胸部深部热疗联合容积旋转调强放疗治疗NSCLC患者急性放射性肺炎临床观察

Deep hyperthermia combined with volumetric-modulated arc therapy in treatment of acute radiation pneumonia in NSCLC patients

目的分析中晚期非小细胞肺癌(non-small-cell lung cancer,NSCLC)患者胸部深部热疗联合容积旋转调强放疗(volumertric modulated arc therapy,VMAT)后急性放射性肺炎(radiation pneumonitis,RP)发生及细胞免疫功能变化。方法回顾性分析68例接受胸部深部热疗联合VMAT的中晚期NSCLC患者,热疗设备采用NRL-003型内生场高频热疗机,热疗在放疗后1 h内进行,自放疗计划开始日起3次/周,靶区中心温度控制在41℃~43℃,至放疗计划结束,治疗中加强观察和护理,统计患者热放疗前、后细胞免疫功能指标变化及急性RP的发生率。结果68例NSCLC患者均接受VMAT胸部放疗联合胸部深部热疗,热放疗后较治疗前CD3+T淋巴细胞增高[(79.26±11.24)vs(73.40±13.16),P=0.033],CD4+T淋巴细胞有增高趋势[(47.81±11.57)vs(42.47±14.20),P=0.068],B淋巴细胞降低[(4.56±2.75)vs(7.05±3.86),P=0.001]。VMAT胸部热放疗后有症状急性RP的发生率为17.6%。结论胸部深部热疗联合VMAT后患者细胞免疫功能得到改善,急性RP的发生率较低。

Objective To analyze the incidence of acute radiation pneumonia(RP)and the change of cellular immunity in advanced non-small-cell lung cancer(NSCLC)patients treated with deep hyperthermia and volumetric-modulated arc therapy(VMAT).Methods A total of 68 NSCLC patients receiving deep hyperthermia and VMAT were retrospectively analyzed.Regional hyperthermia using the endogenetic field,high-frequency tumor hyperthermia system(NRL-003)was given at a temperature of 41℃-43℃three times a week within one hour after radiotherapy.Changes of cellular immunity before and after hyperthermia combined with VMAT and incidence of acute RP were analyzed.Results Deep hyperthermia and VMAT were administered in 68 NSCLC patients.The CD3+T cells were significantly increased post-treatment compared with pre-treatment[(79.26±11.24)vs(73.40±13.16),P=0.033],and there was an increasing trend in the level of CD4+T cells[(47.81±11.57)vs(42.47±14.20),P=0.068].B cells was decreased significantly post-treatment[(4.56±2.75)vs(7.05±3.86),P=0.001].The overall incidence of symptomatic acute RP was 17.6%.Conclusion After deep hyperthermia combined with VMAT,the cellular immune function is improved and the incidence of acute RP is low.