^(192)Ir近距离治疗在局部复发非小细胞肺癌中的应用

Application of^(192)Ir brachytherapy in locally recurrent non-small cell lung cancer

目的探讨局部复发非小细胞肺癌采用^(192)Ir近距离治疗的疗效和安全性。方法收集河北省沧州中西医结合医院自2013—2018年间调强放疗后局部复发的非小细胞肺癌22例。采用^(192)Ir高剂量率近距离治疗复发病灶,处方剂量30Gy1次,治疗后前3个月每1个月复查CT,3个月后每3个月复查CT,评价局控率、不良反应,复发治疗后1、2年总生存率。结果22例患者均顺利完成治疗,1、3、6个月病灶完全缓解率分别为9%、14%、14%,部分缓解率分别为82%、82%、82%,疾病稳定率分别为5%、0%、0%,疾病进展率分别为5%、5%、5%;有效率分别为91%、96%、96%。复发治疗后1、2年总生存率分别为59%、27%。急性放射性肺炎5例占23%(1级3例、2级2例),骨髓抑制4例占18%(白细胞减少1级3例、血小板减少1级1例),术后气胸1例,给予对症治疗后均好转。结论^(192)Ir近距离治疗局部复发非小细胞肺癌安全有效、不良反应可耐受。

Objective To evaluate the clinical efficacy and adverse events of^(192)Ir high-dose rate brachytherapy(HDR-BT)in the treatment of locally recurrent non-small cell lung cancer(NSCLC).Methods Clinical data of 22 cases of recurrent NSCLC after radiotherapy admitted to our hospital from September 2013 to March 2018 were retrospectively analyzed.^(192)Ir HDR-BT was adopted for reradiotherapy.The prescription dose was 30Gy for 1 fraction.CT scan was reviewed every 1 month in the first 3 months after treatment and every 3 months after 3 months.Local control rate and adverse events were evaluated.The 1-and 2-year overall survival(OS)rates of re-treatment after relapse were calculated.Results All the 22 patients completed the treatment successfully.The 1-,3-and 6-month complete response(CR)rates were 9%,14%and 14%,82%,82%and 82%for the partial response(PR)rates,5%,0%and 0%for the stable disease(SD)rates,5%,5%and 5%for the progressive disease(PD)rates,91%,96%and 96%for the objective response rates(ORR),respectively.The 1-and 2-year OS rates of re-treatment after relapse were 59%and 27%.Five patients(23%)experienced acute radiation-induced pneumonitis(3 cases of grade 1 and 2 cases of gradeⅡ),4 cases(18%)of radiation-induced bone marrow suppression(3 cases of grade I leukopenia and 1 case of grade I thrombocytopenia)and 1 case of postoperative pneumothorax.All these adverse events were mitigated after symptomatic treatment.Conclusion^(192)Ir HDR-BT is an efficacious and safe treatment of locally recurrent NSCLC.