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目的:探讨腔内近距离放射治疗配合外照射治疗中央型肺癌的疗效。方法:采用腔内近距离放射治疗配合体外照射治疗累及气管、支气管的中央型肺癌27例,腔内近距离放射治疗采用高剂量率192Ir后装机,纤维支气管镜下将施源管置入病变部位,剂量参考点取施源管中轴外10mm,5～8Gy/次,1次/周,共2～3次,总量10～24Gy,腔内治疗当日不作外照射。结果:治疗后第1周观察由气道阻塞引起的各种症状缓解率达70.07%,第2周92.59%,第3周缓解率达100.00%。治疗期间主要并发症为刺激性剧烈咳嗽,共发生9人次(占总治疗人次的12.60%),经镇静及对症治疗后,所有病人均能顺利完成治疗。治疗后2例发生支气管大出血死亡,发生时间分别为治疗后3个月和1年,出血前均无局部复发或远处转移征象。全组1、2、3年生存率分别为25.93%(7/27)、14.81%(4/27)和11.11%(3/27)。结论:近距离放射治疗中央型肺癌能迅速改善由于气道阻塞引起的临床症状,与外照射或化疗联合应用能达到较好的局部控制和远期效果。
Objective: To investigate the effect of intracavity brachytherapy combined with external irradiation in the treatment of central lung cancer. Methods: Twenty-seven cases of central lung cancer involving trachea and bronchus were treated with brachytherapy combined with external beam irradiation. After high-dose intracavity brachytherapy with 192Ir was performed in the brachytherapy group, the source tube was placed into the lesion under fiberoptic bronchoscopy , The dose reference point to take the source tube axis 10mm, 5 ~ 8Gy / time, 1 times / week, a total of 2 to 3 times, the total 10 ~ 24Gy, intraluminal treatment day without external irradiation. Results: In the first week after treatment, the relief rate of various symptoms caused by airway obstruction was 70.07%, 92.59% in the second week and 100.00% in the third week. During the treatment, the main complication was irritating and severe cough, with a total of 9 persons (accounting for 12.60% of the total treated persons). After the treatment of sedation and symptomatic treatment, all the patients were able to successfully complete the treatment. Two cases of bronchial hemorrhage occurred after treatment, the occurrence time were 3 months and 1 year after treatment, no local recurrence or distant metastasis before hemorrhage. The 1, 2, 3-year overall survival rates were 25.93% (7/27), 14.81% (4/27) and 11.11% (3/27) respectively. Conclusion: Brachytherapy for central lung cancer can rapidly improve the clinical symptoms caused by airway obstruction, and can achieve better local control and long-term effect in combination with external irradiation or chemotherapy.