三维适形放射治疗局部晚期非小细胞肺癌的临床观察

目的评价放弃选择性区域淋巴结照射的低分割三维适形放射治疗局部晚期非小细胞肺癌的毒性和近期疗效.方法 45例经病理组织学和(或)细胞学确诊的局部晚期非小细胞肺癌患者接受三维适形放射治疗,分割剂量2.5～3 Gy/次,5次/周,放疗总量DT 63～72.5 Gy.靶区仅包括肿瘤原发灶和转移淋巴结,放疗前MVP或CAP方案化疗不超过两个周期.结果总有效率为84.5%.1,2年的局部控制率分别为48.9%和37.8%;1,2年生存率分别为65.4%和42.8%.中位生存期13.1个月.未出现Ⅲ级以上的放射性肺炎和放射性食管炎.7例(15.6%)患者在随访期间出现选择性淋巴结失败.结论三维适形放射治疗局部晚期非小细胞肺癌提高了局部控制率和近期疗效,减轻了放疗的毒副反应.放弃选择性区域淋巴结照射并没有明显增加区域淋巴结的复发率,是实现剂量提升的重要途径.

Clinical observation of three-dimension conformal radiotherapy for treatment of locally advanced non-small cell lung cancer

Objective To evaluate the clinical toxicity and efficacy of low fractionted three-dimension conformal radiotherapy(3D-CRT),which ceased to treat elective nodal area,in treatment of locally advanced non-small cell lung cancer(NSCLC).Methods Forty-five patients with locally advanced NSCLC diagnosed by pathology or cytology were treated with 3D-CRT.They received total dose from 63 Gy to 72.5 Gy at 2.5-3.0 Gy/fraction, 5 fractions/week.The elective nodal areas were not treated and only lymph nodes with metastactic tumor were included in the clinical target.All patients received MVP or CAP regimen no more than 2 cycles before radiation.Results The overall response rate(CR+PR) was 84.5% and median survival time was 13.1 months.The 1-year and 2-year local control rates were 48.9%(22/45) and 37.8%(17/45),and the 1-year and 2-year overall survival rates were 65.4% and 42.8%,respectively.None of the 45 patients developed grade-3 or worse pulmonary and esophageal toxicity.Only 7 patients(15.6%) with elective nodal failure were identified.Conclusions 3D-CRT enhances local control rate and short-term efficacy of locally advanced NSCLC and relieves serious radiation toxicity.Local control remains a major challenge in the treatment of locally advanced NSCLC.The omission of elective nodal treatment does not cause a significant amount of failure in lymph node regions not included in the clinical target.It is the important method for dose escalation.