淋巴结累及野照射和预防性照射在老年食管鳞癌患者根治性单纯放疗中的应用效果对比

目的探讨淋巴结累及野照射(IFI)和预防性照射(ENI)在老年食管鳞癌患者根治性单纯放疗中的应用效果。方法回顾性分析接受放射治疗的老年食管鳞癌患者110例的临床资料,根据患者的治疗方式分成观察组(接受IFI)63例及对照组(接受ENI)47例,随访1年,对比两组的近期疗效、照射的肺剂量、1年生存率、转移率、复发率及主要不良反应发生率。结果两组有效率差异无统计学意义(P>0.05)。观察组照射的肺剂量中,靶区体积(V5)及V20均明显低于对照组,V平均明显高于对照组(P<0.05)。观察组的1年生存率、转移率及复发率与对照组相比差异无统计学意义(P>0.05)。观察组的主要不良反应中,放射性肺炎为1~2级、3级的发生率明显低于对照组(P<0.05)。两组放射性食管炎及血液学毒性的发生率相比差异均无统计学意义(P>0.05)。结论 IFI及ENI放疗模式均可有效治疗老年食管鳞癌患者,二者具有类似疗效及预后生存率,但在安全性方面,IFI方式的肺受照剂量较小,减少了放射性肺炎的发生率。     

ⅢA期（N2）非小细胞肺癌术后纵隔三维适形放射治疗技术的应用

目的 采用三维适形放射治疗选择性照射纵隔及肺门淋巴引流区域，替代常规二野对穿照射，探讨ⅢA期(N2）非小细胞肺癌术后采用纵隔三维适形放射治疗技术的临床意义。方法 选取5例经术后病理证实为非小细胞肺癌病例进行研究。根据Naruke／ATS-LCSG的肺癌淋巴分期系统，在病人术后胸部CT断层图上确定CTV即需选择照射的纵隔及肺门淋巴引流区域。设三野和四野非共面等中心适形照射治疗计划并与常规二野照射治疗计划相比较，分别评价靶区及周围正常组织肺、心脏和脊髓的剂量体积直方图(DVH)以及等剂量曲线分布图。结果 CT定位使靶区确定更加明确，通过三维治疗计划设计可获得靶区理想的剂量分布，同时使周围重要器官肺和心脏的受照体积和剂量明显减少。结论 采用三维适形放射治疗技术照射纵隔可以更加明确治疗靶区、优化靶区剂量分布并减小肺和心脏的放射毒性从而提高ⅢA期(N2）小细胞肺癌术后放射治疗的价值。     

三维适形放射治疗局部晚期肺癌53例疗效分析

目的探讨三维适形放疗(3DCRT)在肺瘤治疗中的疗效和毒副反应。方法53例肺瘤患者均采用三维适形放疗,先行大野照射40Gy,1.8~2.0 Gy/次,5次/周,20次完成,后缩野加量DT=10~27 Gy,2.5~3 Gy/次,5次/周;总照射剂量为DT=54~67 Gy。结果53例中CR者7(占13.2%),PR者34例(占64.1%),PR CR者41例(占77.3%)。毒副反应以放射性食管炎为显著均为1~2级,均可耐受。结论三维适形放射治疗局部晚期肺癌可取得较好的局控率。放射副反应轻。值得使用。     

三维适形放射治疗70岁以上老年人非小细胞肺癌48例临床观察

目的探讨70岁以上非小细胞肺癌患行（NSCLC）三维适形放射治疗的疗效。方法对48例70岁以上NSCLC患者实施了三维适形放射治疗,周边剂量每次5～7 Gy,每周3次,共6～10次,生物等效剂最（BED）70～80Gy。结果在治疗结束时,42例临床症状获得改善;肿瘤获得完全缓解14例,部分缓解28例,无变化6例;1、2、3年生存率分别为52.1%、37.3%和27.1%,中化生存时间18个月。结论三维适形放射治疗对于70岁以上的NSCLC患者是一种痛苦较小、安全有效的冶疗措施。     

