Ⅲ期非小细胞肺癌三维适形放射治疗的研究
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摘要
第一部分Ⅲ期中央型非小细胞肺癌常规照射与三维适形放射治疗的剂量学比较研究
[目的]用三维适形治疗计划系统研究Ⅲ期中央型非小细胞肺癌常规放射治疗与适形治疗中肿瘤和正常组织的剂量分布。
[方法]对32例Ⅲ期中央型非小细胞肺癌行常规模拟定位及CT模拟定位;为每例患者设计3套治疗计划。计划1为CT模拟定位下的三维适形治疗计划(3DCRT);计划2为虚拟综合治疗计划(VCTP):即先常规后程适形治疗计划;计划3为普通模拟机定位常规治疗计划(CTP)。均给予常规分割,处方剂量60Gy。用剂量体积直方图(DVH)比较三种计划肿瘤和正常组织的剂量分布差异。
[结果]在3DCRT、VCTP和CTP三组治疗计划中,GTV的最大剂量(Dmax)为64.3Gy、65.1Gy、63.9Gy;平均剂量(Dmean)分别为60.0Gy、60.6Gy、58.6Gy;最小剂量(Dmin)分别为55.9Gy、57.1Gy和52.2Gy。CTV的的最大剂量为67.0Gy、66.1Gy、65.1Gy;平均剂量分别为60.8Gy、60.8Gy、58.0Gy;最小剂量分别为55.3Gy、56.4Gy和50.8Gy。3种治疗计划在靶区剂量上,VCTP的剂量高于3DCRT,3DCRT比CTP剂量高。部分数据有统计学差异。而3DCRT和VCTP计划基本能满足靶区剂量要求。在正常组织受量上,双侧肺受到≥20Gy剂量照射的肺体积占两肺总体积的百分数(V20)分别为22.2%、32.4%和26.4%;≥30Gy剂量照射的肺体积比(V30)分别为12.1%、21.0%和17.5%;平均剂量分别为16.5Gy、27.2Gy和22.5Gy。心脏最大剂量分别为50.3Gy、56.2Gy和57.5Gy;V35分别为27.1%、29.5%和29.6%。脊髓受照射的最大剂量分别为30.0 Gy、40.0Gy和38.8Gy;平均剂量分别为10.3Gy、24.6Gy和21.9Gy;最小剂量分别为0.6Gy、0.8Gy和0.8Gy;受到≥40Gy剂量照射体积百分数(V40)分别为3.3%、10.6%和11.4%。食管受照最大剂量分别为47.6Gy、55.9Gy和49.8Gy;全周受照≥45Gy的长度(LETT45)分别为5.6cm、7.2cm和6.5cm;受到≥45Gy剂量照射体积百分数(V45)分别为30.7%、47.6%和38.5%。在正常组织受量上,3DCRT优于VCTP和CTP。
[结论]三维适形放疗能够在减少正常组织照射剂量同时给予肿瘤靶区更多的剂量照射,进而有助于提高肿瘤局部控制率。
第二部分长春瑞滨加顺铂同步大分割三维适形放疗治疗Ⅲ期非小细胞肺癌的临床研究
[目的]评价大分割三维适形放射治疗同步长春瑞滨加顺铂化疗对Ⅲ期非小细胞肺癌的毒性和近期疗效。
[方法] 42例行三维适形放射治疗的Ⅲ期非小细胞肺癌病人随机分为两组。20例患者采用常规分割三维适形放疗(对照组)。单次剂量2Gy,每周5次,总剂量60-70Gy。22例患者采用大分割三维适形放疗(实验组)。单次剂量4Gy,每周3次,总剂量DT48-56Gy。同期行NP方案化疗。长春瑞滨20mg/m2,每周六给药一次,顺铂20mg/m2,每周六、周日给药一次,共3-4周期。按WHO疗效及毒性标准来评价治疗毒性和近期疗效,用Kaplan-Meier法计算生存率并绘制生存曲线。
[结果]所有患者均完成治疗。对照组中完全缓解CR10%(2/20),部分缓解PR65%(13/20),无变化和肿瘤进展NC+PD25%(5/20),客观有效率CR+PR为75.0% (15/20), l年生存率为75.0%(15/20);实验组完全缓解CR18%(4/22),部分缓解PR68%(15/22),无变化和肿瘤进展NC+PD14%(3/22),客观有效率CR+PR为86.4% (19/22),l年生存率为86.4%(19/22)。在对照组和实验组中,2-3级的放射性食管炎、肺炎和白细胞下降分别为60.0%(12/20)和72.7%(16/22) , 20.0%(4/20)和22.7%(5/22),25.0%(5/20)和31.8%(7/22)。
[结论]大分割三维适形放疗同步小剂量长春瑞滨加顺铂化疗能提高Ⅲ期非小细胞肺癌近期疗效,毒性反应增加,但总体能耐受。远期疗效待观察。
PartⅠDosimetric Comparison between Conventional and Three Dimensional Conformal Radiotherapy for StageⅢCentral Non-small Cell Lung Cancer
Objective:To compare the dose distribution by three dimensional conformal treatment planning system(TPS) for the primary lesion and normal tissues between conventional and three dimensional conformal radiotherapy for stageⅢcentral non-small cell lung cancer.
