摘要
目的 建立非小细胞肺癌适形放疗技术 ,试图获得患者适形放疗的最大耐受剂量 (MTD) ,并观察其即期疗效。方法 1999年 6月至 2 0 0 0年 6月 ,38例Ⅱ～ⅢB期非小细胞肺癌患者进入本研究。常规放疗 42Gy后用适形放疗做肿瘤剂量递增。根据接受 2 0Gy照射的总肺体积百分比 ,计划的肿瘤剂量递增水平分别为 6 9、72、75、78和 81Gy。大于RTOGⅢ级放射性肺损伤为停止剂量递增的标准。结果 已完成放疗计划者有 36例 ,实际可评估疗效者有 33例。各剂量递增组至少已递增一次 ,目前最高剂量为 78Gy。即期疗效为完全缓解率 6 1% ,部分缓解率 2 7% ,无变化率 12 %。急性放射性食管炎发生率Ⅰ、Ⅱ级 6 1% ,Ⅲ级 9% ;急性放射性肺炎Ⅰ、Ⅱ级 2 6 % ,Ⅲ级 3 % ;急性骨髓抑制Ⅰ、Ⅱ级 5 8% ,Ⅲ级 9%。结论 用正常肺组织受一定剂量照射的百分体积数决定递增剂量的方法能为大多数患者所耐受 ,有较好的即期疗效。目前的最高递增剂量已达 78Gy ,MTD尚未获得 。
Objective To establish the technique of 3dimensional conformal radiation therapy (3DCRT) for nonsmall cell lung cancer (NSCLC) in stage ⅡⅢB, and to assess its acute sideeffects and to obtain the maximum tolerance dose (MTD). Methods From June, 1999 to June, 2000, 38 cases of NSCLC in stage ⅡⅢB were enrolled in this study. MTD was identified by dose escalation study. After 42?Gy/21?Fx/4.2?wks by conventional fractionated irradiation through AP/PA fields, which covered the primary tumor and lymph nodes, the technique of 3DCRT was used as boost. The boost fields encompassed the clinical lesions showed on chest CT. The planning of total dose escalation depended on the percentage, i.e., <25%, 25%37%, and >37% of normal lung volume irradiated to over 20?Gy. The scheduled dose escalation ranged from 69 to 81?Gy. The criteria for stopping dose escalation was grade Ⅲ or more worse radiation pneumonitis (RTOG). The boost doses were delivered with 3?Gy/fraction, once a day, 5 fractions a week. Results Thirty three cases had completed their treatments and could be evaluated by now. Acute radiation pneumonitis occurred in 26% of patients with grade ⅠⅡ and 3% with grade Ⅲ, and acute radiation esophagitis in 61% with grade ⅠⅡ and 9% with grade Ⅲ, and the hematopoietic toxicity in 58% with grade ⅠⅡ and9% with grade Ⅲ. The current doses implemented were 78, 78, and 75?Gy respectively for patients with <25%, 25% 37%, and >37% of normal lung volume irradiated. The overall immediate response rate of tumors was 88%(29/33). Conclusion Dose escalation in a volume dependent organ as the lungs is acceptable and applicable. The immediate response is encouraging. MTD is to be determined. The longterm followup is needed to observe late complications and treatment efficacy.
出处
《中国肺癌杂志》
CAS
2000年第5期322-325,共4页
Chinese Journal of Lung Cancer
关键词
非小细胞肺癌
放射疗法
剂量递增试验
Non-small cell lung cancer/radiotherapy 3-dimensional conformal radiotherapy Dose escalation triaH