奈达铂联合多西他赛同步放化疗治疗老年局部晚期非小细胞肺癌临床疗效观察

目的评价奈达铂联合多西他赛同步放化疗治疗老年局部晚期非小细胞肺癌(NSCLC)的近期临床疗效及毒副反应。方法 60例诊断明确的老年局部晚期NSCLC患者随机分为两组,均接受三维适形放疗,照射剂量60~66 Gy;并每周一次同步化疗,方案分别为奈达铂(NDP组)或顺铂(DDP组)联合多西他赛。奈达铂用量为20~25 mg/m2,顺铂为20~25 mg/m2;多西他赛为30 mg/m2;观察两组近期疗效及毒副反应。结果 NDP组和DDP组总有效率均为70.0%;两组中位生存时间分别为17.5个月和16.8个月;差异无统计学意义(P0.05);但NDP组骨髓抑制及胃肠道反应发生率明显低于DDP组(P0.05)。结论奈达铂联合多西他赛同步放化疗治疗老年局部晚期NSCLC有效率不低于顺铂双药方案,且胃肠道反应显著减低,患者耐受性好,更易让患者接受。     

后程加速超分割适形放疗治疗食管癌40例疗效观察

将70例食管癌患者随机分成两组:对照组(30例),放射治疗前程采用前后两野对穿照射,20次后避开脊髓照射;治疗组(40例),放射治疗前程采用常规分割适形放射治疗,后程缩野改用后程加速超分割适形放射治疗.结果 对照组与治疗组肿瘤局部复发率分别为63%和34.8%,远处转移率分别为20.8%和15.2%.对照组与治疗组的有效率分别为56.5%、76.0%(P＞0.05).对照组与治疗组1 a生存率分别为32.6%、67.4%;3 a生存率分别为6.5%、43.5%,治疗组高于对照组组(P均＜0.05).1 a局控率分别为34.8%、71.7%;3 a局控率分别为17.4%、56.5%,治疗组高于对照组组(P均＜0.05).认为后程加速超分割适形放疗组能提高食管癌的3 a局部控制率和3 a生存率,但不良反应两组相当.     

调强放疗联合紫杉醇及恩度治疗老年局部晚期非小细胞肺癌的临床疗效

目的观察调强放疗联合紫杉醇及恩度治疗老年局部晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应。方法调强放疗加紫杉醇加恩度组(调强+紫+恩组)37例,采用6 MV-X射线调强放疗,照射剂量60⁷0 Gy,1.870 Gy,1.8².0 Gy/次,1次/d,5 d/w;每周给予紫杉醇60 mg静点,第1周期化疗第1天开始,恩度15 mg/d,连续静点14 d。适形放疗组(适形组)38例,采用6 MV-X射线照射,照射剂量602.0 Gy/次,1次/d,5 d/w;每周给予紫杉醇60 mg静点,第1周期化疗第1天开始,恩度15 mg/d,连续静点14 d。适形放疗组(适形组)38例,采用6 MV-X射线照射,照射剂量60⁶6 Gy,1.866 Gy,1.8².0 Gy/次,1次/d,5 d/w。结果调强+紫+恩组完全缓解(CR)11例(29.73%),部分缓解(PR)20例(54.05%),稳定(NC)5例(13.51%),进展(PD)1例(2.71%),总有效率83.78%;适形组CR 5例(13.16%),PR 15例(39.47%),NC 16例(42.11%),PD 2例(5.26%),总有效率52.63%。两组比较,调强+紫+恩组疗效明显高于适形组(P<0.05)。毒副反应(骨髓抑制、放射性肺炎、放射性食管炎),调强+紫+恩组与适形组无显著性差异(P>0.05)。1年生存率和2年生存率,调强+紫+恩组分别为70.3%和51.4%,适形组分别为42.1%和28.9%,调强+紫+恩组均明显高于适形组(P<0.05)。结论调强放疗联合紫杉醇及恩度治疗老年局部晚期NSCLC有很好的近期疗效,毒副反应轻,且能为老年患者耐受,远期疗效有待进一步观察。     

