调强放射治疗与容积调强放射治疗对小细胞肺癌合并上腔静脉压迫综合征的效果观察
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摘要
目的观察调强放射治疗(IMRT)与容积调强放射治疗(VMAT)技术治疗小细胞肺癌合并上腔静脉压迫综合征(SVCS)的临床效果。方法回顾性分析2010年1月至2016年1月石家庄市第一医院收治的48例小细胞肺癌合并SVCS患者的病历资料,依据不同放射治疗方案分为IMRT组(23例)和VMAT组(25例)。分析2组患者放射治疗的近期疗效,随访观察2组患者的生存情况。结果 IMRT组和VMAT组放射治疗结束后症状缓解率分别为91.3%(21/23)和92.0%(23/25),差异无统计学意义(P=0.663)。IMRT组和VMAT组治疗后客观有效率分别为82.6%(19/23)和84.0%(21/25),差异无统计学意义(P=0.600)。IMRT组和VMAT组局部控制率分别为69.6%(16/23)和84.0%(21/25),差异无统计学意义(P=0.199)。IMRT组、VMAT组放射治疗结束后半年、1年、2年生存率分别为69.2%比72.0%、21.7%比32.0%、4.3%比8.0%,二者之间差异均无统计学意义(P=0.881、0.612、0.648)。结论小细胞肺癌合并SVCS患者应用IMRT及VMAT近期疗效比较无明显差异,均是放射治疗的优选治疗方式,但具体临床数据上VMAT略优于IMRT,而且VMAT具有更高的局部控制率。
Objective To observe the effect of intensity-modulated radiation therapy(IMRT) and volumetric intensity-modulated arc therapy( VMAT) on small cell lung cancer with superior vena cava syndrome(SCVS).Methods Clinical records of 48 cases of small cell lung cancer with SCVS in the First Hospital of Shijiazhuang from January 2010 to January 2016 were reviewed; 23 patients were treated with IMRT and 25 patients were treated with VMAT.Short-term curative effect of radiotherapy and survival condition of patients were analyzed.Results Symptom remission rates in IMRT group and VMAT group were 91.3%(21/23) and 92.0%(23/25)(P=0.548).Effective rates of radiotherapy in IMRT group and VMAT group were 82.6%(19/23) and 84.0%(21/25)(P =0.600).Local control rates in IMRT group and VMAT group were 69.6%(16/23) and 84.0%(21/25)(P=0.199).The 6-month, 1- and 2-year survival rates in IMRT group and VMAT group were 69.2% vs 72.0%, 21.7% vs 32.0%, 4.3% vs 8.0%(P = 0.881,0.612, 0.648).Conclusions Short-term therapeutic effects of IMRT and VMAT show no significant differences on small cell lung cancer patients with SCVC.VMAT shows a higher local control effect.
Objective To observe the effect of intensity-modulated radiation therapy(IMRT) and volumetric intensity-modulated arc therapy( VMAT) on small cell lung cancer with superior vena cava syndrome(SCVS).Methods Clinical records of 48 cases of small cell lung cancer with SCVS in the First Hospital of Shijiazhuang from January 2010 to January 2016 were reviewed; 23 patients were treated with IMRT and 25 patients were treated with VMAT.Short-term curative effect of radiotherapy and survival condition of patients were analyzed.Results Symptom remission rates in IMRT group and VMAT group were 91.3%(21/23) and 92.0%(23/25)(P=0.548).Effective rates of radiotherapy in IMRT group and VMAT group were 82.6%(19/23) and 84.0%(21/25)(P =0.600).Local control rates in IMRT group and VMAT group were 69.6%(16/23) and 84.0%(21/25)(P=0.199).The 6-month, 1- and 2-year survival rates in IMRT group and VMAT group were 69.2% vs 72.0%, 21.7% vs 32.0%, 4.3% vs 8.0%(P = 0.881,0.612, 0.648).Conclusions Short-term therapeutic effects of IMRT and VMAT show no significant differences on small cell lung cancer patients with SCVC.VMAT shows a higher local control effect.
引文
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[13]张矛,金海国,苏清秀,等.肺癌静态调强与容积旋转调强放射治疗间比较[J].中国医学物理学杂志,2013,30(5):4364-4368.DOI:10.3969/j.issn.1005-202X.2013.05.006.Zhang M,Jin HG,Su QX,et al.Comparison with intensity modulated radiation therapy and volumetric modulated arc therapy for lung cancer[J].Chinese Journal of Medical Physics,2013,30(5):43644368.DOI:10.3969/j.issn.1005-202X.2013.05.006.
[14]Brito DA,Cohen D,Eng TY,et al.Modeling the target dose fall-off in IMRT and VMAT planning techniques for cervical SBRT[J].Med Dosim,2018,43(1):1-10.DOI:10.1016/j.meddos.2017.07.009.
[15]Abbas AS,Moseley D,Kassam Z,et al.Volumetric-modulated arc therapy for the treatment of a large planning target volume in thoracic esophageal cancer[J].J Appl Clin Med Phys,2013,14(3):4269.DOI:10.1120/jacmp.v14i3.4269.
