256例局部晚期NSCLC调强放疗后放射性肺损伤预测因素分析

目的 探讨局部晚期NSCLC受累野IMRT后放射性肺损伤发生率及寻找预测因素。方法 2007—2011年间在我院治疗的256例未手术、Ⅲ期NSCLC患者。放疗采用受累野IMRT。放疗剂量50~70 Gy (中位值60 Gy),分割剂量2 Gy/次。109例(42.6%)接受同期化疗。采用NCI的CTCAE 3.0标准评估级别。以放疗结束后6个月内发生≥2级放射性肺损伤作为终点事件。采用Logistic回归模型对预测因素进行分析。结果 所有患者中男215例(84%)、女41例(16%)。诊断时平均年龄59.2岁。43例(16.7%)发生≥2级放射性肺损伤。出现放射性肺损伤时间距放疗开始时间为20~169 d (中位数64 d)。单因素分析显示吸烟、肿瘤位置、双肺平均剂量、双肺V₅—V₂₀与≥2级放射性肺损伤发生可疑相关(P=0.108、0.106、0.030、0.049),多因素分析结果显示双肺平均剂量和双肺V₅—V₂₀与≥2级放射性肺损伤发生密切相关(P=0.048)。结论 局部晚期NSCLC受累野IMRT后双肺平均剂量和DVH中低剂量区体积可以初步预测症状性放射性肺损伤发生。     

非小细胞肺癌术后放疗的研究现状

相当比例的非小细胞肺癌(NSCLC)患者术后需行辅助治疗,术后放疗是其中重要的治疗手段,本文就近年来术后放疗对NSCLC患者的作用和价值作一综述。     

非小细胞肺癌放射治疗研究进展

目的 肺癌是全球男性肿瘤患者首位死亡原因,也是我国发病率、死亡率第1位的恶性肿瘤,约80%~85%肺癌患者是非小细胞肺癌(non-small cell lung cancer,NSCLC).本文对放疗在NSCLC的治疗现状和研究进展进行综述.方法 检索Pubmed和CNKI期刊全文数据库,以"肺癌与放疗、放疗联合靶向治疗、放疗联合免疫治疗"为关键词,检索2005-11-01-2016-11-30关于NSCLC放疗的文献,共检索文献篇653篇.纳入标准:(1)放疗在NSCLC的应用;(2)放疗与靶向治疗的联合;(3)放疗与免疫治疗联合应用的研究.根据纳入标准最后纳入分析44篇文献.结果早期肺癌患者可选择手术或立体定向放射治疗(stereotacticbodyradiationtherapy,SBRT),尤其是高龄、心肺功能不全及不能耐受手术的Ⅰ期肺癌患者,SBRT已经成为标准的治疗手段,不仅靶区小、单次照射剂量高、照射次数少,并且将邻近正常组织剂量控制在可接受范围.对于中晚期失去手术机会的患者,靶向治疗可以通过抑制放疗引起的DNA双链断裂的损伤修复、诱导肿瘤细胞凋亡及影响细胞周期等机制增加放疗敏感性.而免疫治疗与放疗的结合,可以促进机体的免疫反应,增加针对肿瘤细胞的特异性抗体,从而发挥抗肿瘤作用,尤其是放疗与免疫治疗结合后引起的"远位效应".结论放疗在NSCLC的治疗中有独特的优势,与其他治疗方法的结合为肺癌患者提供了新的治疗模式.     

PET-CT影像引导非小细胞肺癌的放射治疗

CT等解剖影像在非小细胞肺癌(non-small cell lung cancer,NSCLC)影像引导放射治疗(image guided radiotherapy,IGRT)的靶区确定中发挥着重要作用,但在原发肿瘤范围的界定、区域淋巴结转移的判断及远处转移的发现等方面仍然存在局限性.以PET为代表的功能影像在NSCLC原发肿瘤范围的界定、区域淋巴结转移的判断、远处转移的发现及疗效预测等方面优于CT等解剖影像[1-2].作为同机融合的PET-CT,不仅具备了功能与解剖影像融合的特点,还可减少传统融合中的匹配误差.因此,PET-CT在NSCLC的靶区确定、计划制定和靶区修正等影像引导方面都会发挥更为重要的作用.     