联合治疗对非小细胞肺癌疗效观察

目的肺癌探讨三维适形放疗联合PD化疗治疗对老年非小细胞肺癌疗效。方法选取84例本院呼吸科老年非小细胞肺癌患者作为研究对象,随机分为两组,第一组对照组采取PD化疗方案,第二组实验组采取PD化疗方案并结合三维适形放疗方法,总剂量60Gy/30次,5周完成。结果两组有效率分别为57.1%和76.2%,缓解率分别为7.14%(3/42)和26.2%(11/42),(P0.05)。两组患者五年内平均生存期分别为14.3个月和20.5个月(P0.05)。两组后期均出现放射病反应,主要为骨髓抑制和放射性肺炎。结论三维适形放射治疗同期PD化疗方案治疗局部晚期非小细胞肺癌,与序贯放化疗相比,可提高局部晚期非小细胞肺癌的近期疗效,生存期也有提高的趋势,但是放射病反应有所增加。     

三维适形放疗治疗老年局部晚期非小细胞肺癌的疗效分析

目的分析三维适形放疗在老年人非小细胞肺癌的临床效果和放射性损伤情况。方法 69例老年晚期非小细胞肺癌患者,中位年龄71岁,采用三维适形常规分割照射。总剂量60～70 GY/6～7周完成治疗。结果 69例全部完成了适形放疗计划,完全缓解14例(20.35%),部分缓解42例(60.9%),无变化9例(13%),进展4例(5.8%)。中位生存期为10.5个月,1、2年总生存率分别为65.2%(45/69)和39.1%(27/69),2年生存率为26.1%(18/69)。不良反应主要为放射性肺炎、急性放射性食管炎、骨髓抑制,患者多能耐受,无需特殊处理,没有因早期放射反应而终止的患者。结论采用三维适形放射治疗老年晚期非小细胞肺癌疗效较好,不良反应发生率较低,安全可靠。     

沙利度胺联合乌苯美司同步放疗对老年局部晚期非小细胞肺癌的效果

目的探讨沙利度胺联合乌苯美司同步放疗在治疗老年局部晚期非小细胞肺癌(NSCLC)中的作用。方法将60例老年局部晚期NSCLC患者随机分成两组,研究组放疗同步沙利度胺联合乌苯美司,在放射治疗开始之日给予沙利度胺口服,第1周100 mg/d,每晚睡前顿服,第2周开始增加至200 mg/d,并以200 mg/d维持,并同时予乌苯美司胶囊,晨空腹口服30 mg/d,沙利度胺和乌苯美司均维持3个月以上;对照组为单纯放射治疗。两组均采用调强适形放射治疗(IMRT),治疗总剂量60 Gy,2 Gy/次,1次/d,5次/w,共6 w。观察两组生活质量、近期疗效、免疫功能及毒副作用。结果研究组生活质量、近期疗效改善均显著高于对照组(χ~2=4.022,4.267,均P0.05);研究组CD3、CD4、自然杀伤(NK)细胞比例均显著高于对照组(χ~2=5.397、3.152、4.528,均P0.05);两组造血系统毒性差异有统计学意义(P0.05);两组急性放射性肺炎、急性放射性食管炎发生率差异无统计学意义(P0.05)。结论沙利度胺联合乌苯美司同步放疗治疗老年局部晚期NSCLC可提高患者生活质量,增强治疗效果及免疫功能,降低血液系统毒性反应,近期疗效良好。     