Methods:Thirty-two patients were allotted to receive both conventional simulation and CT simulation in the same treatment position.Three kinds of treatment plans were designed for each patient:1.Three dimensional conformal radiotherapy plan(3DCRT),2.Virtual comprehensive treatment plan(VCTP),i.e. it consisted of conventional radiotherapy first , followed by conformal plan , 3 . Conventional treatment plan(CTP) .All plans were received conventional fraction,the total radiation dose was 60Gy.Dose volume histogram(DVH) was applied to evaluate the different of dose distribution for tumors and normal tissues among the three plans.
Results:In three kinds of plan,the maximum dose at GTV were 64.3Gy、67.1Gy、60.9Gy, the mean dose were 60.0Gy、62.6Gy、57.6Gy, and the minimum dose 55.9Gy、57.1Gy、52.2Gy,respectively. the maximum dose at CTV were 67.0Gy、66.1Gy、63.1Gy, the mean dose were 60.8Gy、60.8Gy、58.0Gy, and the minimum dose were 55.3Gy、56.4Gy和50.8Gy,respectively. The target dose of 3DCRT was higher than that of CTP, but lower than that of VCTP, parts of the data have statistical significance. 3DCRT and VCTP could meet the demands of dosimetric requirements for radiation treatment. At the radiation dose to the normal tissue, the whole lung volumes which received radiation dose of≥20Gy(V20) at the three designs were 22.2%、32.4% and 26.4%,≥30Gy(V30) were 12.1%、21.0% and 20.3%, the mean dose were 16.5Gy、27.2Gy and 22.5Gy, respectively. The maximum dose at the heart were 50.3Gy、56.2Gy and 57.5Gy, V35 were 27.1%、29.5% and 29.6%, respectively. The maximum dose at the spinal cord were 30.0 Gy、40.0Gy and 38.8Gy, the mean dose were 10.3Gy、24.6Gy and 21.9Gy, and the spinal cord volume which received radiation of≥40Gy (V40) were 3.3%、10.6% and 11.4%,respectively. The maximum dose at the esophageal were 47.6Gy、55.9Gy and 49.8Gy, the length of esophagus(total circumference) treated with≥45Gy(LETT45) were 5.6cm、7.2cm and 6.5cm, and the volume which received radiation of≥45Gy(V45) were 30.7%、47.6% and 38.5%, respectively. 3DCRT were superior to VCTP and CTP in the volume and dose of lung and spinal cord and esophageal.
Conclusions:3DCRT could achieve more irradiation dose to the target volumes and reduce irradiation dose to normal tissue at the same time compared with the VCTP and CTP, which contributes to raise the local control rate.
