两种剂量分割模式碳离子放射治疗肺癌淋巴引流区临床报告

Clinical report of two dose fractionation modes using carbon ion beam therapy in the lymph node drainage area for lung cancer

目的比较采用相对生物效应(RBE)剂量48 Gy,16次和12次分割碳离子束照射局部晚期非小细胞肺癌(LA-NSCLC)淋巴结引流区的不良反应、有效性及生存率。方法收集2020年6月至2021年12月甘肃省武威肿瘤医院重离子中心收治的病理确诊为LA-NSCLC的患者72例,简单随机法分为A组、B组各36例,分别给予A组48 Gy(RBE)分16次和B组48 Gy(RBE)分12次碳离子束选择野照射淋巴结引流区,观察其急慢性不良反应、有效性及生存率。采用Kaplan-Meier法绘制生存曲线,log-rank法进行差异检验。结果A、B组中位随访时间分别为13.9(8.8~15.7)、14.6(6.3~15.9)个月,治疗有效分别为16例(44.4%)、9例(25.0%),疾病控制分别为34例(94.4%)、30例(83.3%)。统计分析显示A、B组总生存率的差异无统计学意义(χ^(2)=1.192,P=0.275)。两组患者放疗计划参数比较显示,CTV体积,患侧肺D_(mean)、V_(5 Gy(RBE))、V_(20 Gy(RBE))、V_(30 Gy(RBE)),心脏V_(20 Gy(RBE))、V_(30 Gy(RBE))、D_(mean),食管V_(30 Gy(RBE))、V_(50 Gy(RBE))、D_(max)、D_(mean),气管D_(max),脊髓D_(max)等相关指标的差异均无统计学意义(P值均>0.05)。纳入患者在治疗期间及随访过程中均未出现3、4级不良反应;两组患者1、2级急性放射性皮肤反应(χ^(2)=5.134,P=0.077)、放射性食管炎(χ^(2)=1.984,P=0.371)、晚期放射性肺炎(χ^(2)=6.185,P=0.103)发生情况的差异均无统计学意义。结论碳离子放疗系统两种剂量分割模式在LA-NSCLC纵隔淋巴结引流区选择野照射治疗中安全性相近,不良反应可控,远期疗效仍需进一步观察。

Objective To compare the adverse reactions,efficacy and survival rate of carbon ion beam irradiation in the elective lymph node(ENI)drainage area of locally advanced non-small cell lung cancer(LA-NSCLC)with relative biological effect(RBE)dose of 48 Gy using 16 and 12 fractions.Methods A total of 72 patients with pathologically confirmed LA-NSCLC admitted to Wuwei Heavy Ion Center of Gansu Wuwei Tumor Hospital from June 2020 to December 2021 were enrolled and simple randomly divided into groups A and B,with 36 patients in each group.Patients in groups A and B were treated with carbon ion beam irradiation to the lymph node drainage area with 48 Gy(RBE)using 16 and 12 fractions.The acute and chronic adverse reactions,efficacy and survival rate were observed.The survival curve was drawn by Kaplan-Meier method.Difference test was conducted by log-rank test.Results The median follow-up time was 13.9(8.8-15.7)months in group A and 14.6(6.3-15.9)months in group B.Sixteen(44.4%)patients were effectively treated in group A and 9(25%)patients in group B.Thirty-four(94.4%)cases achieved disease control in group A and 30(83.3%)cases in group B.Statistical analysis showed that the overall survival rate in group B was similar to that in group A(χ^(2)=1.192,P=0.275).Comparison of planning parameters between two groups showed CTV volume,D_(mean),V_(5 Gy(RBE)),V_(20 Gy(RBE))and V_(30 Gy(RBE))of the affected lung,cardiac V_(20 Gy(RBE)),V_(30 Gy(RBE))and D_(mean),esophageal V_(30 Gy(RBE)),V_(50 Gy(RBE)),D_(max) and D_(mean),D_(max) of the trachea and spinal cord had no significant difference(all P>0.05).No grade 3 or 4 adverse reactions occurred in the enrolled patients during treatment and follow-up.No statistical differences were observed in the acute radiation skin reaction(χ^(2)=5.134,P=0.077),radiation esophagitis(χ^(2)=1.984,P=0.371),and advanced radiation pneumonia(χ^(2)=6.185,P=0.103)between two groups.Conclusions The two dose fractionation modes of carbon ion therapy system are equally safe in the mediastinal lymphatic drainage area of LA-NSCLC,and the adverse reactions are controllable.The long-term efficacy still needs further observation.