老年人食管癌三维适形放射治疗疗效分析

目的 探讨老年食管癌患者三维适形放射治疗(放疗)的疗效及其预后相关因素.方法 回顾性分析2001年1月至2007年8月在我院接受三维适形放疗的89例65岁及以上老年食管癌患者的临床资料,分析生存率及预后的影响因素. 结果 全组1、2、3和4年局部无复发生存率分别为65.2%、43.0%、27.3%和22.3%.全组1、2、3和4年生存率分别为68.5%、48.8%、36.8%和25.2%,中位生存期21.5个月.单因素分析显示影响预后的因素有:放疗前进食情况(χ~2=6.26,P=0.012)、T分期(χ~2=8.80,P=0.003)、N分期(χ~2=4.33.P=0.038)、临床分期(χ~2=7.88,P=0.005)、CT显示瘤体最大直径(χ~2=10.88,P=0.004)、近期疗效(χ~2=5.28,P=0.022)、化疗(χ~2=5.49,P=0.019);而性别(χ~2=0.74,P=0.390)、年龄(χ~2=1.89,P=0.170)、食管造影显示病变长度(χ~2=2.38,P=0.123)、CT显示病变长度(χ~2=2.69,P=0.101)、原发肿瘤部位(χ~2=2.12,P=0.146)、并存症(χ~2=0.03.P=0.874)、照射方式(χ~2=0.04.P=0.847)和放疗剂量(χ~2=0.24,P=0.627)与预后无关.Cox多因素分析显示治疗前进食情况(P=0.002)、临床分期(P=0.007)和化疗(P=0.011)为独立的预后影响因素.89例中发生0、1、2、3级急性期放射性食管炎分别为20、30、32、7例.发生0、1、2、3和5级急性放射性肺炎分别为57、20、8、2和2例.至随访结束已死亡60例,死于局部复发或病情未控制29例(48.4%)、死于远处转移11例(18.3%)、死于局部复发伴远处转移者5例(8.3%),其他原因死亡15例(25.0%). 结论 老年食管癌患者三维适形放疗是安全有效的,放疗前进食梗阻轻、临床分期早,三维适形放疗预后好;反之预后差.联合化疗可以提高放疗疗效.     

立体定向放射治疗Ⅰ期非小细胞肺癌临床分析

目的使用立体定向放射治疗52例Ⅰ期非小细胞肺癌的临床效果,并探讨使用淋巴引流区照射的价值。方法从1998年6月~2003年6月共有52例因医学原因或者拒绝手术Ⅰ期非小细胞肺癌患者接受了根治性立体定向放射治疗。所有患者均接受根治性立体定向放射治疗,治疗方案为边缘剂量6G y×7次和7G y×6次,以60%~90%的等剂量曲线包括靶区,每周4次,总疗程不超过2周,其中有23例患者同时接受淋巴引流区照射。结果中位随访期为20个月(范围:8~60个月);1、2、3年的局部控制率分别为88%,69%,63%;1、2、3年的生存率分别为73%,51%,34%;7G y×6次生存率和6G y×7次之间无显著性差异。接受与未接受淋巴引流区照射之局部控制率,生存率之间无显著差异。未出现严重早和晚反应放射毒副反应。结论立体定向放射治疗是治疗Ⅰ期非小细胞肺癌安全有效的治疗方法;它缩短治疗总时间,提高了肿瘤吸收剂量;不进行淋巴引流区照射不影响局部控制率和生存率。     

70岁以上老年人非小细胞肺癌的放射治疗

目的　了解老年人非小细胞肺癌 ( NSCLC)放射治疗临床特点。　方法　对 1 3 5例完成根治性放疗的老年 NSCLC患者施行常规和非常规分割放疗 ,其中 52例在放疗前或 (和 )放疗后接受中位数 2周期 ( 1～ 9周期 )的化疗。　结果　按时完成放疗者 89例 ,4 4例疗程有中断。总的 1、2、3年生存率分别为 76%、3 9%、2 3 %;局部控制率分别为 64 %、4 2 %、4 0 %;无远处转移者 1、2、3年生存率分别为 70 %、52 %、3 6%。3 3 %( 44 /1 3 5)未接受连续放疗 ,中断原因 :患者不能耐受 3 1例 ,化疗 4例 ,其他 9例。不同放疗分割方式及辅助化疗对疗程中断无影响 ( P>0 .0 5)。放疗连续组与中断组比较 ,放疗疗程中断明显影响生存率 ( P<0 .0 5)、局控率 ( P<0 .0 1 )。　结论　老年 NSCLC完成根治性放疗后有较好的疗效。部分患者对根治性放疗耐受性较差 ,与放疗分割方式及非正规化疗无关。放疗耐受性差的患者预后较差。     

