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目的 :比较基于正电子发射计算机断层摄影术(positron emission computed tomography,PET)/计算机断层摄影术(computed tomography,CT)的大分割后程加速三维适形放疗(3-dimensional conformal radiotherapy,3D-CRT)与常规分割放疗治疗局部晚期非小细胞肺癌的疗效和不良反应。方法 :2009年4月—2011年12月本院收治的60例局部晚期非小细胞肺癌被随机分为大分割后程加速3D-CRT组(A组,30例)和常规分割放疗组(B组,30例)。2组均在放疗前接受2个周期的诱导化疗(长春瑞滨联合顺铂)。A组患者按照基于PET/CT图像制定的放射治疗计划接受大分割后程加速3D-CRT(2.5 Gy/次至50 Gy,随后3 Gy/次,至放疗总剂量达65 Gy);B组患者按照基于CT图像制定的放射治疗计划接受常规分割放射治疗(60 Gy/30次)。2组患者于放疗结束后至少接受1个周期的辅助化疗(长春瑞滨+顺铂)。结果 :A组完全缓解8例(26.7%),部分缓解13例(43.3%),有效率为70.0%;B组完全缓解4例(13.3%),部分缓解9例(30.0%),有效率为43.3%;2组有效率差异有统计学意义(P=0.037)。A组的中位生存期和中位无进展生存期均优于B组(中位生存期分别为20.5和17.8个月,P=0.236;中位无进展生存期分别为10.2和8.2个月,P=0.001)。2组患者的化疗不良反应主要为骨髓抑制,经对症治疗后未明显影响化疗进程。急性放射反应主要表现为放射性肺炎和放射性食管炎,A组和B组患者中分别有1例和3例发生Ⅲ级放射性肺炎,此外分别有1例和2例发生Ⅲ级放射性食管炎。2组患者的放疗不良反应差异无统计学意义(P>0.05)。结论 :基于PET/CT图像制定的放射治疗计划进行大分割后程加速3D-CRT联合诱导化疗治疗局部晚期非小细胞肺癌显示出较好的疗效,绝大多数患者均能耐受治疗相关不良反应。
OBJECTIVE: To compare 3-dimensional conformal radiotherapy (3D-CRT) based positron emission computed tomography (PET) / computed tomography (CT) ) And conventional radiotherapy in the treatment of locally advanced non-small cell lung cancer efficacy and adverse reactions. METHODS: From April 2009 to December 2011, 60 patients with locally advanced non-small cell lung cancer admitted to our hospital were randomly divided into two groups: group A (n = 30) and group B Group, 30 cases). Both groups received 2 cycles of induction chemotherapy (vinorelbine plus cisplatin) prior to radiotherapy. Patients in group A underwent 3D-CRT (2.5 Gy / second to 50 Gy, followed by 3 Gy / second to a total radiation dose of 65 Gy) according to a radiotherapy schedule based on PET / CT images. Patients in group B Conventional fractionated radiotherapy (60 Gy / 30 times) was performed following a radiotherapy schedule based on CT images. Patients in both groups received at least one cycle of adjuvant chemotherapy (vinorelbine + cisplatin) after the end of radiotherapy. Results: A group of complete remission in 8 cases (26.7%), partial remission in 13 cases (43.3%), the effective rate was 70.0%; B group complete remission in 4 cases (13.3%), partial remission in 9 cases (30.0% Was 43.3%. There was significant difference between two groups (P = 0.037). The median survival and median progression-free survival in group A were significantly better than those in group B (median survival was 20.5 and 17.8 months respectively, P = 0.236; median progression-free survival was 10.2 and 8.2 months, respectively, P = 0.001). The adverse reactions of chemotherapy in the two groups were mainly myelosuppression. After the symptomatic treatment, the progression of chemotherapy was not significantly affected. Acute radiation reactions mainly manifested as radiation pneumonitis and radiation esophagitis, in group A and group B patients were 1 and 3 cases of grade Ⅲ radiation pneumonitis, in addition to 1 case and 2 cases of grade Ⅲ radiation esophagitis. There was no significant difference in adverse reactions between two groups (P> 0.05). Conclusions: Radiation therapy planning based on PET / CT imaging is a promising method for the treatment of locally advanced non-small cell lung cancer with 3D-CRT and 3D-CRT. The vast majority of patients are able to tolerate treatment-related adverse reactions .