PET-CT定位局部晚期非小细胞肺癌IMRT同步化疗的疗效和预后分析

Concurrent chemotherapy and intensity-modulated radiation therapy positioned by PET/CT for patients with locally advanced non-small cell lung cancer

  • 摘要:
      目的   比较局部晚期非小细胞肺癌患者普通模拟机定位常规放疗及PET-CT定位调强放疗(IMRT) 同步化疗的疗效、不良反应和预后。
      方法   对本院放疗中心收治的放疗患者进行回顾性分析。PET-CT定位下的调强放疗同步化疗(IMRT) 组患者48例, 常规放疗同步化疗(CRT) 组患者40例, 放疗总剂量达到60 Gy, 6周完成。同步化疗方案以铂类为基础联合多西他赛、长春瑞滨或培美曲塞等, 同步化疗2个周期, 2~4个周期巩固化疗(21 d为1个周期)。
      结果   IMRT组和CRT组有效率分别为77.1%和52.5%, 两组差异有统计学意义(P=0.015)。IMRT组1、2和3年生存率分别为77.1% (37/48)、54.2% (26/48) 和22.9% (11/48)。CRT组1、2和3年生存率分别为65.0% (26/40)、47.5% (19/40) 和17.5% (7/40) (P=0.292)。两组差异无统计学意义。CRT组的骨髓抑制、体质量变化略高于IMRT组, 但无显著性差异(P > 0.05), 消化道反应、放射性肺炎和放射性食道炎高于IMRT组(P < 0.05)。CRT组死于局部复发以及放射性肺炎的比例高(P < 0.05);IMRT组的局部复发率低(P < 0.01)。
      结论   PET-CT定位IMRT可提高局部晚期非小细胞肺癌患者局部控制率, 对提高近期疗效和降低放疗不良反应方面有明显优势, 而其对生存率的影响, 将需待更长时间的随访结果加以明确。

     

    Abstract:
      Objective   This work aimed to compare the three-year results, prognostic analysis, and adverse reactions of intensity-modulated radiation therapy (IMRT) positioned by PET-CT and conventional radiotherapy in locally advanced non-small cell lung cancer (NSCLC) patients who underwent concurrent chemotherapy.
      Methods   A clinical trial was carried out in Qingdao Cancer Hospital.The patients who joined our study were divided into IMRT and conventional radiotherapy (CRT) groups.A total of 48 patients were in the IMRT group and another 40 were in the CRT group.The total dose was 60 Gy throughout the 6-week treatment.The platinum-based concurrent chemotherapy, combined with regimens such as docetaxel, navelbine, and pemetrexed, was conducted for two cycles followed by two to four cycles of consolidation chemotherapy.
      Results   Significant differences were observed between the curative ratio of the IMRT (77.1%) and CRT (52.5%) groups (P=0.015).No significant difference existed between the short-term survival rates of the two groups.The 1-, 2-and 3-year survival rates were 77.1%, 54.2%, and 22.9% in the IMRT group, as well as 65.0%, 47.5%, and 17.5% in the CRT group, respectively.Significant differences existed in some adverse reactions between the two groups, such as radiation gastrointestinal reactions, esophagitis, and pneumonia.More patients died of local recurrence and radiation pneumonia in the CRT group than in the IMRT group.The local recurrence rate was also lower in the IMRT group than in the CRT group.
      Conclusion   IMRT has obvious advantages in improving the short-term curative effect and reducing adverse reactions.Regarding the survival rate, a long-term follow-up of the two groups is required in the future.

     

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