IMRT与VMAT治疗小细胞肺癌合并上腔静脉压迫综合征患者的急性不良反应比较
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摘要
目的比较调强适形放疗(IMRT)和容积旋转调强放疗(VMAT)治疗小细胞肺癌合并上腔静脉压迫综合征(SVCS)的急性不良反应及耐受性。方法根据治疗方法不同将48例小细胞肺癌合并SVCS患者分为IMRT组(n=23)和VMAT组(n=25),两组患者均行两阶段治疗,比较两组患者的急性不良反应发生情况。结果48例小细胞肺癌合并SVCS患者中,未出现因急性不良反应而中断放疗的患者,且主要发生1～3级急性不良反应,其中食欲下降、白细胞减少、放射性皮炎、乏力、放射性肺损伤、恶心、贫血、食管黏膜损伤等较为常见。VMAT组患者1～3级食管黏膜损伤发生率低于IMRT组(P﹤0.05);VMAT组和IMRT组患者的其他1～3级不良反应发生情况比较,差异均无统计学意义(P﹥0.05)。结论小细胞肺癌合并SVCS患者采用IMRT和VMAT治疗的总体耐受性均较好,IMRT和VMAT均可作为常规放疗手段在小细胞肺癌合并SVCS的患者中应用。
Objective To compare the acute adverse reactions and tolerability of intensity-modulated radiation therapy(IMRT) and volumetric-modulated arc therapy(VMAT) in the treatment of small cell lung cancer patients complicated with superior vena caval syndrome(SVCS). Method 48 small cell lung cancer patients complicated with SVCS were divided into IMRT group(n=23) and VMAT group(n=25) according to treatment modalities. Patients in both groups were treated in two stages, compare the incidence of adverse reactions between two groups. Result In 48 small cell lung cancer patients complicated with SVCS, no patients underwent radiotherapy interruption due to acute adverse reactions,acute adverse reactions were mainly grade 1 to 3, among which decreased appetite, leukopenia, radiation dermatitis, fatigue, radiation lung injury, nausea, anemia, and esophageal mucosal injury were more common. The incidence of grade 1-3 esophageal mucosal injury in VMAT group was lower than that in IMRT group(P<0.05). There was no statistically significant difference between VMAT group and IMRT group in the incidence of grade 1-3 other adverse reactions(P>0.05).Conclusion IMRT and VMAT are generally well tolerated in small cell lung cancer patients complicated with SVCS,and both of them can be used as conventional radiotherapy in these patients.
Objective To compare the acute adverse reactions and tolerability of intensity-modulated radiation therapy(IMRT) and volumetric-modulated arc therapy(VMAT) in the treatment of small cell lung cancer patients complicated with superior vena caval syndrome(SVCS). Method 48 small cell lung cancer patients complicated with SVCS were divided into IMRT group(n=23) and VMAT group(n=25) according to treatment modalities. Patients in both groups were treated in two stages, compare the incidence of adverse reactions between two groups. Result In 48 small cell lung cancer patients complicated with SVCS, no patients underwent radiotherapy interruption due to acute adverse reactions,acute adverse reactions were mainly grade 1 to 3, among which decreased appetite, leukopenia, radiation dermatitis, fatigue, radiation lung injury, nausea, anemia, and esophageal mucosal injury were more common. The incidence of grade 1-3 esophageal mucosal injury in VMAT group was lower than that in IMRT group(P<0.05). There was no statistically significant difference between VMAT group and IMRT group in the incidence of grade 1-3 other adverse reactions(P>0.05).Conclusion IMRT and VMAT are generally well tolerated in small cell lung cancer patients complicated with SVCS,and both of them can be used as conventional radiotherapy in these patients.
引文
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[11]Brito Delgado A,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.
[12]Münch S,Oechsner M,Combs SE,et al.DVH-and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer[J].Radiat Oncol,2017,12(1):128.
[13]Shi J,Yang F,Ju X,et al.Comparative study on dosimetry of VMAT and IMRT in assisted radiotherapy after radical resection of rectal cancer[J].Oncol Lett,2017,13(5):2971-2974.
[14]Wijsman R,Dankers F,Troost EGC,et al.Comparison of toxicity and outcome in advanced stage non-small cell lung cancer patients treated with intensity-modulated(chemo-)radiotherapy using IMRT or VMAT[J].Radiother Oncol,2017,122(2):295-299.
[15]Xia B,Wang JZ,Liu Q,et al.Quantitative analysis of tumor shrinkage due to chemotherapy and its implication for radiation treatment planning in limited-stage small-cell lung cancer[J].Radiat Oncol,2013,8:216.
[2]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 Radiat Oncol,2017,7:43-48.
[3]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.
[4]National Cancer Institute.Common terminology criteria for adverse events v4.0(CTCAE)[EB/OL].[2018-04-01].http://ctep.cancer.gov/protocol Development/electronic_applications/docs/ctcaev4.pdf.
[5]谷铣之,余子豪,徐国镇,等.肿瘤放射治疗学[M].4版.北京:中国协和医科大学出版社,2007:579-580.
[6]Tsuchiya R,Suzuki K,Ichinose Y,et al.Phase II trial of postoperative adjuvant cisplatin and etoposide in patients with completely resected stage I-IIIa small cell lung cancer:the Japan Clinical Oncology Lung Cancer Study Group Trial(JCOG 9101)[J].J Thorac Cardiovasc Surg,2005,129(5):977-983.
[7]Ferrell B,Koczywsa M,Grannis F,et al.Palliative care in lung cancer[J].Surg Clin North Am,2011,91(2):403-417.
[8]Bhushan M,Yadav G,Tripathi D,et al.Dosimetric analysis of unflattened(FFFB)and flattened(FB)photon beam energy for gastric cancers using IMRT and VMAT-a comparative study[J].J Gastrointest Cancer,2018:1-12.
[9]Chow JCL,Jiang R.Dose-volume and radiobiological dependence on the calculation grid size in prostate VMATplanning[J].Med Dosim,2018,43(4):383-389.
[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.
[11]Brito Delgado A,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.
[12]Münch S,Oechsner M,Combs SE,et al.DVH-and NTCP-based dosimetric comparison of different longitudinal margins for VMAT-IMRT of esophageal cancer[J].Radiat Oncol,2017,12(1):128.
[13]Shi J,Yang F,Ju X,et al.Comparative study on dosimetry of VMAT and IMRT in assisted radiotherapy after radical resection of rectal cancer[J].Oncol Lett,2017,13(5):2971-2974.
[14]Wijsman R,Dankers F,Troost EGC,et al.Comparison of toxicity and outcome in advanced stage non-small cell lung cancer patients treated with intensity-modulated(chemo-)radiotherapy using IMRT or VMAT[J].Radiother Oncol,2017,122(2):295-299.
[15]Xia B,Wang JZ,Liu Q,et al.Quantitative analysis of tumor shrinkage due to chemotherapy and its implication for radiation treatment planning in limited-stage small-cell lung cancer[J].Radiat Oncol,2013,8:216.