恶性实体瘤的立体定向适形放疗(附1024例报告)

Three-dimensional conformal radiation therapy for malignant tumors (report of 1 024 cases)

目的 探讨立体定向适形放疗对恶性实体瘤的应用价值。方法对经各种途径确诊的1024例恶性实体瘤患者行立体定向适形放疗。在立体定向适形放疗定位系统下以5mm层厚CT连续扫描靶区,根据三维重建图象资料,应用Fisher三维治疗计划系统确定治疗方案,使90％等剂量曲线包绕100％的剂量体积,治疗的总剂量、分割次数、总时间分别为30-84Gy、3-41F、7-41d。比较治疗前后的症状及各种检查结果。结果立体定向适形放疗后肿瘤完全缓解38.1％（390/1024）,部分缓解55.5％（568/1024）,无变化5.8％（591/1024）,加重0.68％（7/1024）。治疗后CT增强扫描残留灶强化程度减弱,多普勒超声显示癌灶的血流减少,肝癌患者高AFP者显著下降（P<0.05）,临床症状显著缓解或消失。结论立体定向适形放疗是治疗恶性肿瘤、控制局部病灶、提高肿瘤患者生存质量的有效手段。

Objective To evaluate the clinical effect of three-dimensional conformal radiation therapy (3D-CRT) in the treatment of malignant tumors. Methods Between May 1998 and Dec. 2001, 874 patients underwent 3D-CRT (median total dose of 50 Gy, ranging from 30 to 84 Gy in 3 to 41 fractions completed within 7 to 41 d) for malignant tumors. The clinical tumor volume (CTV) was totally encompassed within the exposure by 90% of the prescribed irradiation dose. 6 MV X ray was used and CT image studies before and one year after 3D-CRT were performed to assess the therapeutic effect. Results Complete remission of the tumor occurred in 38.1% (390/1 024) of the cases, partial remission in 55.5% (568/1 024) and no remission in 5.8% (59/1 024), with 0.68% (7/1 024) of the cases showing signs of tumor progression. CT image studies demonstrated obviously weakened enhancement of the tumor residual after treatment, and Doppler ultrasound revealed decreased blood supply of the tumors. The high alpha-fetoprotein levels in patients with hepatic cellular carcinoma (HCC) was significantly reduced (P=0.003). In terms of the adverse effect, 85 patients complained of inertia after radiotherapy, 90 of loss of appetite. Conclusion 3D-CRT is an effective method of treatment in patients with malignant tumors.