PartⅡStudy on Vinorelbine plus Cisplatin Chemotherapy with Concurrent Three-Dimensional Conformal Hypofractionated Radiotherapy (3DCRT) for StageⅢNon-Small Cell Lung Cancer
Objective:To evaluate the clinical toxicity and effect of three-dimensional conformal hypofractionated radiotherapy with concurrent vinorelbine plus cisplatin chemotherapy for StageⅢNon-Small Cell Lung Cancer
Methods: 42 patients were randomly divided into two groups:20 patients were received conventional fraction 3DCRT(control group),The fraction was 2 Gy, 5 times every week,the total dose was 60-70Gy.22 patients were given three dimensional conformal hypofractionated radiotherapy (experimental group),these patients were received 4Gy per fraction,3 times every week,to a total dose of 48-56Gy.42 cases were also given concurrent NP chemotherapy.The chemotherapy regimen consisted of 3-4 cycles of vinorelbine 20mg/m2 for weekly administration in Saturday,cisplatin 20mg/m2 in Saturday and Sunday.Toxicities and effects were evaluated according to the criteria of WHO.The survival rate was calculated and survival curve was plotted by Kaplan-Meier.
Results:All the patients have finished the trial.The complete response(CR) rate was10%(2/20) and partial response(PR) rate was 65%(13/20) in control group.No change and progress disease (NC+PD) was 25% (5/20).The overall response rate (CR+PR) was 75% (15/20),and 1-year survival rate was 75% (15/20).While the CR rate was 18% (4/22) and PR 68% (15/22) in experimental group,NC and PD was 14% (3/22).Total CR and PR was 86.4%(19/22) in experimental group,and 1-year survival rate was 86.4%(19/22).2-3 grade of esophagitis and pneumonia and leukocytopenia in control group and experimental group were 60.0%(12/20) and 72.7%(16/22) ,20.0%(4/20) and 22.7%(5/22),25.0%(5/20) and 31.8%(7/22).
Conclusions : Three-dimensional conformal hypofractionated radiotherapy with concurrent low dose NP chemotherapy for StageⅢNon-Small Cell Lung Cancer is tolerable and improved response rate,long survival time is still farther observed.
[目的]用三维适形治疗计划系统研究Ⅲ期中央型非小细胞肺癌常规放射治疗与适形治疗中肿瘤和正常组织的剂量分布。
[方法]对32例Ⅲ期中央型非小细胞肺癌行常规模拟定位及CT模拟定位;为每例患者设计3套治疗计划。计划1为CT模拟定位下的三维适形治疗计划(3DCRT);计划2为虚拟综合治疗计划(VCTP):即先常规后程适形治疗计划;计划3为普通模拟机定位常规治疗计划(CTP)。均给予常规分割,处方剂量60Gy。用剂量体积直方图(DVH)比较三种计划肿瘤和正常组织的剂量分布差异。
