改良三维适形放疗治疗巨块型局部晚期非小细胞肺癌的临床观察

 目的　探讨改良的三维适形放疗（3D-CRT）计划对巨块型非小细胞肺癌（NSCLC）的靶区剂量的影响，并观察近期及远期疗效和毒副作用。方法　回顾性分析临床确诊为局部晚期NSCLC的81例患者临床资料；肿瘤直径均≥5 cm；鳞状细胞癌52例，腺癌24例，腺鳞癌5例；ⅢA 63例，ⅢB 18例；分为改良前3D-CRT组（简称T1模式组）39例和改良后3D-CRT组（简称T2模式组）42例。T1模式组接受放化疗综合治疗者31例（79.5 %），放疗剂量2 Gy／次，26～30次，总剂量52～60 Gy；T2模式组接受放化疗综合治疗者31例（73.8 %），放疗剂量2 Gy／次，30～35次，总剂量60～70 Gy。结果　T1模式组患者的1、2、3年总生存率分别为56.4 %、33.3 %、28.4 %，1、2、3年局部控制率分别为38.4 %、28.2 %、20.5 %，中位生存期为17个月；T2模式组患者的1、2、3年总生存率分别为61.9 %、35.7 %、28.5 %，1、2、3年局部控制率分别为47.6 %、40.4 %、30.9 %，中位生存期19个月；两组之间局部控制率差异有统计学意义（P＜0.05），总生存率及中位生存期差异无统计学意义（P＞0.05）。结论　改良后的3D-CRT技术能够提高巨块型局部晚期NSCLC患者的局部控制率及生存质量，患者1年生存率有提高，远期生存率无提高。

Clinical observation on improved three-dimensional conformal radiotherapy in the treatment of massive type locally advanced non-small-cell lung cancer

Objective　To analyze the effection of improved three-dimensional conformal radiotherapy (3D-CRT) to the dose of target area of local advanced non-small-cell lung cancer (NSCLC) and observe the therapeutic efficacy and toxity. Methods　81 patients with local advanced NSCLC were collected and treated. The diameter of tumor exceed 5 cm. 52 patients were squamous carcinoma. 24 patients were adencarcinoma. 5 patients were adenosquamous carcinoma. 63 patients were onstage of ⅢA, 18 patients were ⅢB. The patients were randomized into two groups, the first group was unmodified planning of 3D-CRT group (T1 group, 39 patients ), the second group was modified planning of 3D-CRT group (T2 group, 42 patients). The 31 patients of T1 group (79.5 %) received radiotherapy and chemotherapy. Toties quoties was 2 Gy. The fractions were 26-30. The total dose was 52-60 Gy. The 31 patients of T1 group (73.8 %) received radiotherapy and chemotherapy. Toties quoties was 2 Gy. The fractions were 30-35. The total dose was 60-70 Gy. Results　The 1-, 2-, 3- year overall survive rates of T1 group were 56.4 %, 33.3 %, 28.4 %, the 1-, 2-, 3- year local control survive rates were 38.4 %, 28.2 %, 20.5 %, and the median survive time was 17 months. The 1-, 2-, 3- year overall survive rates of T2 group were 61.9 %, 35.7 %, 28.5 %, the 1-, 2-, 3- year local control survive rates were 47.6 %, 40.4 %, 30.9 %, and the median survive time was 19 months. The significant difference was found for the local control survive rates between T1 and T2 group (P < 0.05). No significant difference was found for the overall survive rates and the median survive time between T1 and T2 group (P > 0.05). Conclution　Improved 3D-CRT can advance local control survive rate and living quality to local advanced NSCLC. Meanwhile, it also increases survive rate of 1-year, but can not increase long-time survival rate.