后程立体定向放射治疗Ⅲb期肺鳞癌Ⅰ期临床试验

摘要

Objective　To assess the early response and acute side-effects of late course stereotactic radiosurgery (LCSR) for stage Ⅲb lung squamous cell carcinoma. Methods　 From June 1997 to July 1999, 136 patients with stage Ⅲb squamous cell carcinoma of lung were treated with the conventional radiotherapy of 40 Gy followed by LCSR to the residual lesion. Stereotactic radiosurgery was given in the 5～6th weeks, 5～8 Gy per fraction with the total doses ranging from 24 to 38 Gy. Results　 Five patients were excluded from this study due to distant metastases and acute complications. The remaining 131 patients were analyzed to evaluate the early responses and acute complications. Acute radiation-induced esophagitis occurred in 41.2% of patients (Grades Ⅰ-Ⅱ (RTOG), 4.4% Grade Ⅲ). Acute radiation-induced pneumonitis was observed in 16.9 % of patients ( Grades Ⅰ-Ⅱ (RTOG),5.2% Grade Ⅲ). The overall response rate (CR+PR) was 86.3% for the primary tumor, and 92.4% for metastatic mediastinal lymph nodes. Conclusions　LCSR is well tolerated in most patients with stage Ⅲb squamous cell carcinoma of lung. The early responses of LCSR in the of tumor are better than the conventional radiotherapy.Remote results await further follow-up.%目的　观察后程立体定向放射治疗Ⅲb期肺鳞癌的近期疗效与急性放射反应。方法　136例Ⅲb期肺鳞癌患者进入后程立体定向放射治疗组，常规放射治疗40?Gy后给予残存肿瘤灶立体定向放射治疗，5～8?Gy/次，隔日1次，肿瘤灶总剂量24～38?Gy。 结果　136例中有5例未完成治疗计划，按计划完成的131例中，急性放射性食管炎（RTOG标准）占45.5%，其中Ⅲ级占4.4 %；急性放射性肺炎占22.0%，其中Ⅲ级占5.2%。原发灶完全缓解（CR）占20.6 %，部分缓解（PR)占65.7%，无变化和进展（NR+PD）占13.7 %，总有效率为86.3%；纵隔转移淋巴结完全缓解（CR）占39.7%，部分缓解（PR）52.7%，无变化和进展（NR+PD）为7.6 %，总有效率为92.4%。结论　后程立体定向放射治疗Ⅲb期肺鳞癌能为绝大多数患者耐受，有较好的近期疗效。远期疗效及晚期并发症有待进一步随访证实。