局部复发非小细胞肺癌SRT再程放疗近期疗效及不良反应观察

Observation of short-term clinical efficacy and adverse reactions with stereotactic radiotherapy in locally recurrent non-small cell lung cancer

目的探讨立体定向放疗(SRT)在局部复发非小细胞肺癌(NSCLC)中的近期疗效及不良反应。方法回顾分析2009-2015年收治的120例NSCLC放疗后复发患者,再程放疗使用SRT,处方剂量为50%剂量曲线包绕靶区,总剂量40~50Gy,4~5Gy/次,共8~12次。放疗后每2个月复查胸部CT,评价近期疗效、不良反应,记录放疗前后KPS和生活质量评分(QOL)变化。结果1例患者因3级急性放射性肺炎终止放疗,其余119例完全缓解(CR)占21.0%(25/119)、部分缓解(PR)占51.3%(61/119)、稳定(SD)占16.0%(19/119)、进展(PD)占11.8%(14/119),客观有效(CR+PR)率为72.3%(86/119),疾病控制(CR+PR+SD)率为88.2%(105/119)。放射性肺炎31例,放射性骨髓抑制23例,急性放射性心脏损伤1例,经对症处理后缓解。KPS从疗前68.16±15.22提高至疗后78.39±11.50(P<0.05);QOL从疗前27.58±5.37提高至疗后38.16±8.39(P<0.01)。结论SRT局部复发的NSCLC安全有效、不良反应可控、患者可耐受,并可提高生活质量。

Objective To investigate the short-term clinical efficacy and adverse reactions of stereotactic radiotherapy (SRT) in the treatment of locally recurrent non-small cell lung cancer (NSCLC). Methods Clinical data of 120 cases of recurrent NSCLC after radiotherapy admitted to our hospital from October 2009 to October 2015 were retrospectively analyzed. SRT was adopted for further radiotherapy. The prescription dose was 50% dose curve surrounding the target area. The total dose was 40-50 Gy, with a single dose of 4-5 Gy for 8-12 times. The chest CT was re-examined every 2 months after radiotherapy. The short-term clinical efficacy and adverse reactions were evaluated. The changes of Karnofsky performance score (KPS) and quality of life (QOL) were recorded before and after radiotherapy. Results One patient terminated the radiotherapy due to grade 3 acute radiation-induced pneumonia, 25 patients (21.0%) obtained complete remission (CR), 61 cases (51.3%) of partial remission (PR), 19 cases (16.0%) of stable disease (SD), 14 cases (11.8%) of progress disease (PD), 86 cases (72.3%) of objective remission rate (CR+ PR), and 105 cases (88.2%) of disease control (CR+ PR+ SD), respectively. Thirty-one patients experienced radiation-induced pneumonia, 23 cases of radiation-induced myelosuppression and 1 case of acute radiation-induced heart injury. All these adverse reactions were mitigated after symptomatic treatment. The KPS was significantly increased from 68.16±15.22 before SRT to 78.39±11.50 after SRT (P<0.05). The QOL was considerably elevated from 27.58±5.37 prior to SRT to 38.16±8.39 following SRT (P<0.01). Conclusion SRT is an efficacious and safe treatment of locally recurrent NSCLC, which yields controllable and tolerable adverse reactions and enhances the QOL of patients.