放射治疗在N2期非小细胞肺癌中的地位

1重视N2期非小细胞肺癌(N2期NSCLC)治疗的理由所谓N2期NSCLC是指病理诊断为原发性非小细胞肺癌伴有隆突下和或同一侧纵隔淋巴结转移者。需要重视N2期NSCLC的理由包括:1.1N2期NSCLC是NSCLC主要临床期别由于至今尚无有效的早期诊断的方法,因此NSCLC待确诊时绝大多数为中晚期患者,其中N2期NSCLC所占比例约20%[1,2]。     

Predictive and prognostic factors in small cell lung cancer: current status

Clinical and laboratory parameters can predict response to chemotherapy and long term survival in small cell lung cancer, and may predict those at risk of early treatment related toxicity. This paper reviews the predictive models that have been developed to divide patients into prognostic groups for response and survival on the basis of clinical and laboratory parameters. These factors may be used for the stratification of patients in clinical trials and to help clinicians make appropriate treatment decisions for individual patients. A number of treatment-related factors can also affect outcomes. The evidence for interventions to prevent treatment deaths in high risk patients, such as prophylactic antibiotics, dosage modification or colony stimulating factor support are also reviewed.     

Predictive molecular markers in non-small cell lung cancer

Recent biotechnologic knowledge has enabled the discovery of a cornucopia of genetic abnormalities commonly involved not only in cancer but also in other diseases ranging from the plague to arteriosclerosis. The wealth of possibilities uncovered by this knowledge inspires the hope that today's dream of a unified concept of common treatment for multiple diseases could become a future reality. This review arbitrarily categorizes recent findings into five major areas. First, cisplatin resistance associated with the nucleotide excision repair pathway can help clinical oncologists to choose between cisplatin and noncisplatin combinations. Second, the relevant role of nuclear factor-kappa B as a predictor of chemosensitivity can lead to the development of new drugs abrogating nuclear factor-kappa B expression. Third, the presence of tubulin mutations, which are directly involved in resistance to microtubule-interactive drugs, can guide chemotherapy based on taxane or nontaxane combinations. In addition, certain chromosomal deletions affect genes involved in deoxyribonucleotide synthesis, like ribonucleotide reductase, that intervene in gemcitabine metabolism; this raises interest in investigating deletion at chromosome 11p15.5 as a potential mechanism of gemcitabine resistance. Finally, an overwhelming number of publications have analyzed genes involved in cell cycle regulation and development as predictive markers of survival; however, where these pieces fit into the puzzle of cancer management is still unclear.     

Modern radiotherapy as part of combined modality treatment in locally advanced non-small cell lung cancer: present status and future prospects

Locally advanced stages account for approximately one third of the incident presentations of non-small cell lung cancer (NSCLC). Optimal treatment in selected patients consists of an integration of chemotherapy and radiation therapy. Both modalities have seen numerous advances in the last decade. This article reviews the current status and outcome of treatment in stage III NSCLC, with special emphasis on the role of novel techniques in radiation treatment, including intensity-modulated radiation therapy. The obstacles for improving local control are identified and the technical progress that aims at removing these obstacles is addressed.     

Postoperative radiotherapy in localized non-small cell lung cancer

Surgery alone can cure 40-85% of patients with localized non-small cell lung cancer, depending on tumor stage and metastatic lymph-node involvement. As local failure rates occur in up to 50% of the cases, postoperative radiotherapy as an adjuvant treatment option has been evaluated in several trials. This review briefly summarizes the published data mainly from randomized trials. While most of the studies showed a decrease in local recurrence rate, especially in stage-III/N2 tumors after postoperative radiotherapy, no impact could be shown on overall survival. In early stages a detrimental effect of postoperative radiotherapy has been postulated, but those findings have to be interpreted with caution as radiation techniques used were suboptimal and probably not today's state of the art. A carefully designed randomized trial using modern radiotherapy techniques is warranted to define the impact of irradiation on completely resected NSCLC.     

立体定向放疗治疗周围型非小细胞肺癌

立体定向放疗（SBRT）可对病变实施“手术”式照射,抑制肿瘤细胞增殖,并具有非侵入性的特点,能明显缩短治疗时间。尽管手术、放疗是早期周围型非小细胞肺癌的主要选择,但近来研究表明SBRT相对普通放疗在局部控制率、不良反应等方面具有一定优势,并可获得与手术治疗相近的疗效。     

局部晚期非小细胞肺癌的放射治疗

本文综述了近三年来在局部晚期非小细胞肺癌放射治疗方面的临床研究进展。①术前的诱导治疗，包括术前的化疗或术前放化疗综合应用。②能手术切除病人的化放疗综合治疗，提出了除手术治疗外，综合使用化疗和放射治疗是这些病人的另一个选择。③不能手术切除病人的化疗和放疗。强调了全身化疗的重要性，讨论了化放综合治疗的模式及其疗效和治疗并发症。④三维适形放疗，已有的文献支持该方法能较好地保护肺组织，从而提高肿瘤的照射剂量。因此肿瘤的局控率和生存率均有明显改善。⑤非常规分割放疗。加速超分割放疗在一个较短的照射时间内给一个相对高的放射剂量，结果显示提高了局控率。因而有继续研究的前景。⑥放疗保护剂的试用。Amifostine已被用于肺癌的放疗，实践证实能减少放射性肺炎和食管炎的产生。     