老年与青年晚期非小细胞肺癌患者的临床特点及预后分析

目的 回顾性分析老年及青年晚期非小细胞肺癌(NSCLC)患者的临床特点、治疗及预后因素的异同.方法 收集北京大学临床肿瘤学院胸部肿瘤内科1995年3月至2007年5月住院的晚期NSCLC 399例,其中老年(≥70岁)256例,男199例,女57例;青年(≤45岁)143例,男77例,女66例,均接受一线化疗.采用Kaplan-Meier及Cox回归法分析生存期及其影响因素,疗效相关性分析采用χ~2检验.结果 (1)青年组及老年组均以男性、腺癌、Ⅳ期患者居多,但青年组与老年组相比,女性[46.2%(66/143),22.3%(57/256)]、腺癌[71.3%(102/143),54.7%(105/256)]、Ⅳ期患者[72.7%(104/143),61.7%(158/256)]所占比例高;青年女性吸烟率高达95.5%(63/66);(2)一线治疗的疾病控制率与年龄无关;含铂联合化疗有利于疾病的控制,符合世界卫生组织毒性分级标准3-4度血液学毒性的病例数两组无差异;(3)老年组中位无进展生存期(PFS)为149 d(95%CI为119.5～178.5 d),青年组中位PFS为126 d(95%CI为84.0～168.0 d),两组比较差异无统计学意义;(4)老年组中位生存期为398 d(95%CI为330.3～465.7 d),青年组中位生存期为424 d(95%CI为359.7～488.3 d);(5)东方肿瘤合作组评分为0～1、一线治疗达到疾病控制、以三代新药或靶向治疗为二线治疗者等因素是有利于生存的独立预后因素.结论 青年组中,女性、腺癌、Ⅳ期患者所占比例较老年组高;青年女性NSCLC发生率的增加可能与吸烟有一定关系;年龄与一线治疗的疾病控制率、PFS及总生存期均无相关性.     

后程三维适形放疗联合紫杉醇化疗治疗老年人乳腺癌伴脑转移癌的临床观察

目的 观察后程三维适形放疗(3D-CRT)联合紫杉醇同步化疗治疗老年乳腺癌伴脑转移癌患者的疗效及不良反应.方法 50例患者随机分为观察组(放疗加化疗组,26例)和对照组(单纯放疗组,24例).两组前程全脑均行普通二维放疗,在全脑照射总剂量(DT)30～40 Gy后,后程缩野对脑转移癌局部病灶行3D-CRT,每次2 Gy,每周5次,加量DT 10～24 Gy,至DT 50～64Gy.观察组在放疗2～4周期间给予紫杉醇65～85 mg/m2,静脉滴注第1、8天,同步化疗,然后继续用紫杉醇单药化疗2～4个周期(紫杉醇65～85 mg/m2,第1、8、15天静脉滴注);28 d为1周期,治疗2月后,观察两组近期疗效、不良反应及评价生活质量;随访2年评价客观疗效和生存率.结果 观察组有效率76.9%,高于对照组45.8%,两组比较有统计学差异(x2=5.120,P＜0.05).Karnofsky计分提高+稳定者观察组80.8%、对照组54.2%,观察组生活质量改善高于对照组(x2=4.059,P＜0.05);与对照组相比,观察组白细胞下降,差异有统计学意义;血小板减少、恶心呕吐、肝功能异常等不良反应发生率稍高于对照组,差异无统计学意义.两组2年生存率比较差异有统计学意义(x2=4.7260,P＜0.05).结论 后程3D-CRT联合紫杉醇单药化疗治疗老年乳腺癌伴脑转移癌患者可提高远、近期疗效,不良反应虽有所增加,但患者能耐受,值得临床上进一步推广应用.

Abstract：

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.     

