases were in IVA stage. All of patients were underwent intensity-modulated radiotherapy of dose escalation mode, and prescription doses were 50 Gy, 60 Gy and 70 Gy, respectively, and total times were 15-20 times. And the curative reaction and curative effect of the first month, the third month and the sixth month post treatment were evaluated. Results： After 1 month of treatment, there was no case occurred complete remission（CR） of primary lesion, and there were 9 cases occurred partial remission（PR） and the remission rate was 81.8%, and the total effective rate（CR＋PR） was 81.8%. After 3 months of treatment, there was no case occurred CR of primary lesion, and there were 10 cases occurred PR and the remission rate was 90.9%, and the total effective rate was 90.9%. And after 6 months, there were 2 cases occurred CR of primary lesion and the remission rate was 18.2%, and there were 9 cases occurred PR and the remission rate was 81.8%, and the total effective rate was 100%. And the survival rates of 1 year, 3 years and 5 years were 100%, 81.8% and 81.8%, respectively. Besides, there were 6 cases were digestive system reaction of I-II grade, and there were 4 cases, 3 cases and 2 cases were myelosuppression of I-II grade, respiratory system reaction of I-II grade and skin reaction of I grade, respectively, during treatment. After 1 month of treatment, the digestive system reaction of I grade, myelosuppression of I grade, respiratory system reaction of I-II grade and skin reaction of I grade occurred in 5 cases, 3 cases, 3 cases and 3 cases, respectively. And after 3 months of treatment, the digestive system reaction of I grade, myelosuppression of I grade, respiratory system reaction of I-II grade and skin reaction of I grade occurred in 1 cases, 1 cases, 3 cases and 3 cases, respectively. And after 6 months of treatment, the respiratory system reaction of I-II grade occurred in 6 cases and skin reaction of I grade occurred in 1 case, and they could be relieved through using drug therapy. Conclusion： The intensity-modulated radiotherapy of adopting dose escalation mode is safe and effective for thymoma of locally progressive stage, and it can enhance local control rate and survival rate.