大分割容积旋转调强放疗与常规分割动态调强放疗治疗老年NSCLC的近期疗效观察

Short-term effect of hypofractionated volumetric-modulated arc therapy and dynamic intensity-modulated radiotherapy in elderly non-small cell lung cancer patients

目的比较大分割容积旋转调强放疗与常规分割动态调强放疗治疗老年非小细胞肺癌(NSCLC)的近期疗效和不良反应。方法选择2020年1月至2021年9月南部战区海军第一医院肿瘤放疗科收治的66例老年NSCLC患者为研究对象,按随机数表法分为研究组和对照组各33例,研究组患者开展大分割容积旋转调强放射治疗,对照组患者实施常规分割动态调强放射治疗,两组共治疗4周。比较两组患者治疗4周后的疗效、不良反应和危及器官的受量;比较两组患者治疗前及治疗4周后的肿瘤标志物[癌胚抗原(CEA)、糖抗原125(CA125)]、T淋巴细胞亚群[T淋巴细胞(CD3^(+))、辅助性T细胞(CD4^(+))、细胞毒性T细胞(CD8^(+))、CD4^(+)/CD8^(+)]、血小板-淋巴细胞比值(PLR)和中性粒细胞-淋巴细胞比值(NLR)。结果研究组患者的治疗总有效率为84.85%,明显高于对照组的60.61%,差异有统计学意义(P<0.05);研究组患者的总不良反应发生率为12.12%,明显低于对照组的36.36%,危及心脏、肺部、脊髓的受量明显低于对照组,差异均有统计学意义(P<0.05);治疗前,两组患者的肿瘤标志物、T淋巴细胞亚群、PLR、NLR比较差异均无统计学意义(P>0.05);治疗后,研究组患者的CEA、CA125、PLR、NLR、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)明显低于对照组,但CD8^(+)明显高于对照组,差异均有统计学意义(P<0.05)。结论与常规分割动态调强放疗治疗比较,大分割容积旋转调强放射治疗老年NSCLC的效果更好,其不仅能够改善肿瘤标志物,减少不良反应,减轻炎性反应及免疫抑制,同时还能降低危及器官的受量,值得临床推广应用。

Objective To compare the short-term effect and toxic reactions of elderly non-small cell lung cancer(NSCLC)patients following the hypofractionated volumetric-modulated arc therapy and dynamic intensity-modulated radiotherapy.Methods Sixty-six elderly NSCLC patients treated from January 2020 to September 2021 in Department of Tumor Radiotherapy,the First Naval Hospital of Southern Theater Command were selected as research subjects.According to random number table,the patients were divided into a study group and a control group,with 33 cases in each group.The study group received hypofractionated volumetric-modulated arc therapy,and the control group received dynamic intensity-modulated radiotherapy,both for four weeks.Therapy results were evaluated through the curative effects,toxic reactions,involved organ tolerance doses after 4 weeks,tumor markers like carcino-embryonic antigen(CEA)and carbohydrate antigen 125(CA125),T lymphocyte subsets like cluster of differentiation 3^(+)(CD3^(+)),cluster of differentiation 4^(+)(CD4^(+)),cluster of differentiation 8^(+)(CD8^(+)),and CD4^(+)/CD8^(+),as well as platelet-to-lymphocyte ratio(PLR)and neutrophil-to-lymphocyte ratio(NLR).Results The total effective rate in the study group was 84.85%,significantly higher than 60.61%of the control group(P<0.05).The overall toxic reaction rates in the study group was significantly lower than that of the control group(12.12%vs 36.36%),and the involved tolerance doses of the heart,lung and spinal cord in the study group were lower than those of the control group,with statistically significant differences(P<0.05).Before therapy,the tumor markers,T lymphocyte subsets,PLR,and NLR levels between the two groups showed no statistically significant difference(P>0.05);after therapy,CEA,CA125,PLR,NLR,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)values in the study group were significantly lower than those of the control group,but CD8^(+)value in the study group were significantly higher than that of control group,with statistically significant differences(P<0.05).Conclusion Compared with dynamic intensity-modulated radiotherapy,the hypofractionated volumetric-modulated arc therapy can better improve the tumor markers,reduce the toxicity,inflammatory response,immunological suppression and involved organ tolerance doses.It is worthy of clinical promotion.