IMRT与VMAT治疗小细胞肺癌合并上腔静脉压迫综合征患者的急性不良反应比较

Comparison of acute adverse reactions between IMRT and VMAT in small cell lung cancer patients complicated with superior vena caval syndrome

目的比较调强适形放疗(IMRT)和容积旋转调强放疗(VMAT)治疗小细胞肺癌合并上腔静脉压迫综合征(SVCS)的急性不良反应及耐受性。方法根据治疗方法不同将48例小细胞肺癌合并SVCS患者分为IMRT组(n=23)和VMAT组(n=25),两组患者均行两阶段治疗,比较两组患者的急性不良反应发生情况。结果48例小细胞肺癌合并SVCS患者中,未出现因急性不良反应而中断放疗的患者,且主要发生1～3级急性不良反应,其中食欲下降、白细胞减少、放射性皮炎、乏力、放射性肺损伤、恶心、贫血、食管黏膜损伤等较为常见。VMAT组患者1～3级食管黏膜损伤发生率低于IMRT组(P﹤0.05);VMAT组和IMRT组患者的其他1～3级不良反应发生情况比较,差异均无统计学意义(P﹥0.05)。结论小细胞肺癌合并SVCS患者采用IMRT和VMAT治疗的总体耐受性均较好,IMRT和VMAT均可作为常规放疗手段在小细胞肺癌合并SVCS的患者中应用。

Objective To compare the acute adverse reactions and tolerability of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in the treatment of small cell lung cancer patients complicated with superior vena caval syndrome (SVCS).Method 48 small cell lung cancer patients complicated with SVCS were divided into IMRT group (n=23) and VMAT group (n=25) according to treatment modalities.Patients in both groups were treated in two stages,compare the incidence of adverse reactions between two groups.Result In 48 small cell lung cancer patients complicated with SVCS,no patients underwent radiotherapy interruption due to acute adverse reactions, acute adverse reactions were mainly grade 1 to 3,among which decreased appetite,leukopenia,radiation dermatitis,fatigue, radiation lung injury,nausea,anemia,and esophageal mucosal injury were more common.The incidence of grade 1- 3 esophageal mucosal injury in VMAT group was lower than that in IMRT group (P<0.05).There was no statistically significant difference between VMAT group and IMRT group in the incidence of grade 1-3 other adverse reactions (P>0.05). Conclusion IMRT and VMAT are generally well tolerated in small cell lung cancer patients complicated with SVCS, and both of them can be used as conventional radiotherapy in these patients.