论文部分内容阅读
目的 通过剂量递增试验试图获得非小细胞肺癌 (NSCLC)病例三维适形放射治疗的最大耐受剂量并观察其疗效。方法 50例Ⅱ～ⅢB期非小细胞肺癌病例先用前胸和后背相对野常规分割放射治疗 ,剂量 42Gy ,2 1分次 ,4.2周完成 ;然后再用三维适形放射治疗进行肿瘤加量 ,3Gy/次 ,1次/d ,5d/周 ,剂量递增次数为 9～ 1 2次 ,肿瘤总剂量递增水平分别为 69、72、75和 78Gy。以≥ 1 5 %的患者出现美国肿瘤放射治疗协作组织 (RTOG) 3级或以上急性放射性肺损伤为限制剂量递增标准。所有入组病例给予以铂类药为基础的化疗。结果 50例NSCLC随访 1 5～ 31个月 ,已完成剂量递增计划。近期疗效中完全缓解 (CR)率为 1 6 % ,部分缓解 (PR) 70 % ,无进展 (NR)率为 1 4 % ,总有效率 (CR +PR)为 86 %。 1 +2级急性放射性食管炎发生率为 56 % ,3级为 1 0 % ;1 +2级急性放射性肺炎发生率为36 % ,3级为 2 % ;1 +2级急性骨髓抑制发生率为 58% ,3级为 8%。 1 +2级放射性肺纤维化发生率为30 %。全组中位生存时间 2 2个月 ,1、2年生存率分别为 70 %、47% ,1、2年局部控制率分别为 80 %、62 %。结论 该剂量递增的方法和剂量能为大多数患者所耐受 ,在进一步随访晚期毒副作用后可获得最大耐受剂量。近期疗效令人鼓舞 ,远期疗效有待进一步
OBJECTIVE: To determine the maximum tolerated dose of three-dimensional conformal radiotherapy in non-small cell lung cancer (NSCLC) patients and to observe its efficacy by dose escalation test. Methods Fifty patients with stage Ⅱ ~ ⅢB non-small cell lung cancer were divided into two groups according to conventional radiotherapy of 42Gy, 21 weeks and 4.2 weeks, and then treated with three-dimensional conformal radiotherapy , 3Gy / time, 1 time / d, 5d / week, and the dose increment was 9 ~ 12 times. The total tumor dose increment was 69, 72, 75 and 78 Gy, respectively. A dose escalation criterion was limited to ≥ 15% of patients presenting with American Society of Radiation Oncology (RTOG) Class 3 or above acute radiation-induced lung injury. All patients were given platinum-based chemotherapy. Results Fifty NSCLC patients were followed up for 5 ~ 31 months. The dose escalation plan was completed. The immediate response rate was 16%, partial response (PR) 70%, progression-free (NR) 14%, and total effective rate (CR + PR) 86%. The incidence of grade 1 + 2 acute radiation esophagitis was 56% and grade 3 was 10%. The incidence of grade 1 + 2 acute radiation pneumonitis was 36% and grade 3 was 2%. The incidence of grade 1 + 2 acute myelosuppression was 58%, level 3 is 8%. The incidence of grade 1 + 2 radiation-induced pulmonary fibrosis was 30%. The overall median survival time was 22 months. The 1-year and 2-year survival rates were 70% and 47%, respectively. The local control rates in 1 and 2 years were 80% and 62% respectively. Conclusion The method and dose of this dose increment can be tolerated in most patients, and the maximum tolerated dose can be obtained after further side effects of follow-up. Recent results are encouraging, long-term efficacy needs further