[结果]在3DCRT、VCTP和CTP三组治疗计划中,GTV的最大剂量(Dmax)为64.3Gy、65.1Gy、63.9Gy;平均剂量(Dmean)分别为60.0Gy、60.6Gy、58.6Gy;最小剂量(Dmin)分别为55.9Gy、57.1Gy和52.2Gy。CTV的的最大剂量为67.0Gy、66.1Gy、65.1Gy;平均剂量分别为60.8Gy、60.8Gy、58.0Gy;最小剂量分别为55.3Gy、56.4Gy和50.8Gy。3种治疗计划在靶区剂量上,VCTP的剂量高于3DCRT,3DCRT比CTP剂量高。部分数据有统计学差异。而3DCRT和VCTP计划基本能满足靶区剂量要求。在正常组织受量上,双侧肺受到≥20Gy剂量照射的肺体积占两肺总体积的百分数(V20)分别为22.2%、32.4%和26.4%;≥30Gy剂量照射的肺体积比(V30)分别为12.1%、21.0%和17.5%;平均剂量分别为16.5Gy、27.2Gy和22.5Gy。心脏最大剂量分别为50.3Gy、56.2Gy和57.5Gy;V35分别为27.1%、29.5%和29.6%。脊髓受照射的最大剂量分别为30.0 Gy、40.0Gy和38.8Gy;平均剂量分别为10.3Gy、24.6Gy和21.9Gy;最小剂量分别为0.6Gy、0.8Gy和0.8Gy;受到≥40Gy剂量照射体积百分数(V40)分别为3.3%、10.6%和11.4%。食管受照最大剂量分别为47.6Gy、55.9Gy和49.8Gy;全周受照≥45Gy的长度(LETT45)分别为5.6cm、7.2cm和6.5cm;受到≥45Gy剂量照射体积百分数(V45)分别为30.7%、47.6%和38.5%。在正常组织受量上,3DCRT优于VCTP和CTP。
[结论]三维适形放疗能够在减少正常组织照射剂量同时给予肿瘤靶区更多的剂量照射,进而有助于提高肿瘤局部控制率。
第二部分长春瑞滨加顺铂同步大分割三维适形放疗治疗Ⅲ期非小细胞肺癌的临床研究
[目的]评价大分割三维适形放射治疗同步长春瑞滨加顺铂化疗对Ⅲ期非小细胞肺癌的毒性和近期疗效。
[方法] 42例行三维适形放射治疗的Ⅲ期非小细胞肺癌病人随机分为两组。20例患者采用常规分割三维适形放疗(对照组)。单次剂量2Gy,每周5次,总剂量60-70Gy。22例患者采用大分割三维适形放疗(实验组)。单次剂量4Gy,每周3次,总剂量DT48-56Gy。同期行NP方案化疗。长春瑞滨20mg/m2,每周六给药一次,顺铂20mg/m2,每周六、周日给药一次,共3-4周期。按WHO疗效及毒性标准来评价治疗毒性和近期疗效,用Kaplan-Meier法计算生存率并绘制生存曲线。
[结果]所有患者均完成治疗。对照组中完全缓解CR10%(2/20),部分缓解PR65%(13/20),无变化和肿瘤进展NC+PD25%(5/20),客观有效率CR+PR为75.0% (15/20), l年生存率为75.0%(15/20);实验组完全缓解CR18%(4/22),部分缓解PR68%(15/22),无变化和肿瘤进展NC+PD14%(3/22),客观有效率CR+PR为86.4% (19/22),l年生存率为86.4%(19/22)。在对照组和实验组中,2-3级的放射性食管炎、肺炎和白细胞下降分别为60.0%(12/20)和72.7%(16/22) , 20.0%(4/20)和22.7%(5/22),25.0%(5/20)和31.8%(7/22)。
[结论]大分割三维适形放疗同步小剂量长春瑞滨加顺铂化疗能提高Ⅲ期非小细胞肺癌近期疗效,毒性反应增加,但总体能耐受。远期疗效待观察。
PartⅠDosimetric Comparison between Conventional and Three Dimensional Conformal Radiotherapy for StageⅢCentral Non-small Cell Lung Cancer
Objective:To compare the dose distribution by three dimensional conformal treatment planning system(TPS) for the primary lesion and normal tissues between conventional and three dimensional conformal radiotherapy for stageⅢcentral non-small cell lung cancer.
Methods:Thirty-two patients were allotted to receive both conventional simulation and CT simulation in the same treatment position.Three kinds of treatment plans were designed for each patient:1.Three dimensional conformal radiotherapy plan(3DCRT),2.Virtual comprehensive treatment plan(VCTP),i.e. it consisted of conventional radiotherapy first , followed by conformal plan , 3 . Conventional treatment plan(CTP) .All plans were received conventional fraction,the total radiation dose was 60Gy.Dose volume histogram(DVH) was applied to evaluate the different of dose distribution for tumors and normal tissues among the three plans.
