中晚期非小细胞肺癌放疗临床靶区设置的必要性

目的:探讨中晚期非小细胞肺癌放疗时临床靶区设置的必要性。方法:2006年－2012年福建省肿瘤医院177例经病理组织学和(或)细胞学确诊的中晚期非小细胞肺癌患者接受三维适形放疗或者调强放疗，根据靶区勾画原则分为不勾画肺部肿瘤临床靶区组:勾画肿瘤靶区（GTV）和计划靶区（PTV），勾画肺部肿瘤临床靶区组:勾画肿瘤靶区（GTV）、临床靶区（CTV）和计划靶区（PTV）。两组肺部病灶分割剂量200~220 cGy/次，5次/周，肺部病灶放疗剂量 DT 5 600~6 600 cGy。两组资料经统计学分析具有可比性。结果:不勾画肺部肿瘤临床靶区组和勾画肺部肿瘤临床靶区组相比,肺部肿瘤平均剂量分别为59.6 Gy、60.7 Gy。两组近期总有效率（CR+PR）分别为76.30%、83.33%（P=0.230）。1、2、3年无进展生存率分别为52.98%、35.35%、24.3%和38.95%、24.33%、11.5%（P=0.360）。1、2、3年总生存率分别为69.9%、45.3%、30.8%和62.18%、37.59%、26.58%（P=0.573）。1、2、3年远处转移率分别为61.07%、40.27%、30.4%和43.55%、32.03%、27.56%（P=0.481）。两组复发率分别为38.52%、59.52%，均为野内复发。两组放射性肺炎发生率分别为16.30%、33.33%（P=0.017），放射性食管炎发生率分别为18.52%、21.43%（P=0.414）,骨髓抑制发生率分别为38.52%、33.33%（P=0.338），两组均未出现3级以上放射性肺炎。结论:不勾画肺部肿瘤临床靶区使肺部放疗区域减少，治疗后并不减少局部肿瘤的无进展生存和总生存率，但明显减少放射性肺炎的发生率。

The clinical value of clinical target volume for radiotherapy in locally middle and advanced non-small cell lung cancer

Objective:To evaluate the clinical value of contouring clinical target volume for radiotherapy in locally middle and advanced non-small cell lung cancer.Methods:177 patients with locally middle and advanced NSCLC diagnosed by pathology or cytology were divided into two groups,including without CTV group:Couring GTV and PTV,without CTV,and with CTV group:Couring GTV,CTV and PTV.Lung tumer received total dose from 56 Gy to 66 Gy.Results:The mean dose of lung in without CTV group was 59.6 Gy,with CTV group was 60.7 Gy.The overall response rate（CR+PR） in without CTV group and with CTV group was 76.30%、83.33%（P=0.230）.The 1-year,2-year and 3-year progression-free survival rates were 52.98%,35.35%,24.3%and 38.95%，24.33%，11.5%（P=0.360），and the 1-year,2-year and 3-year overall survival rates were 69.9%,45.3%,30.8%and 62.18%，37.59%，26.58%（P=0.573）.The 1-year,2-year and 3-year distant metastasis rates were 61.07%，40.27%，30.4% and 43.55%，32.03%，27.56%（P=0.481）.The recurrence rate in the two groups were 38.52%,59.52%,and they were wild in relapse.The incidence of pulmonary,esophageal toxicity and myelosuppression were 16.30% and 33.33%（P=0.017），18.52% and 21.43%（P=0.414）,38.52% and 33.33%（P=0.338）.None of the 177 patients developed grade-3 or worse pulmonary and grade-2 or worse esophageal toxicity.Conclusion:Radiation therapy without contouring CTV in locally middle and advanced non-small cell lung cancer did not increase local recurrence and decreased survival rates,but reduced the incidence of radiation pneumonity.