后程加速超分割放射治疗中晚期肺鳞癌的临床研究rnrn后程加速超分割放射治疗中晚期肺鳞癌的临床研究

摘要

Objective　To evaluate the efficacy and acute toxicity of late course accelerated fractionation radiotherapy for advanced squamous cell carcinoma of the lung. 　Methods　Sixty-six patients with squamous cell carcinoma of the lung were randomized into radiotherapy by conventional fractionation or late course accelerated fractionation. The conventional fractionation (CF) consisted of 2.0 ?Gy per day, 5 times a week to a total dose of 66～70?Gy. The late course accelerated fractionation (LCAF) was given with the same schedule as CF during the first two-thirds of radiotherapy to a total dose of 44?Gy in 4.4 weeks, then followed by accelerated fractionation. Accelerated fractionation was 1.5 ?Gy twice a day, with an interval of 6 hours to a total dose of 68～71?Gy in 6.0～6.2 weeks. 　Results　The complete response rate and overall response rate was 21.2% and 87.8% in LCAF, and 9.1% and 63.6% in CF, respectively (P=0.022). LCAF improved 1- and 2-year survival and local control rate as compared to CF. Acute radiation-induced esophagitis was observed in 27 (81.8%) patients with LCAF, and 18 (54.5%) patients with CF (P=0.018). There was no significant difference in the acute radiation induced tracheitis, pneumonitis or lung fibrosis between the two groups. 　Conclusions　The preliminary results from our study has shown that LCAF radiotherapy for squamous cell carcinoma of the lung resulted in better early response rate, survival and local control than CF. The LCAF radiotherapy is tolerable.%目的　评价后程加速超分割放射治疗肺鳞癌的放射反应、并发症、近期疗效和远期疗效。方法　66例中晚期肺鳞癌随机均分至2个组。常规分割放射治疗（CF)组 ：2.0?Gy/次，1次/d，5?d/周。大野照至44?Gy（分22次，4.4周完成）后缩野照射临床肿瘤区，总剂量达 66～70?Gy，总疗程为6.6～7.0周；后程加速超分割放射治疗（LCAF)组：前2/3疗程放射治疗方法同常规放射治疗组，缩野后加速超分割照射，1.5?Gy/次，2次/d，间隔 6?h；照射 8～9个治疗日，总剂量达 68～71?Gy，总疗程 6.0～6.2周。照射野设计及放射线类型2个组均相同。结果　（ 1）疗效：完全缓解 (CR)率和总有效（CR+PR)率LCAF组分别为21.2%和87.8%，CF组分别为 9.1%和63.6%，2个组总有效率差异有显著性意义（χ2=5.280，P=0.022)。1、2年生存率和局部控制率LCAF组分别为75.7%、61.5%和69.7%、46.2%，CF组分别为57.6%、28.6%和51.5%、21.4%，2个组差异有显著性意义（χ2=4.476，P=0.037和χ2=4.087，P=0.043)。（ 2）放射性食管炎：LCAF组为81.8%，CF组为54.5%（χ2=5.657，P=0.018）。（ 3）2个组放射性气管炎、肺炎及肺纤维化均无差异。结论　 后程加速超分割放射治疗肺鳞癌，患者均能耐受，近期疗效和1、2年生存率及局部控制率明显优于常规放射治疗，有望获得较好的远期疗效。