[16]Halperin EC,Wazer DE,Perez CA,et al.Perez and Brady's principles and practice of radiation oncology[M].Phildelphia:Wolters-Kluwer/Lippincol Williams&Wilkins,2007:84.
[17]Timmerman R,Paulus R,Galvin J,et al.Stereotactic body radiation therapy for inoperable early stage lung cancer[J].JAMA,2010,303(11):1070-1076.DOI:10.1001/jama.2010.261.
[2]Ahmann FR.A reassessment of the clinical implication of the superior vena cava syndrome[J].J Clin Oncol,1984,2(8):961-969.DOI:10.1200/JCO.1984.2.8.961.
[3]Brown ML,Glanzmann C,Huber G,et al.IMRT/VMAT for malignancies in the head-and-neck region:outcome in patients aged 80[J].Strahlenther Onkol,2016,192(8):526-536.DOI:10.1007/s00066-016-0986-8.
[4]Lazzari G,Terlizzi A,Leo MG,et al.VMAT radiation-induced nausea and vomiting in adjuvant breast cancer radiotherapy:the incidental effect of low-dose bath exposure[J].Clin Transl Radial Oncol,2017,7:43-48.DOI:10.1016/j.ctro.2017.09.009.
[5]Li Y,Wang J,Tan L,et al.Dosimetric comparison between IMRT and VMAT in irradiation for peripheral and central lung cancer[J].Oncol Lett,2018,15(3):3735-3745.DOI:10.3892/ol.2018.7732.
[6]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.DOI:10.1016/j.ejca.2008.10.026.
[7]Murshed H,Liu HH,Liao Z,et al.Dose and volume reduction for normal lung using intensity-modulated radiotherapy foradvanced-stage non-small-cell lung cancer[J].Int J Radial Oncol Biol Phys,2004,58(4):1258-1267.DOI:10.1016/j.ijrobp.2003.09.086.
[8]刘光波,周丽霞,闫慧娟,等.中央型肺癌目标函数作用域不同的两种调强放射治疗剂量学比较[J].中国医药,2016,11(11):1617-1620.DOI:10.3760/cma.j.issn.1673-4777.2016.11.008.Liu GB,Zhou LX,Yan HJ,et al.Dosimetric comparison of intensity modulated radiotherapy with different objective function scopes treating central type lung cancer[J].China Medicine,2016,11(11):1617-1620.DOI:10.3760/cma.j.issn.1673-4777.2016.11.008.
[9]刘晓刚,陈凡,常巧梅,等.生物等效均匀剂量(EUD)在青海地区胸部肿瘤调强放疗(IMRT)中的应用基础研究[J].中国急救医学,2017,37(z1):8-10.Liu XG,Chen F,Chang QM,et al.Basic research on application of equivalent uniform dose in intensity modulated radiation therapy of thoracic tumor in Qinghai[J].Chinese Journal of Critical Care Medicine,2017,37(z1):8-10.
[10]Woon W,Ravindran PB,Ekayanake P,et al.A study on the effect of detector resolution on gamma index passing rate for VMAT and IMRT QA[J].J Appl Clin Med Phys,2018,19(2):230-248.DOI:10.1002/acm2.12285.
[11]Lee HF,Lan JH,Chao PJ,et al.Radiation-induced secondary malignancies for nasopharyngeal carcinoma:a pilot study of patients treated via IMRT or VMAT[J].Cancer Manag Res,2018,10:131-141.DOI:10.2147/CMAR.S145713.
[12]Teoh M,Clark CH,Wood K,et al.Volumetric modulated arc therapy:a review of current literature and clinical use in practice[J].Br J Radiol,2011,84(1007):967-996.DOI:10.1259/bjr/22373346.
[13]张矛,金海国,苏清秀,等.肺癌静态调强与容积旋转调强放射治疗间比较[J].中国医学物理学杂志,2013,30(5):4364-4368.DOI:10.3969/j.issn.1005-202X.2013.05.006.Zhang M,Jin HG,Su QX,et al.Comparison with intensity modulated radiation therapy and volumetric modulated arc therapy for lung cancer[J].Chinese Journal of Medical Physics,2013,30(5):43644368.DOI:10.3969/j.issn.1005-202X.2013.05.006.
[14]Brito DA,Cohen D,Eng TY,et al.Modeling the target dose fall-off in IMRT and VMAT planning techniques for cervical SBRT[J].Med Dosim,2018,43(1):1-10.DOI:10.1016/j.meddos.2017.07.009.
[15]Abbas AS,Moseley D,Kassam Z,et al.Volumetric-modulated arc therapy for the treatment of a large planning target volume in thoracic esophageal cancer[J].J Appl Clin Med Phys,2013,14(3):4269.DOI:10.1120/jacmp.v14i3.4269.
[16]Halperin EC,Wazer DE,Perez CA,et al.Perez and Brady's principles and practice of radiation oncology[M].Phildelphia:Wolters-Kluwer/Lippincol Williams&Wilkins,2007:84.
[17]Timmerman R,Paulus R,Galvin J,et al.Stereotactic body radiation therapy for inoperable early stage lung cancer[J].JAMA,2010,303(11):1070-1076.DOI:10.1001/jama.2010.261.