CRT+ARC技术在局部晚期肺癌患者中临床应用的初步研究
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摘要
目的研究CRT+ARC技术在局部晚期肺癌中临床应用情况。方法选择2016年3月1日—2017年3月1日在我院放疗科放疗的100例局部晚期肺癌患者,随机分为实验组和对照组,每组各50例患者,实验组制定CRT+ARC计划,对照组制定三维适形放射治疗技术+调强放射治疗技术(Intensity-modulated radiotherapy,IMRT)(CRT+IMRT)计划。根据世界卫生组织(World health organization,WHO)标准评估患者的近期疗效,根据影像学检查及放射治疗肿瘤学组(Radiaton therapy ognization group,RTOG)标准明确放疗主要副反应放射性肺炎发生情况。结果实验组治疗有效率为82%,对照组治疗有效率为76%,两组差异无统计学意义(χ~2=0.542,P=0.461)。实验组肺炎发生率为22%,对照组肺炎发生率18%,两组差异无统计学意义(χ~2=0.250,P=0.617)。结论 CRT+ARC技术在局部晚期肺癌临床应用中,与CRT+IMRT相比,近期疗效和主要的副反应放射性肺炎都没有统计学差异。
Objective This paper investigated the clinical application of CRT+ARC technique in locally advanced lung cancer.Methods A total of 100 patients with locally advanced lung cancer who underwent radiotherapy in our hospital from March 1,2016 to March 1,2017 were randomly assigned to the experimental and control groups.Each group consisted of 50 patients.The CRT+ARC plans were made for the experimental group,and the CRT + intensity-modulated radiotherapy(IMRT)(CRT+IMRT)plans for the control group.According to the World Health Organization(WHO)criteria,the short-term efficacy of patients was assessed.According to the imaging examination and the Radiation Therapy Organization Group(RTOG)standard,the occurrence of major side effects of radiation pneumonia was identified.Results The effective rate of treatment was 82% in the experimental group and 76% in the control group.There was no difference in the effective rate between the two groups(χ~2=0.542,P=0.461).The incidence of pneumonia in the experimental group was 22%,and 18% in the control group.There was also no difference in the incidence of pneumonia between the two groups(χ~2=0.250,P=0.617).Conclusion In the clinical application of locally advanced lung cancer,CRT+ARC technique has no difference in the short-term efficacy and the main side effects of radiation pneumonitis compared with CRT+IMRT.
Objective This paper investigated the clinical application of CRT+ARC technique in locally advanced lung cancer.Methods A total of 100 patients with locally advanced lung cancer who underwent radiotherapy in our hospital from March 1,2016 to March 1,2017 were randomly assigned to the experimental and control groups.Each group consisted of 50 patients.The CRT+ARC plans were made for the experimental group,and the CRT + intensity-modulated radiotherapy(IMRT)(CRT+IMRT)plans for the control group.According to the World Health Organization(WHO)criteria,the short-term efficacy of patients was assessed.According to the imaging examination and the Radiation Therapy Organization Group(RTOG)standard,the occurrence of major side effects of radiation pneumonia was identified.Results The effective rate of treatment was 82% in the experimental group and 76% in the control group.There was no difference in the effective rate between the two groups(χ~2=0.542,P=0.461).The incidence of pneumonia in the experimental group was 22%,and 18% in the control group.There was also no difference in the incidence of pneumonia between the two groups(χ~2=0.250,P=0.617).Conclusion In the clinical application of locally advanced lung cancer,CRT+ARC technique has no difference in the short-term efficacy and the main side effects of radiation pneumonitis compared with CRT+IMRT.
引文
1 孙明亮,徐建宇,徐向英.早期非小细胞肺癌立体定向放疗的相关研究[J].实用肿瘤学杂志,2018,32(1):53-56.
2 杜夜生,胡松柳,徐向英.非小细胞肺癌寡转移的立体定向放射治疗研究[J].实用肿瘤学杂志,2018,32(2):154-158.
3 Sapkaroski D,Osborne C,Knight KA,et al.A review of stereotactic body radiotherapy-is volumetric modulated arc therapy the answer?[J].J Med Radiat Sci,2015,62(2):142-151.
4 Fitzgerald R,Owen R,Hargrave C,et al.A comparison of three different VMAT techniques for the delivery of lung stereotactic ablative radiation therapy[J].J Med Radiat Sci,2016,63(1):23-30.