Results:In three kinds of plan,the maximum dose at GTV were 64.3Gy、67.1Gy、60.9Gy, the mean dose were 60.0Gy、62.6Gy、57.6Gy, and the minimum dose 55.9Gy、57.1Gy、52.2Gy,respectively. the maximum dose at CTV were 67.0Gy、66.1Gy、63.1Gy, the mean dose were 60.8Gy、60.8Gy、58.0Gy, and the minimum dose were 55.3Gy、56.4Gy和50.8Gy,respectively. The target dose of 3DCRT was higher than that of CTP, but lower than that of VCTP, parts of the data have statistical significance. 3DCRT and VCTP could meet the demands of dosimetric requirements for radiation treatment. At the radiation dose to the normal tissue, the whole lung volumes which received radiation dose of≥20Gy(V20) at the three designs were 22.2%、32.4% and 26.4%,≥30Gy(V30) were 12.1%、21.0% and 20.3%, the mean dose were 16.5Gy、27.2Gy and 22.5Gy, respectively. The maximum dose at the heart were 50.3Gy、56.2Gy and 57.5Gy, V35 were 27.1%、29.5% and 29.6%, respectively. The maximum dose at the spinal cord were 30.0 Gy、40.0Gy and 38.8Gy, the mean dose were 10.3Gy、24.6Gy and 21.9Gy, and the spinal cord volume which received radiation of≥40Gy (V40) were 3.3%、10.6% and 11.4%,respectively. The maximum dose at the esophageal were 47.6Gy、55.9Gy and 49.8Gy, the length of esophagus(total circumference) treated with≥45Gy(LETT45) were 5.6cm、7.2cm and 6.5cm, and the volume which received radiation of≥45Gy(V45) were 30.7%、47.6% and 38.5%, respectively. 3DCRT were superior to VCTP and CTP in the volume and dose of lung and spinal cord and esophageal.
Conclusions:3DCRT could achieve more irradiation dose to the target volumes and reduce irradiation dose to normal tissue at the same time compared with the VCTP and CTP, which contributes to raise the local control rate.
PartⅡStudy on Vinorelbine plus Cisplatin Chemotherapy with Concurrent Three-Dimensional Conformal Hypofractionated Radiotherapy (3DCRT) for StageⅢNon-Small Cell Lung Cancer
Objective:To evaluate the clinical toxicity and effect of three-dimensional conformal hypofractionated radiotherapy with concurrent vinorelbine plus cisplatin chemotherapy for StageⅢNon-Small Cell Lung Cancer
Methods: 42 patients were randomly divided into two groups:20 patients were received conventional fraction 3DCRT(control group),The fraction was 2 Gy, 5 times every week,the total dose was 60-70Gy.22 patients were given three dimensional conformal hypofractionated radiotherapy (experimental group),these patients were received 4Gy per fraction,3 times every week,to a total dose of 48-56Gy.42 cases were also given concurrent NP chemotherapy.The chemotherapy regimen consisted of 3-4 cycles of vinorelbine 20mg/m2 for weekly administration in Saturday,cisplatin 20mg/m2 in Saturday and Sunday.Toxicities and effects were evaluated according to the criteria of WHO.The survival rate was calculated and survival curve was plotted by Kaplan-Meier.
Results:All the patients have finished the trial.The complete response(CR) rate was10%(2/20) and partial response(PR) rate was 65%(13/20) in control group.No change and progress disease (NC+PD) was 25% (5/20).The overall response rate (CR+PR) was 75% (15/20),and 1-year survival rate was 75% (15/20).While the CR rate was 18% (4/22) and PR 68% (15/22) in experimental group,NC and PD was 14% (3/22).Total CR and PR was 86.4%(19/22) in experimental group,and 1-year survival rate was 86.4%(19/22).2-3 grade of esophagitis and pneumonia and leukocytopenia in control group and experimental group were 60.0%(12/20) and 72.7%(16/22) ,20.0%(4/20) and 22.7%(5/22),25.0%(5/20) and 31.8%(7/22).
Conclusions : Three-dimensional conformal hypofractionated radiotherapy with concurrent low dose NP chemotherapy for StageⅢNon-Small Cell Lung Cancer is tolerable and improved response rate,long survival time is still farther observed.
引文
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[7] Emami B,Mirkovic N,Scott C,et al.The impact of regional nodal radiotherapy (dose/volume) on regional progression and survival in unresectable non-small cell lung cancer:an analysis of RTOG data[J].Lung Cancer,2003,41(2):207-214.
[8] Rosenzweig KE,Sim SE,Mychalczak B,et al.Elective nodal irradiation in the treatment of non-small-cell lung cancer with three-dimensional conformal radiationtherapy[J].Int J Radiat Oncol Biol Phys,2001,50(3):681-685.
[9]谢松喜,李伟雄,林映如,等.大分割三维适形放疗在非小细胞肺癌治疗中的应用[J].中国癌症杂志,2006,16(12):1034-1037.
[10] Cox JD,Stetz J,Pajak TF.Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) [J].Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346.
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