摘要
目的 观察立体定向放射治疗对70岁及以上早期非小细胞肺癌患者的近期疗效和放射反应。方法 对31例70岁及以上临床Ⅰ、Ⅱ期非小细胞肺癌患者行立体定向放射治疗,患者年龄70～88岁,中位年龄76岁;Ⅰ期21例,Ⅱ期10例;病灶<3 cm 14例,≥3 cm 17例。采用真空袋及体部定位架,CT模拟机定位和三维治疗计划。<3 cm病灶采用弧形照射,剂量10～15 Gy/次,共3～5次;≥3 cm病灶采用非共面适形野,剂量5～8 Gy/次,共6～12次。计划要求95％以上计划靶区(PTV)体积接受95％以上剂量。结果 近期疗效中完全缓解(CR)率为48％,部分缓解(PR)率为39％,无进展(NR)率为13％,总有效率(CR+PR)为87％。肿瘤直径<3 cm者CR率为71％,而≥3cm者CR率为29％,两者比较差异有显著性(P<0.05)。1、2年生存率分别为83.9％。52.6％。Ⅰ、Ⅱ期1年生存率分别为95％、60％,差异有显著性(P<0.05),2年生存率分别为54.5％、50.0％,两者比较差异无显著性(P>0.05)。放射性肺反应早期0级19例,Ⅰ级9例,Ⅱ级3例;晚期肺反应Ⅰ级25例,Ⅱ级6例,无Ⅲ级以上早期及晚期放射性肺反应。结论 立体定向放射治疗技术治疗老年人早期非小细胞肺癌是安全的,近期疗效满意,远期疗效有待进一步观察。
Objective To evaluate the short-term therapeutic effect and radiation reaction of stereotactic radiotherapy for early stage non-small cell lung cancer in the elderly patients. Methods Thirty-one patients with stage Ⅰ - Ⅱ non-small cell lung cancer were treated with stereotactic radiotherapy. Patients aged 70-88 years, median age 76; 21 were stage I patients, and 10 stage Ⅱ ; 14 patients had tumor <3 cm and 17 patients had tumor ≥3 cm. Vacuum bag and body frame were used. CT simulation location and three dimensional treatment plan were used. Tumor <3 cm received arc irradiation, with dose 10-15 Gy/f, totally 3-5 fractions, and tumor≥3 cm received 3-dimensional conformal field, with dose 5-8 Gy/f, totally 5-8 fractions. The treatment plans required that more than 95% PTV should receive more than 95% dose. Results The short-term treatment resulted in complete response (CR) rate of 48% , partial response (PR) rate of 39% , and overall response rate of 87%(CR+PR). CR rate was 71% for tumor<3 cm, and was 29% for tumor ≥3 cm, showing significant difference (P<0. 05). 1- and 2-year survival rate were 83. 9% and 52. 6% respectively. 1-year survival rate for stage Ⅰ and stage Ⅱ were 95. 2% and 60% respectively with the significant difference (P < 0. 05). 2-year survival rate for stage Ⅰ and stage Ⅱ were 54.5% and 50.0% respectively. Acute radiation pneumonitis were mostly RTOG grade 0 , 9 patients had grade 1, and 3 patients had grade 2. Late radiation pulmonary fibrosis were mostly grade 1, 6 patients had grade 2. There were no acute and late radiation pneumonitis above grade 2. Conclusions Stereotactic radiotherapy for elderly early stage non-small cell lung cancer is safe and effective. The short-term therapeutic effect is satisfactory. Long-term treatment result needs further follow-up.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2003年第8期460-462,共3页
Chinese Journal of Geriatrics
基金
国家八六三计划重点项目(863-306-ZD13-03-02)
