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目的 建立非小细胞肺癌适形放疗技术 ,试图获得患者适形放疗的最大耐受剂量 (MTD) ,并观察其即期疗效。方法 1999年 6月至 2 0 0 0年 6月 ,38例Ⅱ～ⅢB期非小细胞肺癌患者进入本研究。常规放疗 42Gy后用适形放疗做肿瘤剂量递增。根据接受 2 0Gy照射的总肺体积百分比 ,计划的肿瘤剂量递增水平分别为 6 9、72、75、78和 81Gy。大于RTOGⅢ级放射性肺损伤为停止剂量递增的标准。结果 已完成放疗计划者有 36例 ,实际可评估疗效者有 33例。各剂量递增组至少已递增一次 ,目前最高剂量为 78Gy。即期疗效为完全缓解率 6 1% ,部分缓解率 2 7% ,无变化率 12 %。急性放射性食管炎发生率Ⅰ、Ⅱ级 6 1% ,Ⅲ级 9% ;急性放射性肺炎Ⅰ、Ⅱ级 2 6 % ,Ⅲ级 3 % ;急性骨髓抑制Ⅰ、Ⅱ级 5 8% ,Ⅲ级 9%。结论 用正常肺组织受一定剂量照射的百分体积数决定递增剂量的方法能为大多数患者所耐受 ,有较好的即期疗效。目前的最高递增剂量已达 78Gy ,MTD尚未获得 ,放射后期毒副作用及远期疗效有待进一步观察
Objective To establish conformal radiotherapy for non-small cell lung cancer (NSCLC) and try to obtain the maximum tolerated dose (MTD) of patients with conformal radiotherapy and observe its immediate efficacy. Methods From June 1999 to June 2000, 38 patients with stage II-IIIB non-small cell lung cancer entered the study. After conventional radiotherapy 42Gy, conformal radiotherapy was used to increase the tumor dose. Based on the percentage of total lung volume receiving 20 Gy irradiation, the planned tumor dose increment levels were 69, 72, 75, 78, and 81 Gy, respectively. Radioactive lung injury greater than RTOG III is the criterion for stopping dose escalation. Results Thirty-six patients had completed radiotherapy plans and 33 patients had actual evaluable efficacy. Each dose escalation group has been increased at least once, the current highest dose is 78Gy. The immediate effect was a complete remission rate of 6 1%, a partial remission rate of 27%, and no change rate of 12%. The incidence of acute radiation esophagitis was grade I and II 6 1%, grade III 9%, acute radiation pneumonitis grade I and II 2 6%, grade III 3%; acute myelosuppression grades I and II 58%, grade III 9% . Conclusions The method of increasing the dose determined by the percentage of the volume of normal lung tissue irradiated by a certain dose can be tolerated by most patients and has a good immediate effect. The current highest ascending dose has reached 78Gy, MTD has not yet been obtained, the late radiation side effects and long-term efficacy need further observation