5 Yamgguchi S,Ohguri T,Matsuki Y,et al.Radiothrapy for thoracic tumors:association between subclinical interstitial lung disease and fatal radiation pneumonitis[J].Int J Clin Oncol,2015,20(1):45-52.
6 Kannarunimit D,Descovich M,Garcia A,et al.Analysis of dose distribution and risk of pneumonitis in stereotactic body radiation therapy for centrally located lung tumors:a comparison of robotic radiosurgery,helical tomotherapy and volumetric modulated arc therapy[J].Technol Cancer Res Treat,2015,14(1):49-60.
7 Ferrero C,Badellino S,Filippi AR,et al.Pulmonary function and quality of life after VMAT-based stereotactic ablative radiotherapy for early stage inoperable NSCLC:a prospective study[J].Lung Cancer,2015,89(3):350-356.
8 张彦秋,韩阿蒙,李金旺,等.CRT+ARC技术在肺癌"T"形靶区患者放射治疗中的剂量学研究[J].中国医学物理学杂志,2017,34(7):712-718.
9 Zhao Y,Chen L,Zhang S,et al.Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J].Thorac Cancer,2015,6(1):49-57.
10 Yokouchi H,Miyazaki M,Miyamoto T,et al.Post-recurrence survival after surgical resection of non-small cell lung cancer with local recurrence[J].Gan To Kagaku Ryoho,2014,41(12):2050-2052.
11 Wijsman R,Dankers FJWM,Troost EGC,et al.Inclusion of incidental radiation dose to the cardiac atria and ventricles does not improve the prediction of radiation pneumonitis in advanced-stage non-small cell lung cancer patients treated with intensity modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2017,99(2):434-441.
12 李丹明,王黎,王沛沛,等.适形调强与容积旋转调强技术对局部晚期非小细胞肺癌临床效果比较[J].中国肿瘤,2016,25(9):742-746.
13 Zhang J,Yu XL,Zheng GF,et al.Intensity-modulated radiotherapy and volumetric-modulated arc therapy have distinct clinical advantages in non-small cell lung cancer treatment[J].Med Oncol,2015,32(4):94.
14 宋明永,戴相昆,杜乐辉,等.3 种调强放疗方式治疗非小细胞肺癌的剂量学比较[J].中国医学物理学杂志,2017,34(2):121-124.
15 刘建平,杨海芳,王志武,等.部分弧容积旋转调强计划在中央型肺癌的应用[J]。中国医学物理学杂志,2017,34(11):1091-1095.
16 Danita K,Martina D,Aaron G,et al.Analysis of dose distribution and risk of pneumonitis in stereotactic body radiation therapy for centrally located lung tumors:a comparison of robotic radiosurgery,helical tomotherapy and volumetric modulated arc herapy[J].Technol Cancer Res Treat,2015,14(1):49-60.
17 Zhao YQ,Chen L,Zhang S,et al.Predictive factors for acute radiation pneumonitis inpostoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J].Thorac Cancer,2015,6(1):49-57.
18 Bongers EM,Botticella A,Palma DA,et al.Predictive parameters of symptomatic radiation pneumonitis following stereotactic or hypofractionated radiotherapy delivered using volumetric modulated arcs[J].Radiother Oncol,2013,109(1):95-99.
19 Leprieur EG,Fernandez D,Chatellier G,et al.Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer:clinical,dosimetric,and associated-treatment risk factors[J].J Cancer Res Ther,2013,9(3):447-451.
20 王天昶,冯杏,王浩,等.放疗前肺功能参数对非小细胞肺癌放射性肺炎的预测价值[J],实用癌症杂志,2016,31(4):581-584.
21 Vogelius IR,Bentzen SM.A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumoniti[J].Acta Oncol,2012,51(8):975-983.
22 吴双,杨泽,张远净,等.局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗疗效及安全性Meta分析[J].中华肿瘤防治杂志,2017,24(1):55-61.
23 Dang J,Li G,Zang S,et al.Comparison of risk and predictors for early radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with radiotherapy with or without surgery[J].Lung Cancer,2014,86(3):329-333.
2 杜夜生,胡松柳,徐向英.非小细胞肺癌寡转移的立体定向放射治疗研究[J].实用肿瘤学杂志,2018,32(2):154-158.
3 Sapkaroski D,Osborne C,Knight KA,et al.A review of stereotactic body radiotherapy-is volumetric modulated arc therapy the answer?[J].J Med Radiat Sci,2015,62(2):142-151.