Therapeutic effects and prognostic factors in three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

AIM: To evaluate the therapeutic efficacy of threedimensional conformal radiotherapy (3D-CRT) combined with transcatheter arterial chernoembolization (TACE) on the patients with hepatocellular carcinoma (HCC).METHODS: Between 1998 and 2001, 94 patients with HCC received 3D-CRT combined with TACE. A total 63 patients had a Okuda stage Ⅰ lesion and 31 patients had stage Ⅱ. The median tumor size was 10.7 cm (range 3.0-18 cm), and liver drrhosis was present in all the patients. There were 43 cases of class A and 51 dass B. TACE was performed using lipiodol,5-fluorouracil, cisplatin, doxorubicin hydrochloride and mitomycin, followed by gelatin sponge cubes. Fifty-nine patients received TACE only one time, while the others 2 to 3 times. 3D-CRT was started 3-4 wk after TACE. All patients were irradiated with a stereotactic body frame and received 4-8 Gy single high-dose radiation for 8-12 times at the isocenter during a period of 17-26 d (median 22 d).RESULTS: The median follow-up was 37 mo (range 10-48 mo) after diagnosis. The response rate was 90.5%. The overallsurvival rate at 1-, 2-, and 3- year was 93.6%, 53.8% and 26.0% respectively, with the median survival of 25 too. On univariate analysis, age (P=-0.026), Child-Pugh classification for cirrhosis of liver (P=0.010), Okuda stage (P=-0.026),tumor size (P=0.000), tumor type (P=0.029), albuminemia (P=0.035), and radiation dose (P=0.000) proved to be significant factors for survival. On multivariate analysis,age (P=-0.024), radiation dose(P=-0.001), and tumor size (P=0.000) were the significant factors.CONCLUSION: 3D-CRT combined with TACE is an effective and feasible approach for HCC. Age, radiation dose and tumor size were found to be significant prognostic factors for survival of patients with HCC treated by 3D-CRT combined with TACE. Further study for HCC is needed to improve the treatment efficacy.     

Impact of comorbidity and age on the outcome of patients with inoperable NSCLC treated with concurrent chemoradiotherapy

BACKGROUND: The value of concurrent chemoradiotherapy (CRT) for treatment of locally advanced non-small cell lung cancer (NSCLC) in elderly and multimorbid patients is generally disputed due to the assumed lack of toxicity compensation or the limited prognosis of the accompanying morbidity. AIM: We investigated correlation between impaired organ function, age, tumor-associated symptoms, social factors and acute toxicity as well as survival following CRT. PATIENTS AND METHODS: Retrospective data collection and analysis were performed on the variables age, functional parameters: FEV1, VC, DLCO, LVEF, creatinine clearance, age, several categories of comorbidities, WHO performance status, alcohol and nicotine habits, toxicity according CTC-criteria and survival of all patients (n=66) with inoperable NSCLC suffering substantial comorbidities or advanced age (>70 years) treated with an CRT consisting of two cycles cisplatin or carboplatin plus vinorelbine and a conventionally fractionated radiotherapy up to 63Gy. RESULTS: Median survival of all patients was 13 months (10.6-15.4 months, 95% confidence interval). Univariate analyses showed significantly poorer survival (12 months vs. 15 months) in patients with LVEF<50% compared with LVEF> or = 50% (P=0.022, in log-rank test). All other variables did not exhibit any significant correlation to survival. Multivariate analyses revealed significantly inferior survival in patients suffering from cardiac or pulmonary dysfunction (P=0.039, hazard ratio [HR]: 2.18; 95% CI of HR [1.04-4.59]). Elderly patients (>70 years) had a higher prevalence of hematotoxicity of higher degree than younger patients (< or = 70 years), but without significant impact on the feasibility of both treatment modalities. CONCLUSION: Our results suggest that cardiac and pulmonary dysfunction may be associated with a reduced survival in elderly or poor-risk patients with inoperable NSCLC after CRT.     

Clinical and dosimetric factors of radiation-induced esophageal injury： Radiation-induced esophageal toxicity

AIM: To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during three-dimensional conformal radiotherapy (3D-CRT). METHODS: We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus≥60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P= 0.0001<0.01). However, no grade 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P=0.0001<0.01). CONCLUSION: Concurrent chemotherapy and the maximal esophageal point dose≥60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT.     

