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目的观察Ⅲ期非小细胞肺癌(NSCLC)常规分割(CF)加X线立体定向适形放射治疗(SCRT)的近期疗效和急性放射性反应。方法采用CF+SCRT治疗Ⅲ期NSCLC20例,首先选用CF,6MV-X线,照射范围包括原发灶、肺门、纵隔淋巴结引流区,每次1.8￣2.0Gy,每周5次,肿瘤总量40￣41.4Gy。锁骨上淋巴结如有转移,用混合线(6MV-X线和电子线)照至DT60￣70Gy,随后改用SCRT,主要针对肿瘤靶区(GTV)追加剂量,采用4￣6个非共面适形野,90%等剂量线包绕PTV,并以此为处方线,单次量2.5Gy或5Gy,每周3￣5次,总剂量30￣40Gy。按WHO和RTOG标准观察近期疗效和急性放射反应。结果全部患者均顺利完成治疗。肺原发灶疗效为CR25.0%,PR60.0%,总有效率(CR+PR)为85.0%。1￣2级急性食管炎为25.0%,1￣2级急性放射性肺炎为30.0%,1￣2级心脏损伤为5.0%。1年生存率为85.0%。结论CF加SCRT治疗Ⅲ期非小细胞肺癌,由于提高了肿瘤靶区剂量,减少了正常组织和器官的放射损伤取得了较好的近期疗效,但远期疗效尚需进一步观察。
Objective To observe the short-term curative effect and acute radiation response of routinely divided (CF) plus X-ray stereotactic radiotherapy (SCRT) in stage Ⅲ non-small cell lung cancer (NSCLC) Methods 20 cases of stage Ⅲ NSCLC were treated with CF + SCRT. First of all, CF and 6MV-X were used. The irradiation range included primary tumor, hilar and mediastinal lymph node drainage area, 1.8 ~ 2.0Gy each time, 40 ~ 41.4Gy. If supraclavicular lymph node metastasis, with mixed lines (6MV-X line and electronic line) according to DT60 ~ 70Gy, then switch to SCRT, the main target for the tumor target (GTV) additional dose, the use of 4 ~ 6 non-coplanar Morino, 90% isodose line wrapped around PTV, and as a prescription line, a single amount of 2.5Gy or 5Gy, 3 to 5 times a week, the total dose of 30 ~ 40Gy. According to WHO and RTOG standard observation of short-term efficacy and acute radiation response. Results All patients successfully completed the treatment. The efficacy of primary lung cancer was CR25.0%, PR60.0%, and the total effective rate (CR + PR) was 85.0%. Grade 1 ~ 2 acute esophagitis was 25.0%, grade 1 ~ 2 acute radiation pneumonitis was 30.0%, grade 1 ~ 2 heart injury was 5.0%. One-year survival rate was 85.0%. Conclusion CF and SCRT for treatment of stage Ⅲ non-small cell lung cancer, due to increased tumor target dose, reduce the normal tissue and organ radiation injury achieved good short-term efficacy, but the long-term efficacy needs further observation.