4 Fitzgerald R,Owen R,Hargrave C,et al.A comparison of three different VMAT techniques for the delivery of lung stereotactic ablative radiation therapy[J].J Med Radiat Sci,2016,63(1):23-30.
5 Yamgguchi S,Ohguri T,Matsuki Y,et al.Radiothrapy for thoracic tumors:association between subclinical interstitial lung disease and fatal radiation pneumonitis[J].Int J Clin Oncol,2015,20(1):45-52.
6 Kannarunimit D,Descovich M,Garcia A,et al.Analysis of dose distribution and risk of pneumonitis in stereotactic body radiation therapy for centrally located lung tumors:a comparison of robotic radiosurgery,helical tomotherapy and volumetric modulated arc therapy[J].Technol Cancer Res Treat,2015,14(1):49-60.
7 Ferrero C,Badellino S,Filippi AR,et al.Pulmonary function and quality of life after VMAT-based stereotactic ablative radiotherapy for early stage inoperable NSCLC:a prospective study[J].Lung Cancer,2015,89(3):350-356.
8 张彦秋,韩阿蒙,李金旺,等.CRT+ARC技术在肺癌"T"形靶区患者放射治疗中的剂量学研究[J].中国医学物理学杂志,2017,34(7):712-718.
9 Zhao Y,Chen L,Zhang S,et al.Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J].Thorac Cancer,2015,6(1):49-57.
10 Yokouchi H,Miyazaki M,Miyamoto T,et al.Post-recurrence survival after surgical resection of non-small cell lung cancer with local recurrence[J].Gan To Kagaku Ryoho,2014,41(12):2050-2052.
11 Wijsman R,Dankers FJWM,Troost EGC,et al.Inclusion of incidental radiation dose to the cardiac atria and ventricles does not improve the prediction of radiation pneumonitis in advanced-stage non-small cell lung cancer patients treated with intensity modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2017,99(2):434-441.
12 李丹明,王黎,王沛沛,等.适形调强与容积旋转调强技术对局部晚期非小细胞肺癌临床效果比较[J].中国肿瘤,2016,25(9):742-746.
13 Zhang J,Yu XL,Zheng GF,et al.Intensity-modulated radiotherapy and volumetric-modulated arc therapy have distinct clinical advantages in non-small cell lung cancer treatment[J].Med Oncol,2015,32(4):94.
14 宋明永,戴相昆,杜乐辉,等.3 种调强放疗方式治疗非小细胞肺癌的剂量学比较[J].中国医学物理学杂志,2017,34(2):121-124.
15 刘建平,杨海芳,王志武,等.部分弧容积旋转调强计划在中央型肺癌的应用[J]。中国医学物理学杂志,2017,34(11):1091-1095.
16 Danita K,Martina D,Aaron G,et al.Analysis of dose distribution and risk of pneumonitis in stereotactic body radiation therapy for centrally located lung tumors:a comparison of robotic radiosurgery,helical tomotherapy and volumetric modulated arc herapy[J].Technol Cancer Res Treat,2015,14(1):49-60.
17 Zhao YQ,Chen L,Zhang S,et al.Predictive factors for acute radiation pneumonitis inpostoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer[J].Thorac Cancer,2015,6(1):49-57.
18 Bongers EM,Botticella A,Palma DA,et al.Predictive parameters of symptomatic radiation pneumonitis following stereotactic or hypofractionated radiotherapy delivered using volumetric modulated arcs[J].Radiother Oncol,2013,109(1):95-99.
19 Leprieur EG,Fernandez D,Chatellier G,et al.Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer:clinical,dosimetric,and associated-treatment risk factors[J].J Cancer Res Ther,2013,9(3):447-451.
20 王天昶,冯杏,王浩,等.放疗前肺功能参数对非小细胞肺癌放射性肺炎的预测价值[J],实用癌症杂志,2016,31(4):581-584.
21 Vogelius IR,Bentzen SM.A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumoniti[J].Acta Oncol,2012,51(8):975-983.
22 吴双,杨泽,张远净,等.局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗疗效及安全性Meta分析[J].中华肿瘤防治杂志,2017,24(1):55-61.
23 Dang J,Li G,Zang S,et al.Comparison of risk and predictors for early radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with radiotherapy with or without surgery[J].Lung Cancer,2014,86(3):329-333.