多呼吸时相CT模拟适形放射治疗70岁以上患者非小细胞肺癌

目的 探讨多呼吸时相CT模拟定位法在高龄非小细胞肺癌患者适形放疗中的应用价值.方法 利用不同呼吸时相CT模拟定位扫描图像,对51例70岁以上(70～88岁,平均年龄75.2岁)非小细胞肺癌患者全程单纯三维适形放射治疗,其中Ⅰ_b期3例、Ⅱ_b期7例、Ⅲ_a期19例、Ⅲ_b期17例、Ⅳ期5例.平静吸气末和平静呼气末CT图像上分别勾画大体肿瘤体积(GTV),两者融合形成的GTV近似为肿瘤在平静呼吸全程运动的范围,临床靶区-内靶区外扩区(CTV-PTV)过程不必再外扩呼吸动度.与经典三维适形放射治疗计划比较,评价近远期疗效、预后相关因素和不良反应.结果与传统的CTV外扩至PTV方法比较,不同呼吸时相CT模拟定位法PTV平均缩小19.3%(中位值17.5%),达到处方剂量的肺组织体积平均降低21.8%(中位值19.9%).肺原发灶有效率78.4%,1～3年总生存率分别为70.6%、54.9%、29.4%,Karnofsky(KPS)评分和N分期为独立预后因素,年龄并不独立影响预后. 结论 多呼吸时相CT模拟定位法在不影响疗效的前提下显著降低PTV、改善生存质量,70岁以上非小细胞肺癌患者耐受良好.     

Concurrent low-dose cisplatin and thoracic radiotherapy in patients with inoperable stage III non-small cell lung cancer: a phase II trial with special reference to the hemoglobin level as prognostic parameter

Purpose To evaluate the efficacy of concurrent radiochemotherapy in patients with stage III non-small cell lung cancer (NSCLC), and to examine the effect of hemoglobin levels on survival of those patients. The negative impact of anemia on survival has been noticed for other cancer sites including the head and neck, and the uterine cervix, but it has been rarely described in NSCLC cancer patients treated with radiotherapy.Methods From April 1995 through March 2002, 56 patients with inoperable stage III non-small lung cancer were treated with radiotherapy consisting of 60 Gy (50 Gy+10 Gy boost) given in 30 fractions of 2 Gy daily, 5 days a week, over a period of 6 weeks, and concurrent low-dose daily chemotherapy (CHT) consisting of 6 mg/m² of cisplatin given Mondays–Fridays during weeks 1–2 and 5–6. All patients had stage III disease and ages ranged from 39 to 81 years old (median 63.9 years).Results The 2-year and 3-year survival rates were 34% and 16%, respectively. Patients with a pretreatment hemoglobin level superior or equal to 11.6 g/dl had a 2-year survival rate of 52% as compared to 15.5% for patients with a pretreatment hemoglobin level inferior to 11.6 g/dl (p=0.0075). Patients with higher KI (>70%) showed better survival rates than those with lower KI. Surprisingly, patients in stage IIIA did not survive significantly longer than those in stage IIIB. Hematological toxicity (grade 2) prevailed (25%), followed by esophageal (5.4%) and bronchopulmonary (2%) toxicity. Only three patients experienced acute grade 3 hematological toxicity. Because of acute toxic effects, irradiation was interrupted in 8 patients (14.3%) for 7–13 days (median 7.5 days). Late high-grade (3) toxicity was not found. No grade 4 toxicity or treatment-related deaths were observed during this study.Conclusion Our data show that concurrent radiotherapy with daily low dose cisplatin is well tolerated, and shows survival rates comparable to more aggressive treatment regimens. A combination of this chemotherapy with accelerated hyperfractionated radiotherapy might improve the results in the future. Furthermore, we could show that the hemoglobin levels prior to therapy have an influence on the prognosis, where lower levels were associated with worse outcome. Further trials should consider supplementation with erythropoietin.