Ⅳ期NSCLC放疗的回顾与展望

Ⅳ期NSCLC在2DRT时代的姑息减症作用已经肯定,但是研究设计未能很好体现放疗对生存的作用、部分研究结果延长生存的作用未被人们接受。随着3DRT技术的发展、综合治疗理念的广泛应用、对不同转移状态与生存关系的认识,逐渐开展的前瞻性和回顾性研究证实,基于全身治疗联合原发肿瘤3DRT比单纯药物治疗更有利于改善症状和延长生存,尤其对于寡转移的Ⅳ期NSCLC。原发肿瘤剂量与生存密切相关,高剂量放疗可能更有利于延长生存;但仍存在放疗剂量、时机、技术选择等诸多问题,需要更广泛地开展研究。     

Prognostic factors in non-small cell lung cancer

Identification of prognostic factors is critical in optimizing treatment for patients with cancer. The purpose of this work is to review the modern literature with regard to prognostic factors for patients with non-small-cell lung cancer (NSCLC) taking into account ongoing advances in clinical evaluation, staging, surgery, radiation therapy, chemotherapy, and molecular biology in this widely heterogeneous patient population.     

陀螺刀对部分早期非小细胞肺癌放疗的疗效观察

目的:回顾性分析32例陀螺刀治疗早期非小细胞肺癌放疗效果。方法:采用50%等剂量线包绕95%以上PTV靶区,单次剂量3.0-5.5Gy,每天一次,一周5次,边缘总剂量48-52Gy,2-3周内完成。结果:32例病人全部完成治疗,中位随访22个月,CR为34%(11/32)、PR为50%(16/32)、SD为9%(3/32)、PD为6%(2/32),全组有效率(CR+PR)为84%。结论:陀螺刀放疗治疗早期非小细胞肺癌是安全有效的,具有较好远期疗效及较少放射性不良反应,失败主要原因是远处转移。     

非小细胞肺癌放疗抵抗研究进展

放射治疗是非小细胞肺癌的重要治疗手段之一,而肿瘤放疗抵抗限制了放疗的疗效。提高放疗疗效仍是目前非小细胞肺癌患者治疗中亟待解决的重要难题之一。研究PI3K/AKT/mTOR信号通路、肿瘤干细胞、微小RNA、HGF/c-Met、常规分割放疗等在非小细胞肺癌放疗抵抗中的作用机制,对提高非小细胞肺癌患者的生存率及改善非小细胞肺癌患者的预后具有重要意义。     

非小细胞肺癌的放疗剂量分割

 放疗是非小细胞肺癌（NSCLC）重要的局部治疗方法。近年来,随着分子生物学、放疗技术的发展及设备的更新,不同剂量分割的放疗模式及放化疗综合治疗的理念逐渐应用于临床,并取得了较好的效果。     

长春瑞滨联合放射治疗非小细胞肺癌

放化疗联合治疗局限晚期非小细胞肺癌已取得较大的成功,但仍存在一些问题亟待解决。近年,同步化放疗日益受到关注,其策略思路是强化局部病灶控制的同时,兼顾全身转移微小病灶的治疗。     

Outcome following radiotherapy for loco-regionally recurrent non-small cell lung cancer

Local and regional recurrence of non-small cell lung cancer is reported to occur in 13–20% of treatment failures after resection. Reported post-recurrent median survival following radiotherapy ranges from 9 to 14 months. This study examines survival following radiotherapy alone for patients with loco-regionally recurring non-small cell lung cancer after initial surgery. Fifty-five patients, receiving radiotherapy at Westmead Hospital between 1979 and 1997, were eligible for study. Data were collected retrospectively by reviewing patient records. The end-point was overall survival. Symptom control was also recorded. Prognostic factors for analysis included age, sex, original presenting stage, disease-free interval (DFI), performance status, site of recurrence, treatment intent and dose. The median overall survival was 11.5 months (95% confidence interval: 8.1–13.0). Survival following treatment with radical intent was 26 months compared to 10.5 months for patients treated with palliative intent (P = 0.025). There was no significant difference in survival for short (≤2 years) or long DFI, performance status, radiation dose, age, sex, site of recurrence or stage. Most patients (55%) had partial or complete resolution of symptoms. Radiotherapy results in overall post-recurrence median survival of nearly 1 year, consistent with previous published data. Radical treatment intent predicts better prognosis as a result of patient selection and higher dose. Radiotherapy is effective at palliating symptoms of this disease.     

非小细胞肺癌三维适形放射治疗进展

近年来三维适形放射治疗技术（3D—CRT）的运用使非小细胞肺癌治疗效果得到了提高。使用此技术,可以在正常组织耐受的条件下提高局部照射剂量,并且在此基础上使用非常规照射方法以及联合化疗的综合治疗措施,达到了较为满意的治疗效果。